The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis

The role of economic news in predicting suicides

In this paper we explore the role of media and language used to comment on economic news in nowcasting and forecasting suicides in England and Wales. This is an interesting question, given the large delay in the release of official statistics on suicides. We use a large data set of over 200,000 news articles published in six major UK newspapers from 2001 to 2015 and carry sentiment analysis of the language used to comment on economic news. We extract daily indicators measuring a set of negative emotions that are often associated with poor mental health and use them to explain and forecast national daily suicide figures. We find that highly negative comments on the economic situation in newspaper articles are predictors of higher suicide numbers, especially when using words conveying stronger emotions of fear and despair. Our results suggest that media language carrying very strong, negative feelings is an early signal of a deterioration in a population's mental health.

The impact of national and international financial crises on mental health and well-being: a systematic review

BACKGROUND

Evidence suggests that financial crises and poor mental health are reciprocally related, but no systematic review has been conducted to synthesise the existing literature on the impact of national and international financial crises on population-level mental health and well-being.

AIMS

The aim of this study was to systematically review the available literature on the global impact of financial crises on mental health and well-being outcomes.

METHODS

After registration on PROSPERO, a systematic search was conducted in PsycINFO, MEDLINE, Wiley, and Web of Science for papers published until 21 November 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, 98 papers were identified as meeting eligibility criteria. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and results were presented in a formal narrative synthesis.

RESULTS

Our findings show that financial crises are significantly associated with well-being and occurrence of psychological conditions. Several socio-demographic, cultural, and country-specific characteristics played a crucial role in the prevention of population mental health decline in periods of financial crises.

CONCLUSIONS

Based on the findings of this review, evidence-based recommendations were developed to guide the design of policy actions that protect population mental health during and after financial crises.

IPPASOS: The first digital forensic information system in Greece

OBJECTIVE

This article describes the first digital clinical information system tailored to support the operational needs of a forensic unit in Greece and to maintain its archives.

METHOD

The development of our system was initiated towards the end of 2018, as a close collaboration between the Medical School of the University of Crete and the Forensic Medicine Unit of the University Hospital of Heraklion, Crete, where forensic pathologists assumed active roles during the specification and testing of the system.

RESULTS

The final prototype of the system was able to manage the life cycle of any forensic case by allowing users to create new records, assign them to forensic pathologists, upload reports, multimedia and any required files; mark the end of processing, issue certificates or appropriate legal documents, produce reports and generate statistics. For the first 4 years of digitised data (2017-2021), the system recorded 2936 forensic examinations categorised as 106 crime scene investigations, 259 external examinations, 912 autopsies, 102 post-mortem CT examinations, 804 histological examinations, 116 clinical examinations, 12 anthropological examinations and 625 embalmings.

CONCLUSION

This research represents the first systematic effort to record forensic cases through a digital clinical information system in Greece, and to demonstrate its effectiveness, daily usability and vast potential for data extraction and for future research.

Exploring cause-specific strategies for suicide prevention in India: A multivariate VARMA approach

Efficiently predicting suicide rates aids resource allocation and response preparedness. This study investigates time-series data with multiple variables to model and forecast suicide events in India. Utilizing official suicide statistics (2001-2021), results highlight the superiority of the multivariate VARMA model over VAR and univariate ARIMA models. This approach uncovers overlooked patterns and a concerning upward trend in future Indian suicide incidents. The research provides insights that aid public health professionals in targeting high-need areas and enhancing readiness and suggests cause-specific preventive strategies to counter this trend.

Unmet healthcare needs in Southeastern Europe: a systematic review

Objectives

This study sought to systematically review the existing literature on self-reported unmet healthcare needs in Southeastern Europe.

Methods

A systematic literature review of quantitative evidence in English and Bulgarian was performed in July 2023 using the following databases: Medline, Embase and EconLit. Publications were only included if they used self-reported unmet healthcare needs as an indicator of access to healthcare, concerned people living in Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, Serbia, North Macedonia or Romania and if they were published after 2003. Quality assessment of the included publications was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool.

Results

Twenty-three publications of varying quality were included in the review. Significantly more evidence was available for Greece, Bulgaria and Romania than for the rest of the region. Data collected through Pan-European surveys were commonly used, but almost half of the studies were only descriptive. Generally, the prevalence of unmet healthcare needs has decreased over the years. Unmet healthcare needs were higher among people of lower socioeconomic and educational status, ethnic minorities and migrants and high cost was consistently identified as the primary barrier to accessing healthcare.

Conclusion

Unmet healthcare needs are more prevalent among already disadvantaged societal groups. A trend of a declining prevalence of unmet needs has been observed, but it is more notable in the more socioeconomically developed countries. Improving financial protection should be a priority for the healthcare systems.

Is the economic uncertainty- human health relationship nonlinear? An empirical analysis for the China

The health costs of economic uncertainty always remain a major concern among policymakers of China. The theoretical and empirical literature on the economic uncertainty-human health nexus is still in its infancy stage. This study is firmly rooted in the economic uncertainty theory advanced by Baker, Bloom, & Davis. In this study, the primary objective of the analysis is to estimate the asymmetric impact of economic uncertainty on human health in China's economy. In order to evaluate the short and long-run estimates of economic uncertainty on human health across various quantiles, we have employed the linear and nonlinear QARDL models. The linear QARDL model shows that the long-run relationship between economic uncertainty and the infant mortality rate is positive and significant at all quantiles, while the long-run relationship between economic uncertainty and the death rate is positive and significant at higher quantiles. The nonlinear QARDL model reveals that, in the long run, the relationship between the positive shock of economic uncertainty and the infant mortality rate is positive and significant at quantiles 0.30 to 0.95, while the long-run relationship between the positive shock of economic uncertainty and the death rate is positive and significant at higher quantiles. The relationship between the negative shock of economic uncertainty and the infant mortality rate is negative and significant at the highest quantiles, while the relationship between the negative shock of economic uncertainty and death rate is negative and significant at higher quantiles in the long run. The findings indicate a positive relationship between economic uncertainty in China and higher rates of infant mortality and death. Thus, adopting suitable policies for controlling economic uncertainty can help in improving human health in China.

Uncertainty, Anxiety and the Post-Pandemic Economic Environment

There is ample evidence from medical and social sciences that economic crises impact on individual mental health. This makes neuro-psychiatric dynamics and individual mental health, particularly that of entrepreneurs, relevant for economic policy designers. At the same time, economic policies can have an impact on mental health, reducing or increasing economic uncertainty and, consequently, changing the level of anxiety in individuals. The COVID-19 pandemic resulted in a severe economic crisis and a drastic transformation of the European economic environment. However, the severity and impact of this crisis differ from many other economic and financial setbacks of the past, including the one resulting from the 2008 crisis. Moreover, the consequences of the pandemic on mental health will add to the long-term consequences of the 2010s crisis and the effects of the war at Europe's Eastern borders. Together, the three crises may increase economic uncertainty in the post-pandemic World and its impact on mental health. This essay examines the connections between economic uncertainty, anxiety, and mental health. It suggests considering some relevant elements to estimate the impact of economic uncertainty on individual mental health. Also, hypotheses about the consequences of the "three crises shock" on mental health in the post-pandemic World are advanced. Finally, the essay helps anticipate how the EU anti-crisis economic policies may generate needs and opportunities for mental health care in national health systems.

The impact of labour market shocks on mental health: evidence from the Covid-19 first wave

In this study, we estimate the effect of a negative labour market shock on individuals' levels of stress, anxiety, and depression. We use a dataset collected during the first wave of the Covid-19 pandemic, on a representative sample of citizens from Italy, Spain, and the United Kingdom, interviewed on three occasions. We measure stress, anxiety and depression and labour shocks using validated scales. Our research design is a standard difference-in-differences model: we leverage the differential timing of shocks to identify the impact on mental health. In our estimations, a negative labour shock increases the measure of stress, anxiety, and depression by 16% of a standard deviation computed from the baseline.

Forced social isolation and lockdown during the COVID-19 pandemic: depression, anxiety, trauma-distress and coping mechanisms of a Greek sample

Aim

The COVID-19 outbreak escalated into a global pandemic, pushing many governments around the world to impose measures affecting all aspects of life. Similar to other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person-to-person. This cross-sectional study investigated the association between social restriction measures, an mental health and coping strategies employed by a Greek adult sample.

Subject and methods

An online questionnaire was used to collect data during the second national lockdown (February to May 2021). A total of 650 participants (M age 33.13, 71.5% female) comprised the final sample.

Results

The results show 21.3% of respondents reported moderate-to-extremely severe anxiety, 33% moderate-to-extremely severe depression, 31.8% moderate-to-severe stress, and 38% clinically significant trauma-related distress. Hierarchical linear regression analyses revealed that the strongest contributors to adverse mental health outcomes were being female, of younger age, experiencing increases in verbal arguments at home, being separated from family and close friends, and being unable to afford enough or healthy food. Lastly, participants reported moving away from social support and into more individual strength and resilience-based coping strategies to cope with challenges.

Conclusion

These findings suggest that in addition to the detrimental effects on physical health, social restriction measures related to COVID-19 also imposed a heavy psychological burden on the population via forced social isolation, which, by design, increased not only physical distancing but also psychological distancing between people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01907-3.

Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review

BACKGROUND

A rise in mental illness is expected to follow the COVID-19 pandemic, which has also been projected to lead to a deep global economic recession, further adding to risk factors.

AIMS

The aim of this review was to assess the impact of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health.

METHOD

Searches were conducted in PubMed, Web of Science, PsycINFO and Sociological Abstracts. We included studies of all populations exposed to the COVID-19 pandemic, and other similar pandemics/epidemics and economic crises, compared with non-exposed time periods or regions. The outcome was mental health.

RESULTS

The 174 included studies assessed mental health impacts of the COVID-19 pandemic (87 studies), 2008 economic crisis (84 studies) and severe acute respiratory syndrome (SARS) epidemic (three studies). Outcomes were divided into affective disorders, suicides, mental healthcare utilisation and other mental health. COVID-19 pandemic studies were of lesser quality than those for the economic crisis or SARS epidemic. Most studies for all exposures showed increases in affective disorders and other mental health problems. For economic crisis exposure, increases in mental healthcare utilisation and suicides were also found, but these findings were mixed for COVID-19 pandemic exposure. This is probably because of quarantine measures affecting help-seeking and shorter follow-ups of studies of COVID-19 pandemic exposure.

CONCLUSIONS

Our findings highlight the importance of available, accessible and sustainable mental health services. Also, socioeconomically disadvantaged populations should be particular targets of policy interventions during the COVID-19 pandemic.

Spatio-Temporal Variation of Lung Cancer in Crete, 1992-2013. Economic or Health Crisis?

(1) Background: This is the first population-based study in Greece, with the aim to measure the changing trends of lung cancer (LC) and the associated risk factors before and after the economic crisis. Among the main objectives were the identification of LC hot spots and high-risk areas; (2) Methods: The study was conducted in Crete, the biggest island in Greece. Data (5057 LC cases) were collected from the Cancer Registry of Crete (CRC). The age-standardized incidence and mortality rates (ASIR, ASMR/100,000/year) were estimated, while additional indexes were used, including the adjusted Charlson's comorbidity index (CCI%), the deprivation index (HPI-2), and the exposure to outdoor air pollution (OAP). The analysis was performed for two time periods (Period A: 1992-2008; Period B: 2009-2013); (3) Results: ASIR presented a significant increase during the economic crisis, while an even higher increase was observed in ASMR (Period A: ASMR = 30.5/100,000/year; Period B: ASMR = 43.8/100,000/year; p < 0.001). After 2009, a significant increase in the observed LC hot spots was identified in several sub-regions in Crete (p = 0.04). The risk of LC mortality increased even more for smokers (RR = 5.7; 95%CI = 5.2-6.3) and those living in highly deprived geographical regions (RR = 5.4; 95%CI = 5.1-5.8) during the austerity period. The multiple effect of LC predictors resulted in adjusted RRs ranging from 0.7 to 5.7 within the island (p < 0.05); (4) Conclusions: The increased LC burden after the onset of the economic crisis, along with a changing pattern of LC predictors stressed the urgent need of geographically oriented interventions and cancer control programs focusing on the most deprived or vulnerable population groups.

Participatory Action Research for Tackling Distress and Burnout in Young Medical Researchers: Normative Beliefs before and during the Greek Financial Crisis

(1) Background: We aimed to explore Young medical researchers (YMR) normative beliefs and perceived causes of distress and burnout, prior and during the financial crisis in Greece, and to assess their views on Participatory Action Research (PAR) interventions towards tackling these disorders. (2) Methods: A Participatory Learning and Action (PLA) methodology was performed in two time periods (prior crisis: December 2008; during crisis: February-March 2017). In both time periods, three different groups (Group 1: females, Group 2: males, Group 3: mixed) of 5-7 participants and two sessions (≈1 h/session) per group took place in each site. Overall, 204 sessions with 1036 YMR were include in the study. (3) Results: Several socio-demographic characteristics of YMR altered during the crisis (lower income, higher smoking/alcohol consumption, etc.). The majority of YMR conceived distress and burnout as serious syndromes requiring professional support. Feeling very susceptible and the necessity for establishing PAR interventions were frequently reported during the crisis. Numerous (a) barriers and (b) cues to action were mentioned: (a) lack of time, money and support from friends/family/colleagues (b) being extensively informed about the intervention, participation of their collaborators, and raising awareness events. (4) Conclusions: The changing pattern of Greek YMR's beliefs and needs during the crisis stresses the necessity of interventions to tackle distress and burnout. Effectiveness of these interventions could be enhanced by the suggested cues to action that emerged from this study.

The fear of COVID-19 and job insecurity impact on depression and anxiety: An empirical study in China in the COVID-19 pandemic aftermath

The employees' psychological health and resilience in times of emergency and general uncertainty was chosen due to the immense implications for economics, entrepreneurs, psychologists and psychiatrists, and policymakers. This study aims to provide an insight into uncertainty-induced anxiety and depression among Chinese employees in the aftermath of the COVID-19 outbreak. Analysis performed in the context of China in the COVID-19 pandemic aftermath is significant due to the universal nature of external shock impact on psychological welfare, applicable across nations and business sectors and in similar contexts. The statistical analysis was performed with SEM software AMOS version 23. The research model consisting of fear of COVID-19, job insecurity, anxiety, depression, was empirically tested. A purposive sampling technique was applied with the online questionnaire shared with employees in companies located in China. Respondents were working in educational services, information technology, engineering, electronics, and other sectors on white-collar jobs. The data collection was conducted from May to August 2020, in the aftermath of the COVID-19 pandemic in China. The research sample consisting of 283 respondents was used for analysis. Path analysis was performed, and standardized parameter estimates, standard errors, and p-values were calculated. The results indicate a positive and significant impact of job insecurity on depression and anxiety. Furthermore, results indicate that the fear of COVID-19 significantly impacts anxiety and depression but does not impact job insecurity. The findings can be used in a multidisciplinary effort to mitigate the psychological damage. Furthermore, they complement the ongoing epidemiological and scientific discourse on people's personal health and choice of coping.

Relationships between Expenditure of Regional Governments and Suicide Mortalities Caused by Six Major Motives in Japan

Suicide mortality in Japan reduced in the period of 2009-2018. A number of studies identified the impact of financial governmental support for social welfare systems on suicide mortality; however, the detailed effects of specific regional policies, designed according to regional cultural, economic, education and welfare situations, on suicide mortality remain to be clarified. Therefore, the present study analyses the associations between the regional governmental expenditure of six major divisions, "public health", "public works", "police", "ambulance/fire services", "welfare" and "education", and suicide mortalities caused by six major suicidal motives, related to "family", "health", "economy", "employment", "romance" and "school", across the 47 prefectures in Japan during the period of 2009-2018, using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure of "public works" displayed a positive relationship with suicide mortality of females caused by family-related motives but was not related to other suicide mortalities, whereas the expenditures in "public health", "police", "ambulance/fire services", "welfare" and "education" contributed to a reduction in suicide mortality, at least in some statistical indicators. The expenditures of both "ambulance/fire" and "education" were predominantly effective among the six major divisions of regional governmental expenditure in reducing suicide mortalities. In the education subdivisions, the expenditure of "kindergarten" was related to a reduction in suicide mortalities caused by a wide spectrum of motives. The amount of expenditure of welfare indicated the limited possibility of facilitating a reduction in suicide mortalities caused by only motives associated with economy or employment. However, in the welfare subdivisions, the expenditure of "child welfare" and "social welfare" was effective in reducing suicide mortalities, but the expenditure of "elderly welfare" was unexpectedly related to an increase in suicide mortalities. These results suggest that most Japanese people are struggling to bring up children even in the situation of an increasing elderly population with a decreasing birth rate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. Although the issue of an increasing elderly population and a decreasing birth rate in Japan has not yet improved, the obtained results suggest that evidence-based welfare expenditure redistributions of prefectures and municipalities could improve Japanese society and welfare systems.

Analysing the Impacts of Financial Expenditure of Prefectures on Methods of Suicide Completion in Japan

Recently, several studies reported that the governmental financial expenditures play important roles in the prevention of increasing suicide mortalities; however, the specific regional policies, designed dependent on regional cultural, economic, education and welfare backgrounds, affect suicide mortality by a specific suicidal means. Therefore, the present study determined the impacts of the regional governmental expenditure of six major divisions, “public health”, “public works”, “police”, “ambulance/fire services”, “welfare” and “education” on suicide mortalities by five major suicidal means, “hanging”, “poisoning”, “charcoal burning”, “jumping” and “throwing”, across the 47 prefectures in Japan during 2009–2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditures of “ambulance/fire services” and “education” indicated the negative relation to suicide mortalities by wide-spectrum suicidal means, whereas expenditures of “public works” did not affect suicide mortalities. In the education subdivisions, expenditure of “kindergarten” and “elementary school” indicated the impacts of reduction of suicide mortalities, whereas the expenditures of “special school” for individuals with disabilities unexpectedly contribute to increasing suicide mortalities by poisoning, charcoal burning and throwing of females. Regarding subdivisions of welfare, expenditure of “child welfare” and “social welfare” contributed to a reduction in suicide mortalities, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortalities. Furthermore, expenditures of welfare subdivision abolished the negative impacts of the expenditures of educational subdivisions, kindergarten and elementary school, but the positive impact of expenditure of special school on female suicide mortalities was not affected. These results suggest that most Japanese people are struggling to care for children even in the situation of an increasing elderly population with a decreasing birthrate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. The results demonstrated by this study suggest that the scientifically evidence-based redistributions of welfare expenditure in regional government, at least partially, provide improvement of Japanese society and welfare systems, under the continuous severe Japanese social concerns associated with increasing elderly population with a decreasing birthrate.

Unemployment and suicide among the Brazilian population in the crisis of capitalism

The current crisis of capitalism has multiple economic, financial, social, environmental, cultural and political facets. In Brazil, the severity of the crisis is no different, resulting from the exhaustion of the neo-developmentalist model and its inability to resist global crisis. This study compares suicide mortality rates (MR) among employed and unemployed persons in Brazil prior to and during the economic crisis using death records from the period 2011 to 2016. The findings show that in the period 2011 to 2016 the suicide MR fell from 2.66/100,000 to 2.46 among unemployed persons and increased from 5.52/100,000 to 6.89/100,000 in employed persons. Suicide is a complex, multi-causal phenomenon determined by a diverse range of social factors, including strategies that increase worker exploitation. Indeed, being employed can have a greater negative impact on the mental health of workers than being unemployed.

Employment and suicidal rates during economic recession: A country-targeted integrative review

BACKGROUND

The economic crisis' effects on suicide rates for countries undergoing or exiting austerity measures have been widely debated. This integrative review aimed to identify, appraise, and synthesize available evidence of employment status effect on suicide mortality rates in Greece during the recent economic recession period.

METHODS

A literature review of studies evaluating suicides in the general Greek population, as well as across age and gender groups, in relation to employment during the economic crisis period was performed. PubMed electronic database was searched for relevant articles published in English or Greek language from 2009 up to February 2020. Appraisal was carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines.

RESULTS

A total of 24 articles met all inclusion criteria with 20 of them at level IV, 2 at level VII, and 2 at level VIII. A total of 18 studies reported increase of suicide rates during the economic recession period. About 12 studies examined the co-relation between unemployment and suicide rate, with ten studies showing a positive correlation. Moreover, thirteen studies reported data on the effect of gender and age variables on suicide rates.

CONCLUSION

Evidence shows that suicide mortality rates in Greece increased after the eruption of economic recession, particularly after the implementation of radical austerity measures (2011-2014). This increase was positively correlated with unemployment and was more prominent among males of working age. Further in depth epidemiological research of regional variations in terms of profile and contributing or enabling factors of suicidal behavior is needed.

Help-seeking intentions in the U.S. population during the COVID-19 pandemic: Examining the role of COVID-19 financial hardship, suicide risk, and stigma

The primary goal of this study was to increase understanding of help-seeking intentions in the U.S. population during the COVID-19 pandemic and to examine influencing factors such as COVID-19 financial hardship, suicide risk, and stigma in order to contribute to effective theory-based help-seeking and suicide prevention campaigns. In a representative sample of U.S. adults (N = 5,010), this research tested whether COVID-19 financial hardship was associated with higher levels of depression and suicidal ideation (supported), and whether the reasoned action framework could usefully predict help-seeking intentions in this context (supported). The reasoned action framework explained 36% of the variance in help-seeking intentions in the U.S. population and identified injunctive norm (social support) as primary determinant of intention. Neither suicidal ideation, COVID-19 financial hardship, or self-stigma of seeking help influenced determinants of help-seeking. Future research should test injunctive norm as causal predictor of help-seeking in the U.S. population to usefully inform effective help-seeking campaigns, particularly among those who have experienced COVID-19 financial hardship. Additionally, effective dissemination strategies for help-seeking campaigns should be tested and identified, such as broader targeted approaches as well as intentional mis-targeting techniques.

The Threat of COVID-19 and Job Insecurity Impact on Depression and Anxiety: An Empirical Study in the USA

As the coronavirus disease 2019 pandemic causes a general concern regarding the overall mental health of employees worldwide, policymakers across nations are taking precautions for curtailing and scaling down dispersion of the coronavirus. In this study, we conceptualized a framework capturing recurring troublesome elements of mental states such as depression and general anxiety, assessing them by applying standard clinical inventory. The study explores the extent to which danger control and fear control under the Extended Parallel Processing Model (EPPM) threat impact job insecurity, with uncertainty phenomenon causing afflicting effect on the experiential nature of depression heightened by anxiety. With the aim to explore the job insecurity relationship with anxiety and depression, and measure the impact of EPPM threat, an empirical study was conducted in the United States on a sample of 347 white collar employees. Demographic data, EPPM threat, job insecurity, anxiety, and depression data were collected via a standardized questionnaire during the coronavirus disease 2019 (COVID-19) pandemic. The questionnaire consisting of multi-item scales was distributed online. All the scale items were evaluated on a 5-point Likert scale. SEM software AMOS version 23 was used to perform confirmatory factor analysis with maximum likelihood estimation. In the structural model, relationships between the threat of COVID-19, job insecurity, anxiety, and depression were assessed. The findings of the study suggest that job insecurity has a significant impact on depression and anxiety, whereas the threat of COVID-19 has a significant impact on depression. Mediating effects of job insecurity and EPPM threat impact on anxiety were not established in the study. The study contributes to the apprehension of the repercussions of major environmental disruptions on normal human functioning, and it investigates the effects of self-reported protective behaviors on risk perception. The study also explains the underlying mechanisms of coping behavior as possible antecedents to mental disorders. When subjected to stressful events, heightened psychological arousal causes physical and psychological challenges of affected employees to manifest as behavioral issues.

Perceived Importance of Public Health Risks in Greece: A Nationwide Survey of the Adult Population

The current study is the first to examine the perceptions of the Greek public towards selected health risks and prioritize perceived risk importance and the needs to be addressed for public health promotion. Participants were asked to consider the individual importance of selected risks and the top three most important risks. Data collection took place on February 2020 in a representative sample of the adult Greek population. Differences between groups were assessed with Chi-square tests. Logistic regression models were used to identify perceptions based on participants’ characteristics. Analysis was conducted in Stata 14, and 1976 adults participated in the survey: 48% male and 52% female. Road accidents, cancer and air pollution and environmental protection were considered the top three most important public health risks. Differences were observed between sexes; females were more concerned regarding the importance of the examined public health risks, and between age groups, younger ages considered STDs and contraception more important than older ages. Finally, non-smokers considered exercise and smoking to be more important than smokers. This is the first study to present and grade the public’s perceptions on the importance of public health risks in Greece. Our study’s prioritization of health risks could aid health authorities in improving and promoting the overall public health in Greece.

Economic uncertainty and suicide in the United States

Previous studies have found an association between recessions and increased rates of suicide. In the present study we widened the focus to examine the association between economic uncertainty and suicides. We used monthly suicide data from the US at the State level from 2000 to 2017 and combined them with the monthly economic uncertainty index. We followed a panel data econometric approach to study the association between economic uncertainty and suicide, controlling for unemployment and other indicators. Economic uncertainty is positively associated with suicide when controlling for unemployment [coeff: 8.026; 95% CI: 3.692-12.360] or for a wider range of economic and demographic characteristics [coeff: 7.478; 95% CI: 3.333-11.623]. An increase in the uncertainty index by one percent is associated with an additional 11-24.4 additional monthly suicides in the US. Economic uncertainty is likely to act as a trigger, which underlines the impulsive nature of some suicides. This highlights the importance of providing access to suicide prevention interventions (e.g. hotlines) during periods of economic uncertainty.

Economic Distress in Families with a Member Suffering from Severe Mental Illness: Illness Burden or Financial Crisis? Evidence from Greece

The present study aims to explore the economic distress and pertinent coping strategies in families with a member suffering from a severe mental illness. Furthermore it endeavors to gauge the impact of illness burden and that of the Greek recession on economic distress, while disentangling their contribution. In total, 190 key relatives of people with severe mental illness were recruited from community mental health services in the region of Attica. Relatives completed a self-reported questionnaire consisting of the Index of Personal Economic Distress, the Family Burden scale and the Family Rituals scale. Information on financial strategies for tackling recession and income loss due to the recession was also gleaned. Regarding economic distress, only 15% had frequent difficulty meeting routine financial demands in their household. The preponderant strategy was spending savings (56.8%). Income category and spending less on basic needs were the main predictors of economic distress. Objective poverty indices rather than burden predicted economic distress to a greater extent.

The ACE Index: mapping childhood adversity in England

Background

Studies of adults show that adverse childhood experiences (ACEs) are associated with health and social problems and are more common among people living in deprived areas. However, there is limited information about the geographical pattern of contemporary ACEs.

Methods

We used data from the police, social services, schools and vital statistics in England to calculate population rates of events that represent childhood adversity. We constructed an ‘ACE Index’ that summarizes the relative frequency of ACEs at local authority level, informed by the methods of the Index of Multiple Deprivation. We explored associations between the ACE Index and local characteristics in cross-sectional ecological analysis.

Results

The ACE Index was strongly associated with the proportion of children that live in income-deprived households (child poverty). In addition, the ACE Index was independently associated with higher population density and was higher in certain regions, particularly the north-east.

Conclusions

The association between ACEs and child poverty provides evidence of a process in which deprivation increases the risk of adverse experiences in childhood. The ACE Index can inform allocation of resources for prevention and mitigation of ACEs.

Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study

Background

Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition.

Methods

Data were retrieved on all suicides in Iceland during 2002–14. The study period was divided into a pre-collapse period (2002–08) and a post-collapse period (2008–14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex.

Results

A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94–1.35). This was true for both men and women (RR 1.18; CI 0.96–1.46 and RR 0.96; CI 0.67–1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86–1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94–1.79) or balance of trade (RR 1.08; CI 0.96–1.22).

Conclusion

The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.

Do Locus of Control, Self-esteem, Hope and Shame Mediate the Relationship Between Financial Hardship and Mental Health?

In a longitudinal study of 104 participants, the psychological factors of economic locus of control, self-esteem, hope and shame were explored for their impact on the relationship between financial hardship and mental health. Participants completed measures of financial hardship, the psychological factors and measures of mental health three times at three-monthly intervals. A hierarchical regression analyses indicated that subjective financial hardship, hope and shame significantly predicted mental health outcomes. Mediation analyses demonstrated that hope mediated the relationship between subjective financial hardship and depression, stress and wellbeing; that shame mediated the relationship between subjective financial hardship and anxiety; and that neither shame nor hope mediated the relationship between subjective financial hardship and suicide ideation.

Thank goodness for stickiness: Unravelling the evolution of income-related health inequalities before and after the Great Recession in Europe

The Great Recession in Europe sparked concerns that the crisis would lead to increased income related health inequalities (IRHI). Did this come to pass, and what role, if any, did government transfers play in the evolution of these inequalities? Motivated by these questions, this paper seeks to (i) study the evolution of IRHI during the crisis, and (ii) decompose these evolutions to examine the separate roles of government versus market transfers. Using panel data for 7 EU countries from 2004 to 2013, we find no evidence that IRHI persistently rose after 2008, even in countries most affected by the crisis. Our decomposition reveals that, while the health of the poorest did indeed worsen during the crisis, IRHI were prevented from increasing by the relative stickiness of old age pension benefits compared to the market incomes of younger groups. Austerity measures weakened the IRHI reducing effect of government transfers.

Government spending, recession, and suicide: evidence from Japan

Backgrounds

Austerity has been shown to have an adverse influence on people’s mental health and suicide rates. Most existing studies have focused on the governments’ reactions to a single event, for example, the Great Recession of 2008.

Methods

This study focused on significant changes in fiscal policy between 2001 and 2014 in Japan. The size of expenditures by national and local governments decreased dramatically between 2001 and 2006 under the neoliberal reform and then increased after the global economic crisis and the Great East Japan Earthquake. Using the data from 47 prefectures between 2001 and 2014, we tested whether more spending by the local governments was associated with a lower suicide rate in their jurisdiction. We also investigated whether this relationship was particularly salient during a more severe recession.

Results

Our analysis revealed that an increase of 1% in the per capita local government expenditures was associated with a decrease of 0.2% in the suicide rates among males and females aged between 40 and 64 and that this correlation was strengthened as the unemployment rate increased, particularly among males.

Conclusions

Government’s reaction to economic crises can either exacerbate or mitigate the negative impact of the economic recession on people’s mental health and suicide rates.

Mental health and politics since the eurozone crisis: The role of mental health professionals

Some of the most immediate health effects of the 2008 economic crisis concerned the mind, not the body. Rates of generalized anxiety, chronic depression, and even suicide spiked in many European societies. This viewpoint highlights the role of mental health professionals in responding to this emergency, and argues that their sustained mobilization is necessary to its long-term resolution.

Attitudes to depression and psychiatric medication amid the enduring financial crisis in Attica: Comparison between 2009 and 2014

BACKGROUND

Only a handful of studies have explored the effect of the financial crisis on public attitudes to mental illness.

AIMS

This study examines changes in lay attitudes to depression and psychiatric medication between 2009 and 2014 in Attica region. Furthermore, it explored a potential interaction with employment status.

METHODS

Data were drawn from two surveys conducted in 2009 and 2014 using the same sampling procedure, interview mode, and survey instrument. Specifically, a random and representative sample of 586 people was recruited in 2009 and of 604 in 2014. Attitudes to depression were measured by the Personal Stigma subscale of the Depression Stigma Scale and attitudes to psychiatric medication by a self-constructed scale with good psychometric properties. Data collection occurred via telephone.

RESULTS

There has been no overall change in lay attitudes to depression. Nonetheless, a positive change was recorded with regard to the belief that depression is a sign of personal weakness and a negative change with respect to people with depression being dangerous. Attitudes to psychiatric medication have worsened during the study period. Employment status was not found to interact with the survey year.

CONCLUSION

Anti-stigma efforts should be tailored on counteracting the dangerousness stereotype, while they should prioritize targeting attitudes to psychiatric medication.

NEET status among young Greeks: Association with mental health and substance use

BACKGROUND

Prior studies have shown that young people "not in education, employment or training" ("NEET") are at higher risk for psychopathology and substance abuse. Similar studies are lacking in Southern European populations. We aimed to examine the associations of anxiety and depressive symptoms, and substance use with NEET status in a large, randomized population-based sample in Greece.

METHODS

A telephone structured questionnaire was conducted in a representative sample of 2771 young Greeks aged 15-24 years. Anxiety and depressive symptoms were assessed with GAD-7 and PHQ-9 scales, respectively. Substances use and several sociodemographic parameters were also examined.

RESULTS

In our sample 16.4% were NEETs. In multivariate analyses, NEETs compared to non-NEETs were older, with lower family income, without insurance and more likely to be married and smoke. Furthermore, NEET status was associated with a higher GAD-7 score among older NEETs and long-term NEETs (NEETs unemployed for more than a year). Moreover, being NEET among older participants was associated with severe symptoms of anxiety and moderate/severe symptoms of depression.

LIMITATIONS

This was a telephone survey and a clinical evaluation of the patients was not performed. Furthermore, the structured interview was not designed to detect the level of substance use or the reasons for being NEET.

CONCLUSIONS

NEET status is frequent among young Greeks. Older, and long-term NEETs appear to be at higher risk for presenting anxiety/depression symptoms. Whether NEET status is associated with adverse outcomes later in life requires longitudinal studies.

Sociocultural factors associated with attitudes toward suicide in Australia

To investigate the role of cultural and economic factors on suicide attitudes and stigma toward suicide, we recruited 230 Australian adults for an online survey, assessing demographic characteristics (including ethnicity and socioeconomic status, SES), suicide attitudes, stigma toward people who die by suicide, and public knowledge of suicide prevention (suicide literacy). Regression analyses indicated that participants affiliated with non-Anglo cultures or with higher SES had higher suicide stigma and lower suicide literacy than Anglo participants and those in lower SES areas. Increased stigma in minority cultural groups may impact help-seeking behaviors that protect against suicide.

A Time-Series Analysis of Firearm Purchasing After Mass Shooting Events in the United States

IMPORTANCE

Increased understanding of public response to mass shootings could guide public health planning regarding firearms.

OBJECTIVES

To test the hypothesis that mass shootings are associated with gun purchasing in the United States and to determine factors associated with gun purchasing changes.

DESIGN AND SETTING

In a cross-sectional study, monthly data on US background checks for all firearm purchases, handgun permits, and long gun permits between November 1, 1998, and April 30, 2016, were obtained from the National Instant Criminal Background Check System. All mass shootings resulting in 5 or more individuals injured or killed during the study period were also identified. Interrupted autoregressive integrated moving average time-series modeling was used to identify events associated with changes in gun purchase volume. Then, logistic regression was used to identify event characteristics associated with changes in gun purchases. Analyses were performed between June 6, 2016, and February 5, 2019.

EXPOSURES

For the time-series analysis, each mass shooting was modeled as an exposure. In the logistic regression, examined factors were the shooter's race/ethnicity, the region in the United States in which a shooting occurred, whether a shooting was school related, fatalities, handgun use, long gun use, automatic or semiautomatic gun use, media coverage level, and state political affiliation.

MAIN OUTCOMES AND MEASURES

Identification of major mass shootings significantly associated with changes in gun purchases, and the identification of event-specific factors associated with changes in gun purchases.

RESULTS

Between November 1998 and April 2016, 124 major mass shootings and 233 996 385 total background checks occurred. A total of 26 shootings (21.0%) were associated with increases in gun purchases and 22 shootings (17.7%) were associated with decreases in gun purchasing. Shootings receiving extensive media coverage were associated with handgun purchase increases (odds ratio, 5.28; 95% CI, 1.30-21.41; P = .02). Higher-fatality shootings had an inverse association with handgun purchase decreases (odds ratio, 0.73; 95% CI, 0.53-1.00; P = .049).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest an association between mass shootings and changes in gun purchases, observed on a comprehensive timescale. Identification of media coverage and fatalities as significant factors underlying this association invites further study into the mechanisms driving gun purchase changes, holding implications for public health response to future gun violence.

'Suicide rates in Crete, Greece during the economic crisis: the effect of age, gender, unemployment and mental health service provision'

BACKGROUND

Recently, suicides in Greece have drawn national and international interest due to the current economic crisis. According to published reports, suicides in Greece have increased up to 40% and Crete has been highlighted as an area with the sharpest increase.

AIM

To investigate the suicide mortality rates in Crete between 1999 and 2013 and their association with the economic crisis.

METHODS

Data on suicides were selected from the Department of Forensic Medicine files of the University of Crete.

RESULTS

Our analysis showed that (1) Crete, has the highest suicide mortality rate in Greece, however no significant increase was observed between 1999 and 2013, (2) there were opposing trends between men and women, with women showing a decrease whereas men showed an increase in that period, (3) there was a significant increase of suicides in middle-aged men (40-64 yrs) and elderly, although the highest unemployment rates were observed in young men and women, and (4) finally, there was a regional shift of suicides with a significant decrease in Western Crete and a significant increase in Eastern Crete.

CONCLUSIONS

Although, Crete has the highest suicide mortality rates in Greece, we did not observe an overall increase during the last 15 years, including the period of economic crisis. Furthermore, there was an increase in middle-aged and elderly men, whereas young men and women showed oppositional trends during the years of austerity. This may be related to the culturally different expectations for the two genders, as well as that younger individuals may find refuge to either strong family ties or by immigrating abroad. Finally, the relative increase of suicides in Eastern Crete may be explained by factors, such as the lack of community mental health services in that area.

Distress and burnout in young medical researchers before and during the Greek austerity measures: forerunner of a greater crisis?

PURPOSE

Distress and burnout are strongly correlated with austerity and financial recessions. Aim of this study was to assess distress and burnout among young medical researchers (YMR) in Greece before and during the financial crisis.

METHODS

In total 2050 YMR affiliated in all the nursing and medical departments of Greece were enrolled (1025 in Period A: 2008 and 1025 in Period B: 2017). Distress and burnout were measured via DASS-21 and Maslach Burnout Inventory (MBI) questionnaires.

RESULTS

Before the crisis, prevalence of distress and burnout among young medical researchers was 24 and 20%, respectively. During the financial crisis distress prevalence increased significantly (56%), while there has also been a tremendous increase in burnout occurrence (60%). Specific sociodemographic characteristics presented significantly increased rate of change (females, singles and divorced/widowers, living with family members, volunteers, smokers and heavy alcohol consumers). Distress and burnout scales were positively correlated (Spearman's r = 0.81; p = 0.01). Depression scores shifted from normal to moderate (rate of change = 13.1%), anxiety levels increased from normal to severe (rate of change = 14.3%) and tension/stress scores elevated from normal to severe (rate of change = 20.2%).

CONCLUSIONS

It is evident that the current financial crisis and working conditions have a strong impact on health status of young medical researchers in Greece. The observed increased trends and the identified predictors could guide targeted and comprehensive interventions towards tackling distress among the medical researchers not only in Greece but also in other countries suffering from financial crisis.

Ten-year evolution of suicide rates and economic indicators in large Brazilian urban centers

PURPOSE OF REVIEW

This was a retrospective ecological study to examine the relationship between suicide rates and economic indicators in large Brazilian urban centers. Data on macroeconomic indicators (GDP and unemployment rates) and suicide rates of the largest Brazilian cities were collected from January 2006 to December 2015.

RECENT FINDINGS

Six cities were included in the study: Porto Alegre in the South, Recife and Salvador in the Northeast, and Belo Horizonte, São Paulo and Rio de Janeiro in the Southeast region. We observed a 4% increase in the age-adjusted suicide rate in these large Brazilian urban centers from 2006 to 2015, which is less pronounced than the 9% increase in the national rates of suicide observed in the same period.

SUMMARY

The effect of economic indicators was heterogeneous among the centers, but, overall, the variation in suicide rates was inversely related to unemployment and did not show a significant relationship with GDP. These findings indicate a more complex link between economics and suicide whenever looking at local regional indicators. Further research should focus on possible intervening factors, what may inform better preventive interventions.

Changing Trends in Nutritional Behavior among University Students in Greece, between 2006 and 2016

The objective of the present survey was to study the dietary behavior of university students residing away from the family home. In this context, we (a) compared their dietary habits in two time periods, namely 2006 and 2016; and (b) explored the possible impact of gender on the behavioral changes in nutritional choices. A total of four hundred and five university students (2006, n = 242; 2016, n = 163) participated in the study. Dietary assessment was carried out using a qualitative Food Frequency Questionnaire, while data about demographic and lifestyle factors were also collected. Students' dietary habits have been modified in a generally desirable direction, as reflected, e.g., in the elevated consumption of several plant-based foods. Gender was also significantly associated with Body Mass Index (BMI) and changes in dietary attitudes. Possible reasons for the transition towards healthier and more balanced dietary habits could involve the budgetary constraints facing Greece in the last decade, as well as increasing nutritional awareness and other socio-cultural factors characterizing this target group. A deeper understanding of these relations would be crucial to foster nutritional education and further enhance the effectiveness of health promotion campaigns.

The relationship of the perceived impact of the current Greek recession with increased suicide risk is moderated by mental illness in patients with long-term conditions

OBJECTIVE

Adverse life events may contribute to the emergence of suicidality. We aimed to test the relationship between the impact of the Greek recession and suicidal risk in people with long-term conditions (LTCs) and to determine whether this relationship is moderated by the presence of a mental disorder.

METHODS

Suicidal risk (RASS) and crisis parameters were assessed in a cross-sectional survey including 376 patients with LTCs (type-II diabetes mellitus, rheumatological disorders and chronic obstructive pulmonary disease) attending the Emergency Department or specialty clinics. A diagnosis of mental disorder was confirmed by the Mini International Neuropsychiatric Interview (MINI) interview. Hierarchical regression models were used to quantify moderator effects.

RESULTS

Suicidal risk was significantly associated with the perceived impact of the recession (p=0.028). However, moderation analysis showed that this relationship was significant only in those diagnosed with either major depressive disorder or generalized anxiety disorder.

CONCLUSIONS

These findings suggest that the perceived impact of the current Greek recession is not correlated with suicidal risk per se, but the recession may act as precipitator in combination with other risk factors, such as the presence of a mental illness, thus supporting the importance of early diagnosis and treatment of mental disorders in vulnerable groups.

Exploring public sector physicians' resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal's capital city area

BACKGROUND

Evidence is accumulating on the impact of the recent economic crisis on health and health systems across Europe. However, little is known about the effect this is having on physicians - a crucial resource for the delivery of healthcare services. This paper explores the adaptation to the crisis of public sector physicians and their ability to keep performing their functions, with the objective of gaining a better understanding of health workers' resilience under deteriorating conditions.

METHODS

We conducted a survey among 484 public primary care and hospital physicians in Portugal's capital city area and explored their perceptions of the crisis, adaptation and coping strategies. We used ordinal and logistic regression models to link changes in hours worked and intentions to migrate with physicians' characteristics and specific answers.

RESULTS

We found little evidence of physicians changing their overall allocation of working time before and after the crisis, with their age, types of specialisation, valuation of job flexibility and independence significantly associated with changes in public sector hours between 2010 and 2015. Being divorced, not Portuguese, of younger age, and working a high number of hours per week, were found to increase the probability of physicians considering migration, the same as having a poor opinion of recent government health policies. On the other hand, enjoying their current working environment, not wanting to disrupt provision of service, and leisure time were found to protect against scaling down public sector hours or considering migration.

CONCLUSIONS

Our work on Portuguese physicians contributes to the debate on health workers' resilience, showing the value of understanding the influence of personal characteristics and opinions on their adaptation to changing circumstances, before designing policies to improve their working conditions and retention.

Crisis, suicide and labour productivity losses in Spain

OBJECTIVES

Suicide became the first cause of death between the ages of 15 and 44 in Spain in the year 2013. Moreover, the suicide rate in Spain went up by more than 9 % with respect to the previous year. This increase could be related to the serious economic recession that Spain has been experiencing in recent years. In this sense, there is a lack of evidence to help assess to what extent these suicides have a social cost in terms of losses in human capital. Firstly, this article examines the relationship between the variables related to the economic cycle and the suicide rates in the 17 Spanish regions. Secondly, an estimate is made of the losses in labour productivity owing to these suicides.

METHODOLOGY

In this article, panel data models are used to consider different variables related to the economic cycle. Demographic variables and the suicide rates for regions across Spain from 2002 to 2013 also come into play. The present and future production costs owing to premature death from suicide are calculated using a human capital model. These costs are valued from the gross salary that an individual no longer receives in the future at the very moment he or she leaves the labour market.

RESULTS

The results provide a strong indication that a decrease in economic growth and an increase in unemployment negatively affect suicide rates. Due to suicide, 38,038 potential years of working life were lost in 2013. This has an estimated cost of over 565 million euros.

CONCLUSIONS

The economic crisis endured by Spain in recent years has played a role in the higher suicide rates one can observe from the data in official statistics. From a social perspective, suicide is a public health problem with far-reaching consequences.

Global trends in suicide epidemiology

PURPOSE OF REVIEW

Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide.

RECENT FINDINGS

The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools.

SUMMARY

The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.