Επιδημιολογική μελέτη Συνοσηρότητας Διαταραχών Χρήσης Αλκοόλ με την Κατάθλιψη και τις Αγχώδεις διαταραχές στον ελληνικό πληθυσμό

ΕΙΣΑΓΩΓΗ Οι ασθενείς που παρουσιάζουν συνοσηρότητα προβλημάτων χρήσης αλκοόλ με ψυχικές διαταραχές (“Διπλή Διάγνωση”, ΔΔ), παρουσιάζουν υψηλότερη έκπτωση στην λειτουργικότητα, χαμηλότερη ανταπόκριση στην θεραπεία και χειρότερη κλινική πρόγνωση σε σύγκριση με τους πάσχοντες από καθεμιά διαταραχή χωριστά. Περαιτέρω μελέτη της επιδημιολογίας της ΔΔ θα συμβάλλει στην διερεύνηση των ιδιαίτερων θεραπευτικών αναγκών και προκλήσεων των ασθενών αυτών. Στόχος της παρούσας μελέτης είναι η μέτρηση του επιπολασμού και των συσχετίσεων που παρουσιάζουν οι ασθενείς με ΔΔ σε ένα αντιπροσωπευτικό του ελληνικού πληθυσμού δείγμα ΜΕΘΟΔΟΛΟΓΙΑ Δείγμα 5894 συμμετεχόντων συγκεντρώθηκε με την μέθοδο της τυχαίας διαστρωματοποιημένης δειγματοληψίας από τον γενικό πληθυσμό . Η παρουσία Διαταραχής Χρήσης Αλκοόλ (ΔΧΑ) και η Επιβλαβούς Χρήσης Αλκοόλ (ΕΧΑ) προσδιορίστηκαν με το εργαλείο Alcohol Use Disorders Identification Test (AUDIT). Η παρουσία ψυχιατρικής νοσηρότητας, διαγνώσεων (Κατάθλιψη, Γενικευμένη Αγχώδη Διαταραχή, Διαταραχή Πανικού και Φοβική Διαταραχή) και ψυχιατρικών συμπτωμάτων προσδιορίστηκαν με την ψυχιατρική συνέντευξη Composite Interview Schedule. ΑΠΟΤΕΛΕΣΜΑΤΑ Ο επιπολασμός της ΔΔ είναι περίπου 1% και είναι υψηλότερος στους άνδρες σε σύγκριση με τις γυναίκες.. Οι ΔΧΑ σχετίζονται ισχυρά με την παρουσία κλινικής διάγνωσης και κυρίως με διάγνωση αγχώδους διαταραχής.. Η ΕΧΑ σχετίζεται μόνο με την υπο-ουδική ψυχιατρική νοσηρότητα και δεν σχετίζεται με την παρουσία κλινική διάγνωσης. Και τα 2 αυτά προβλήματα σχετίζονται πιο ισχυρά με τις κοινές ψυχικές διαταραχές στους άνδρες σε σύγκριση με τις γυναίκες. Οι ασθενείς με ΔΔ παρουσιάζουν χειρότερους κλινικούς δείκτες και δείκτες ποιότητας ζωής και είναι πιο πιθανό να κατοικούν σε μη-αστικές περιοχές σε σύγκριση με τους πάσχοντες από καθεμιά διαταραχή ξεχωριστά. Οι ασθενείς με ΔΔ παρουσιάζουν επίσης μειωμένη χρήση υπηρεσιών υγείας και υψηλότερη απροθυμία να αναζητήσουν βοήθεια από μη-επαγγελματίες ψυχικής υγείας σε σύγκριση με τους πάσχοντες μόνο από Αγχώδεις Διαταραχές ή Κατάθλιψη. Τέλος, παρατηρούνται κάποιες διαφορές με πιθανή κλινική σημασία στην κατανομή των ψυχιατρικών συμπτωμάτων στους πάσχοντες από συνοσηρότητα ΔΧΑ και κατάθλιψης ή Αγχωδών Διαταραχών σε σχέση με τους πάσχοντες μόνο από ψυχική διαταραχή. ΕΠΙΛΟΓΟΣ Οι ασθενείς με ΔΔ αποτελούν έναν πληθυσμό με αυξημένες ακάλυπτες ανάγκες θεραπείας-φροντίδας. Οι ασθενείς με ΔΔ είναι πρόθυμοι στο να λάβουν θεραπείες από ειδικές υπηρεσίες ψυχικής υγείας.INTRODUCTION Patients suffering from comorbid alcohol-related problems and mental disorders (“Dual Diagnosis”, DD) present higher disability, lower responsiveness to treatment and poorer prognosis comparing to sufferers from each condition separately. Further study on the epidemiology of DD could contribute in the assessment of the special therapeutic needs and challenges of this group of patients. Aim of the current study is to assess the prevalence and associations of DD patients in a general population representative sample of Greek participants. METHODS 5894 participants were selected using a stratified random sampling from the general Greek population. Alcohol Use Disorders (AUD) and Harmful Alcohol Consumption (HAC) were assessed using Alcohol Use Disorders Identification Test (AUDIT). The presence of Psychiatric Morbidity, Diagnoses (Depression, GAD, Panic Disorder, OCD and Phobic Disorders) and psychiatric symptoms were assessed using the structured psychiatric Interview Composite Interview Schedule . RESULTS DD prevalence is about 1% and DD is more prevalent in males comparing to females. HAC is strongly associated only with the sub-threshold psychiatric morbidity and not with the presence of Psychiatric Diagnoses. AUDs are strongly associated with the presence of Psychiatric Diagnoses, and stronger with Anxiety Disorders comparing to depression. Both alcohol related problems are associated with common mental disorders stronger in males comparing to females. DD patients present worst clinical and quality of life indicators and are more possible to live in rural areas comparing to sufferers from each disorder separately (“non-comorbid” patients). Furthermore DD patients present lower use of health services and higher reluctance to ask for help from a non-mental health professional comparing to Depression or Anxiety disorders non-comorbid sufferers. Finally there are some differences in the distribution of psychiatric symptoms, which may imply clinical significance, in the DD patients comparing to patients presenting with non-comorbid Depression or Anxiety Disorders. CONCLUSION DD patients constitute a population with increased unmet needs for treatment. DD patients are not reluctant to receive treatment from specialized mental health services

Socioeconomic inequalities in general and psychological health among adolescents: a cross-sectional study in senior high schools in Greece

<p>Abstract</p> <p>Background</p> <p>Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.</p> <p>Methods</p> <p>This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting.</p> <p>Results</p> <p>One out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only.</p> <p>Conclusions</p> <p>Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.</p

Health related quality of life in patients with anogenital warts

<p>Abstract</p> <p>Introduction</p> <p>The health-related quality-of-life (HRQoL) instruments are an important tool for the evaluation of medical outcomes. Sexually transmitted diseases (STDs) influence the patients' life. We aimed to evaluate the HRQoL in patients with anogenital warts at the time of and 1 month after the diagnosis.</p> <p>Materials and methods</p> <p>We used the short-form (SF)-36 questionnaire to compare the HRQoL of 91 patients with anogenital warts to 53 control subjects with the same socioeconomic characteristics.</p> <p>Results</p> <p>There was no statistical difference in the overall HRQoL measurement between the anogenital wart patients and controls. However, there was an improvement in the scales of vitality (65.22 ± 15.70 vs. 69.04 ± 14.11, respectively; p < 0.05) and mental health (65.00 ± 20.09 vs. 69.43 ± 18.08, respectively; p < 0.05) in anogenital warts patients between the time of diagnosis and 1 month later. Furthermore, there was a significant deterioration in the scale of social functioning (73.47 ± 22.18 vs. 72.89 ± 19.28, respectively; p < 0.05). The small sample size is a limitation of our study.</p> <p>Conclusions</p> <p>HRQoL does not appear to be influenced in anogenital wart patients, as measured by the generic instrument SF-36. It is therefore important to develop specific instruments for the measurement of HRQoL in this group of patients.</p

The association between bullying and early stages of suicidal ideation in late adolescents in Greece

<p>Abstract</p> <p>Background</p> <p>Bullying in schools has been associated with suicidal ideation but the confounding effect of psychiatric morbidity has not always been taken into account. Our main aim was to test the association between bullying behavior and early stages of suicidal ideation in a sample of Greek adolescents and to examine whether this is independent of the presence of psychiatric morbidity, including sub-threshold symptoms.</p> <p>Methods</p> <p>5614 pupils 16-18 years old and attending 25 senior high schools were screened in the first phase and a stratified random sample of 2431 were selected for a detailed interview at the second phase. Psychiatric morbidity and suicidal ideation were assessed with the revised Clinical Interview Schedule (CIS-R) while bullying was assessed with the revised Olweus bully/victim questionnaire.</p> <p>Results</p> <p>Victims of bullying behavior were more likely to express suicidal ideation. This association was particularly strong for those who were bullied on a weekly basis and it was independent of the presence of psychiatric morbidity (Odds Ratio: 7.78; 95% Confidence Interval: 3.05 - 19.90). In contrast, being a perpetrator ("bullying others") was not associated with this type of ideation after adjustment. These findings were similar in both boys and girls, although the population impact of victimization in the prevalence of suicidal ideation was potentially higher for boys.</p> <p>Conclusions</p> <p>The strong cross-sectional association between frequent victimization and suicidal ideation in late adolescence offers an opportunity for identifying pupils in the school setting that are in a higher risk for exhibiting suicidal ideation.</p

Bullying behaviour in schools, socioeconomic position and psychiatric morbidity: a cross-sectional study in late adolescents in Greece

<p>Abstract</p> <p>Background</p> <p>Bullying is quite prevalent in the school setting and has been associated with the socioeconomic position and psychiatric morbidity of the pupils. The aim of the study was to investigate the association between bullying and socioeconomic status in a sample of Greek adolescents and to examine whether this is confounded by the presence of psychiatric morbidity, including sub-threshold forms of illness.</p> <p>Methods</p> <p>5,614 adolescents aged 16-18 years old and attending 25 senior high schools were screened and a stratified random sample of 2,427 were selected for a detailed interview. Psychiatric morbidity was assessed with a fully structured psychiatric interview, the revised Clinical Interview Schedule (CIS-R), while bullying was assessed with the revised Olweus bully/victim questionnaire. The following socio-economic variables were assessed: parental educational level and employment status, financial difficulties of the family and adolescents' school performance. The associations were investigated using multinomial logit models.</p> <p>Results</p> <p>26.4% of the pupils were involved in bullying-related behaviours at least once monthly either as victims, perpetrators or both, while more frequent involvement (at least once weekly) was reported by 4.1%. Psychiatric morbidity was associated with all types of bullying-related behaviours. No socioeconomic associations were reported for victimization. A lower school performance and unemployment of the father were significantly more likely among perpetrators, while economic inactivity of the mother was more likely in pupils who were both victims and perpetrators. These results were largely confirmed when we focused on high frequency behaviours only. In addition, being overweight increased the risk of frequent victimization.</p> <p>Conclusions</p> <p>The prevalence of bullying among Greek pupils is substantial. Perpetration was associated with some dimensions of adolescents' socioeconomic status, while victimization showed no socioeconomic associations. Our findings may add to the understanding of possible risk factors for bullying behaviours in adolescence.</p

Alcohol use and common mental disorders in primary health care and community

INTRODUCTION: Alcohol is present in all stages of development of human civilization, constituting the most widely used psychoactive substance. Alcohol effects on physical health are dose related and non linear, simulating a “U-shape” association. Considering alcohol-mental health association, the majority of relevant studies has focused on the harmful effects of heavy/problematic alcohol consumption, while studies about moderate alcohol consumption are limited and present controversial results. AIM: The current thesis aims to study is to study the association between varying levels of alcohol consumption and depressive/anxiety disorders. METHODS: 2 samples are used a) a cross-cultural sample of primary care attenders from 14 countries (N=5438), a subset of which was followed-up for 1 year (Ν=3201) and b) a nationally representative cross-sectional sample from Greece (N=4894). Alcohol consumption and related problems were measured with AUDIT (Alcohol Use Disorders Identification Test). Depression and anxiety disorders were assessed using structured clinical interviews [Composite International Diagnostic Interview (CIDI) and Clinical Interview Schedule-Revised (CIS-R), for each sample respectively].RESULTS: Mild to moderate alcohol consumption (up to 280gr/week of pure alcohol for men and 140gr/week for women) is more common than alcohol abstinence or harmful alcohol consumption. Mild to moderate alcohol consumption is not associated with higher prevalence of common mental disorders compared to abstinence, while there is some evidence that it may be protective regarding a new onset of depression or generalized anxiety disorder. The association between heavy alcohol consumption and depression/anxiety is strongly mediated by the development of alcohol related problems or alcohol dependence. The association between alcohol consumption and mental health is mildly mediated by socioeconomic and physical health related factors. Alcohol consumption is associated with lower prevalence of common mental disorders in subgroups of participants facing severe financial difficulties compared to participants with less financial difficulties, and in older comparing to younger (40 ετών) και στους ασθενείς ΠΦΥ σε σχέση με τους συμμετέχοντες από την κοινότητα.ΣΥΜΠΕΡΑΣΜΑ: Τα προβλήματα από την χρήση αλκοόλ (και όχι η βαριά κατανάλωση) σχετίζονται με μεγαλύτερη πιθανότητα ανάπτυξης ψυχιατρικών διαταραχών αλλά η ήπια χρήση μπορεί να είναι ωφέλιμη για κάποιους ανθρώπους. Η εντονότερη αντίστροφη συσχέτιση της χρήσης αλκοόλ με την παρουσία ψυχικών διαταραχών, στις ομάδες των ανθρώπων με περισσότερα οικονομικά προβλήματα ή προβλήματα υγείας, δείχνει έμμεσα ότι η χρήση αλκοόλ μπορεί να λειτουργεί «ρυθμιστικά» σε περιπτώσεις εξωτερικής πίεσης. Περαιτέρω διαχρονική έρευνα είναι απαραίτητη για να προσδιοριστούν τα δοσολογικά όρια της πιθανής ωφέλιμης χρήσης και δείκτες ή παράγοντες κινδύνου που υποδηλώνουν αυξημένη πιθανότητα μετάπτωσης από την ήπια χρήση αλκοόλ στην βαριά και ανάπτυξης προβλημάτων χρήσης αλκοόλ. Σε κάθε περίπτωση τα οφέλη στην ψυχική υγεία από την ήπια χρήση αλκοόλ πρέπει να σταθμιστούν σε σχέση με τον κίνδυνο ανάπτυξης «προβλημάτων χρήσης αλκοόλ» σε κάποιους από τους ήπιους χρήστες

Prevalence of Alcohol Use Disorders and Their Association with Sociodemographic Determinants and Depression/Anxiety Disorders in a Representative Sample of the Greek General Population.

BACKGROUND: Country-level epidemiological data about alcohol-related problems is useful for planning prevention and treatment services. Heavy Alcohol Consumption (HAC) and Alcohol Use Disorder (AUD) are two syndromes of alcohol-related problems that have been recognized worldwide. Study of the epidemiological determinants of HAC and AUD in different sociocultural contexts could inform hypotheses about the etiology or the consequences of alcohol-related problems. OBJECTIVES: We assessed the prevalence and associations of HAC and AUD with sociodemographic variables adjusting for common mental disorders in a representative sample of the general population of Greece (N = 4894 participants). The period of data collection just preceded the emergence of the financial crisis in Greece. RESULTS: The majority of the population did not report HAC, AUD or abstinence from alcohol. HAC was reported by 12.7% (95% CI: 11.8-13.6) of the population while 3.1% (95% CI: 2.7-3.6) met criteria for AUD. Younger age, divorce, lower educational level, living in an urban area, physical health problems, and smoking were associated with a higher prevalence of both conditions. Presence of severe financial difficulties and never married family status were associated with a higher prevalence of HAC but not AUD. HAC was associated with nonspecific psychiatric morbidity while AUD was associated with more specific psychiatric disorders. Conclusion/Importance. Both alcohol-related problems are frequent in the general population and have common and distinct determinants. The comparison between the findings of our study and those of similar studies during or after the period of financial austerity in Greece, would offer the opportunity to assess the possible effects of changes in the economical context in the determinants of alcohol-related problems

Depression and Its Relationship with Coping Strategies and Illness Perceptions during the COVID-19 Lockdown in Greece: A Cross-Sectional Survey of the Population

Objective. The COVID-19 epidemic has shown a more benign course in Greece possibly due to the early lockdown measures. Mental health consequences of the lockdown however are unknown. In addition, illness perceptions and relevant strategies to cope with the stress of the epidemic may have played a role in complying with the restrictions. We conducted a survey of the Greek population with the aim to investigate the prevalence of anxiety and depression during the lockdown, the emotional impact of the epidemic, and the effect of coping strategies and illness perceptions in mental health. Methods. Adult persons were invited during the peak of the lockdown period through social media. Depressive and anxiety symptoms were assessed with the PHQ-9 and GAD-2 scales, respectively. Coping strategies were assessed with selected items of the Brief COPE questionnaire, while illness beliefs were assessed with items from the revised Illness Perception Questionnaire (IPQ-R). Results. A total of 3379 individuals took part. A strong emotional impact of the epidemic was more often in women and in those with severe financial difficulties. Levels of depressive and anxiety symptoms were high but similar to past assessments. Participants showed high levels of personal control and used more often positive strategies to cope with the stress of the epidemic. Depressive symptoms were higher in the younger, in students, in those with a stronger emotional impact, in those isolated due to symptoms, and those overexposed to media for COVID-19-related news. Lower levels of depression were seen in those using positive coping strategies and showing high levels of personal and treatment control. Conclusions. The study shows that certain psychological and social determinants were associated with increased depressive symptoms during the lockdown warranting the development of public health guidelines to mitigate the effects of the epidemic to the mental health of the population