Attitudes toward help-seeking and duration of untreated mental disorders in a sectorized Athens area of Greece

Pathways to Mental Health Care in a Defined Geographic Area of Athens

The purpose of the present study was to explore the duration between the onset of psychopathology and the first contact either with a sectorized Community Mental Health Centre (CMHC) of Athens area or other mental health services, identify the pathways to the CMHC as well as possible sociodemographic and clinical factors affecting help-seeking behavior. The sample consisted of 355 individuals who visited the CMHC, but had sought help from another mental health care source prior to their visit to the Centre (group A), and was compared with 398 individuals who had no previous contact with any other psychiatric service (group B). The average duration of untreated mental disorders was found to be 19.85 (SD 23.113) for males of group A and 26.26 (SD 41.158) for males of group B. Among females the mean duration was found to be 18.11 (SD 27.293) for group A and 22.21 (SD 29.440) for group B, a statistically significant difference. In group A, the intervening services referred the clients at an earlier stage. The striking difference is that only eight individuals (2%) of group B (first timers) were diagnosed as suffering from schizophrenia contrasting to the 61 (17.4%) counterparts of group A. Individuals in our study diagnosed with psychosis seemed to have sought help first from other mental health services and delay to visit a CMHC. People who face problems resulting from their interpersonal or professional relationships often choose to have a first contact with a CMHC. Reduction of the delay in treatment will require clearer understanding of the contributing factors. Liaison activities with public and mental health sector services and outreach interventions to increase awareness on the early recognition of psychopathologic symptoms and the need for early referral could reduce the duration of untreated mental disorders.

Factors of Specialized Mental Health Care Use in the Netherlands: A Scoping Review Applying Andersen-Newman's Care Utilization Model

As mental disorders impact quality of life and result in high costs for society, it is important patients receive timely and adequate care. This scoping review first aims to summarize which factors contribute to specialized mental health care (SMHC) use. Within the Dutch health care system, the general practitioner (GP) is the filter for SMHC and care use costs are relatively low. Second, to organize factors by Andersen and Newman’s care utilization model in illness level, predisposing, and enabling factors. Third, to assess equity of access to SMHC in the Netherlands. A health care system is equitable when illness level and the demographic predisposing factors age and gender account for most variation in care use and inequitable when enabling factors and social predisposing factors such as education predominate. We identified 13 cross-sectional and cohort studies in the Netherlands published between 1970 and September 2020 with 20 assessed factors. Illness level factors, disease severity, diagnosis, personality, and comorbidity contributed the most to SMHC use. Predisposing factors related to a more solitary lifestyle contributed to a lesser degree. Enabling factors income and urbanicity contributed the least to SMHC use. These results imply inequity. Factors that did not fit the care utilization model were GP related, for example the ability to recognize mental disorders. This emphasizes their importance in a system where patients are dependent on GPs for access to SMHC. Focus should be on improving recognition of mental disorders by GPs as well as collaboration with mental health care professionals.

Openness to help-seeking for mental illness among Greek-Cypriots

The aim of this study was to test a model of people's willingness to seek help for mental illness whether currently diagnosed or not. A cross-sectional design was used to test this model in a non-clinical convenience sample of Greek-Cypriots. Participants were 196 Greek-Cypriots living in Cyprus (age M = 34.50 years, SD = 14.16). They provided demographic data on their age, gender, SES and whether diagnosed or not with a mental illness, from whom they have/would seek help for a mental illness, and their willingness to seek help. They completed the Inventory of Attitudes towards Seeking Mental Health Services, the Multidimensional Scale of Perceived Support, and the Practical Barriers in Seeking Mental Health Services Scales, translated into Greek for this study. Approximately 24% of the sample reported being diagnosed with a mental illness within the past 12 months, and around a third of these people were taking prescribed medication. Willingness to seek help across all participants was predicted negatively by stigma and positively by openness to help. The findings of the current study extend our previous limited understanding of the factors affecting people's willingness to seek help or their intentions towards the use of mental health services among Greek-Cypriots. Future research should consider whether there are any differences in help-seeking behaviours and motivations across people experiencing different disorders. Despite this limitation in the current data, these results can, in general terms, be used to inform policy in Cyprus for mental health promotions and interventions especially with respect to fostering an open attitude towards mental illness.

Epilepsy coexisting with depression

Depression episodes in epilepsy is the most common commorbidity, affecting between 11% and 62% of patients with epilepsy. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. The manifestation of depression in epilepsy is a complex issue having many interacting neurobiological and psychosocial determinants, including clinical features of epilepsy (seizure frequency, type, foci, or lateralization of foci) and neurochemical or iatrogenic mechanisms. Other risk factors are a family history of psychiatric illness, particularly depression, a lack of control over the seizures and iatrogenic causes (pharmacologic and surgical). In addition, treatment with antiepileptic drugs (AEDs) as well as social coping and adaptation skills have also been recognised as risk factors of depression associated with epilepsy. Epilepsy may foster the development of depression through being exposed to chronic stress. The uncertainty and unpredictability of seizures may instigate sadness, loneliness, despair, low self-esteem, and self-reproach in patients with epilepsy and lead to social isolation, stigmatization, or disability. Often, depression is viewed as a reaction to epilepsy's stigma and the associated poor quality of life. Moreover, patients with epilepsy display a 4-5 higher rate of depression and suicide compared with healthy population.

Homeless mentally ill in Athens area: a cross-sectional study on unmet needs and help-seeking

BACKGROUND

Homelessness, a worldwide psychosocial phenomenon, is now also prevalent in Greece, mainly in Athens area.

METHODS

The possible psychiatric morbidity related to help-seeking and the underlying factors were explored in a sample of 254 homeless people from Greater Athens area, using the Mini International Neuropsychiatric Interview (M.I.N.I.).

RESULTS

The sample was predominantly male (74%) with mean age of 51 years, being in their majority homeless for over 25 months, 34.3% of them living in rough sleeping places. Overall, 56.7% of the sample met the criteria for a current Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) psychiatric disorder with 20.8% comorbidity. Only 36.2% of the identified psychiatric cases had any recent psychiatric care, while 44.4% were taking non-prescribed medication and 20.2% have been hospitalized in the last year. On the contrary, 70% of alcohol- and drug-dependent persons have been treated in a psychiatric agency, while 60.0% of them participated in rehabilitation program the last year. Logistic regression analysis revealed that being older, more educated with longer duration of homelessness, recognizing the suffering from a psychiatric problem as well as being diagnosed as 'psychotic' increased the likelihood to seek help.

CONCLUSIONS

The vast majority of the homeless mentally ill persons were lacking any current psychiatric care. The planning of a mental health-care delivery parallel to the existing social welfare system is needed to serve the unmet mental health needs of this population.

Determinants of depression among patients with epilepsy in Athens, Greece

OBJECTIVE

Depression is common among patients with epilepsy. The aim of our study was twofold: to estimate the prevalence of a major depressive episode and to identify its determinants among patients with epilepsy treated in the largest Greek hospital in Athens.

METHODS

All consecutive patients with epilepsy that visited the epilepsy outpatient clinic of Evangelismos General Hospital were invited to participate in the study. Ninety-four patients met our inclusion criteria.

RESULTS

A diagnosis of a current major depressive episode was established in 21 out of 94 eligible to participate (22.3%) patients. Being a female was associated with a 19.68-fold increase in the odds of having a major depressive episode (95% CI 3.39-114.14, p=0.001); being unemployed was associated with a 6.46-fold increase in the odds of having a major depressive episode (95% CI 1.23-34.07, p=0.028), and each extra seizure experienced per month was associated with a 1.38-fold increase in the odds of having a major depressive episode (95% CI 1.03-1.85, p=0.031).

CONCLUSION

Unemployment, female gender, and seizure control are important determinants of a major depression episode among patients with epilepsy.

Prevalence of psychiatric disorders among homeless people in Athens area: a cross-sectional study

PURPOSE

Homelessness is a chronic social phenomenon in European and other Western cities. In the recent years, the number of homeless people in Greece, mainly in Athens, is also increasing.

METHOD

The aim of this study was to explore the prevalence of psychiatric disorders among a sample of 254 homeless people, using the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was drawn from the existing shelters, soup kitchens, and the streets.

RESULTS

The sample was predominantly male (74 %) with mean age 51 years, being in their majority homeless for over 25 months, 27 % of them living in the streets. The vast majority of the sample was single or separated with an education level <12 years. Current prevalence of psychiatric disorders was 56.7 % with 20.8 % comorbidity. For psychotic and mood disorders, current prevalence rates were 13 and 16 %, respectively. One year prevalence of alcohol and drug dependence was found to be low. Logistic regression analysis revealed that being older with higher number of months living in the streets and exposed to high frequency of adverse social events, increase the likelihood to become a psychiatric case. Finally, the vast majority of the identified psychiatric cases were lacking any current psychiatric care.

CONCLUSIONS

The magnitude of the prevalence of psychiatric morbidity was more than three times higher than that of the general population in Athens. Implications for psychosocial care and the organization of a support network for the homeless people are discussed.

Investigating unmet health needs in primary health care services in a representative sample of the Greek population

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access.