Health effects of Greece’s austerity measures are “worse than imagined,” report researchers
Cite this as: BMJ 2013;346:f2740
Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers' letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.
Displaying 1-1 out of 1 published
Recently a paper published in the BMJ suggested that suicide and murder rates rose by 22.7% between 2007 and 2009, in Greece and this is a consequence of austerity 1 2. It is well known that during the last 5 years, Greece has entered a long period of economic crisis with adverse effects on various aspects of daily life, including the mental health of its citizens. In the past, it has been announced by the Greek Ministry of Health that the annual suicide rate might had been increased by 40% 3 4 while also other authors reported a 17% increase in suicidal rates during 2008-9 5. However the Greek Statistics Authority data do not suggest any increase at least until 2010 3 6-9.
In this frame it is important to note that the rates recently reported for 2011 by the Hellenic Statistical Authority (www.statistics.gr) suggest a significant increase. While for the years 2000-2010 the number of completed suicides ranged from 323 (in 2002) to 402 (in 2006), for 2011 the total number is 477 (393 males and 84 females), that is increased by 26.52% in comparison to 2010 (377). The number of suicides by year and age group are shown in table 1. The increase happened in males of the aged 45-64. The data for ages 35-44 are grossly fluctuating throughout the decade and no clear trend is present.
In previous papers it had been noted that only after 2009 Greece experienced extreme indices of crisis (e.g. unemployment rate above 17% during late 2011), so there was a possibility, high distress and suicidal thoughts to lead to increased numbers of completed suicide only after a few years 8 and this seems to be the case now.
It is evident that there is an urgent need for intensive screening, follow-up, and treatment of people with suicidal ideation. The actions to be taken are also of prime importance. Since it is reported that the majority of suicide victims die by the first attempt 10 11 targeting suicide prevention beyond the framework of healthcare could be the only realistic option for suicidal prevention. A recent systematic review by the first author of the current article showed that only community networking is effective in reducing the actual number of suicides, while training of gatekeepers and other ‘educational-type’ campaigns have no real effect at all 12.
Concerning Greece, although prevention programs are in place since the 70s, no systematic assessment and publication of their results are available and only limited data exist on the qualitative characteristics of suicidal attempts 12. It also remains to be determined whether local differences in medical practice across the country play any role and whether not one single solution is suitable for all areas.
However, it should be stressed that these data should be received with caution. The suicidal rates in Greece were always and still are extremely low, thus significant fluctuations are not uncommon. An effect of an increased sensitivity towards recognizing suicides cannot be ruled out. It is unfortunate that during the previous years the media over-emphasized the possible relationship between periods of economic crisis and suicidality. We know that such publicity is harmful; it has been shown that the discussion of suicidality in an idealized or heroic or martyr-like promotional way by the media might cause an increase of the rates per se. To say it in simple words, media coverage is an independent risk factor for the increase of suicidal rates 13-15. Thus, it is unknown to which extend, this increase in suicidality in Greece, constitutes a self-fulfilling prophecy. Further processing and analysis of the complete set of data concerning all causes of death throughout the last few years is necessary before definite conclusions can be made.
1. Arie S. Health effects of Greece's austerity measures are "worse than imagined," report researchers. BMJ 2013;346:f2740.
2. Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. Economic crisis, restrictive policies, and the population's health and health care: the Greek case. Am J Public Health 2013;103(6):973-9.
3. Hellenic Statistical Authority. December 2011. Monthly Statistical Bulletin 2011;56(XII):15.
4. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet 2011;378(9801):1457-8.
5. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet 2011;378(9786):124-5.
6. Fountoulakis KN, Grammatikopoulos IA, Koupidis SA, Siamouli M, Theodorakis PN. Health and the financial crisis in Greece. Lancet 2012;379(9820):1001-2; author reply 02.
7. Fountoulakis KN, Koupidis SA, Siamouli M, Grammatikopoulos IA, Theodorakis PN. Suicide, recession, and unemployment. Lancet 2013;381(9868):721-2.
8. Fountoulakis KN, Savopoulos C, Siamouli M, Zaggelidou E, Mageiria S, Iacovides A, et al. Trends in suicidality amid the economic crisis in Greece. Eur Arch Psychiatry Clin Neurosci 2012.
9. Fountoulakis KN, Siamouli M, Grammatikopoulos IA, Koupidis SA, Siapera M, Theodorakis PN. Economic crisis-related increased suicidality in Greece and Italy: a premature overinterpretation. J Epidemiol Community Health 2013;67(4):379-80.
10. Rihmer Z, Belso N, Kiss K. Strategies for suicide prevention. Curr Opin Psychiat 2002;15:83-87.
11. Isometsa E, Henriksson M, Aro H, Heikkinen M, Kuoppasalmi K, Lonnqvist J. Suicide in psychotic major depression. J Affect Disord 1994;31(3):187-91.
12. Fountoulakis KN, Gonda X, Rihmer Z. Suicide prevention programs through community intervention. J Affect Disord 2010;130(1-2):10-6.
13. Niederkrotenthaler T, Fu KW, Yip PS, Fong DY, Stack S, Cheng Q, et al. Changes in suicide rates following media reports on celebrity suicide: a meta-analysis. J Epidemiol Community Health 2012.
14. Hassan R. Effects of newspaper stories on the incidence of suicide in Australia: a research note. Aust N Z J Psychiatry 1995;29(3):480-3.
15. Etzersdorfer E, Sonneck G, Nagel-Kuess S. Newspaper reports and suicide. N Engl J Med 1992;327(7):502-3.
Competing interests: None declared
Aristotle University of Thessaloniki Greece, Odysseos 6 55535 Thessaloniki Greece
Click to like: