During the late 1960s and early 1970s community psychiatry and the transformation of psychiatric services was introduced in several Northern European countries. ln Southern Europe, with the exception of Italy, changes in the mental health care delivery system regarding mental health legislation and decentralisation of services have only taken place since the mid-1980s. ln this report several issues related to developments in institutional and community psychiatric care in Greece, Italy, Portugal and Spain are presented. A comparison is provided between some socioeconomic and psychiatric morbidity indicators and the availability of alternative community based care and rehabilitation in these countries.
This report examines the trends in the utilization of psychiatric inpatient care for the period 1984-1996, when the implementation of the psychiatric reform programme was initiated in Greece. Admissions in public mental hospitals declined by 7.2%. However discharges have been increased by 30.6% with a parallel decrease of the length of stay by 53.7% followed by an increase in discharges of patients diagnosed as suffering from schizophrenia and affective psychoses by 61.1 % and 123.8% respectively. In the prirrate sector a remarkable reduction in both admissions and discharges was noticed. Admissions in psychiatric departments of general hospi tals for the same years have been increased by 1054.1 %. It seems that the recent deinstitutionalization process resulted in increasing trends in the discharges of patients suffering from psychoses. Additionaliy, a substantial increase in the number of extramural psychiatric services and rehabilitation places between 1994-1996 was observed.The demand for the mental health care services expressed as the urbanization index was found to be related with mental health professionals and the extramural units ratios. The higher degree of urbanism is, the greater the number of extramural services exist. The models explained variance reached 50.6%.
Background: In recent decades entire populations have been living under chronic strain, apprehension and violence. This is the case for Palestinians. Despite the increased volume of mass media attention on this situation, little is known about the psychological effects of this condition on this population.Aims: The study was designed to investigate the lifetime and one-month prevalence of major depression episode (MDE) in a multi-stage sample of 916 adult Palestinians drawn from the Al-Aqsa Intifada.Methods: The survey was based on personal interviews and was carried out from February to September 2007. The clinical examination used DSM-IV criteria for the detection of MDE, extracted from SCID-I. Data, suicidal behaviour, previous help seeking, medication use and exposure to trauma were also collected.Results: Lifetime and one-month prevalence of MDE was found to be 24.3% and 10.6%, respectively. Male Palestinians suffered from slightly higher rates of MDE than their female counterparts, but this difference was not statistically significant. Being widowed and living in towns in West Bank also increased the likelihood to develop MDE. A comparison of prevalence rates in refugee and non-refugee populations showed no significant differences. This could be explained by the fact that though refugees were forcibly displaced, they were living among compatriots (non-refugees), thus both groups were experiencing the same sociopolitical adversities. Being also exposed to traumatic events increased the risk of suffering from MDE.Conclusions: This study provides evidence that a population under continuous strain and apprehension, living in unremitting socioeconomic deprivation, is more likely to suffer from major depression.
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.
The process of acculturation observed in immigrants is part of an adjustment to the values and norms of a new society, and possibly the loss of norms of the society of origin. Acculturation has been linked to stress-related psychological disorders such as depression. The present study investigates the relationship between three acculturation domains (everyday life behaviors, wishful orientation/ nostos, and ethnic identity) and symptoms of depression in a sample of foreign immigrants living in Athens, Greece. The sample consisted of 317 immigrants who visited two non-governmental organization polyclinics. All participants were interviewed using the Immigrant Acculturation Scale (IAS) and the Center for Epidemiological Studies Depression Scale (CES-D). The results showed that 133 (42%) out of the 317 interviewees were in a depressive state (CES-D > 15). The main finding was that high CES-D scores were related to low scores in the IAS Everyday Life and Wishful Orientation factors, while no relationship was found between depressive symptomatology and the IAS Identity factor. Short duration of stay in Greece, lack of steady job, and lack of residence permit were also related to high CES-D scores. In conclusion, adaptation to mainstream culture daily behaviors as well as the wish to integrate with individuals from the mainstream culture and settle permanently in the new country could be seen as part of an adaptive mechanism that protects the individual from experiencing depressive symptomatology.
