Adolescent gambling in greater Athens area: a cross-sectional study.

PURPOSE: Problem gambling in adolescents has recently emerged as a pressing public health concern. In this context and in light of the pervasive financial crisis in Greece, the present study aimed to explore adolescents' gambling involvement in Athens region to estimate the prevalence of its problematic form and to identify its risk/protective factors. METHODS: A total of 2141 students were recruited from a representative sample of 51 schools located in greater Athens area. The presence of problem gambling was assessed through the use of the DSM-IV-MR-J questionnaire. Data were collected in the form of a self-reported questionnaire during one school hour. RESULTS: Results indicate that 1-year prevalence of high severity problem gambling was found to be 5.6%. Regarding the risk factors for problem gambling; male gender, parental engagement with gambling activities, living without the parents, low grades at school, foreign nationality and the referent absence of availability of food in the household, increased the risk of suffering from the disorder. CONCLUSION: Gambling behavior among adolescents constitutes a problem in Greece and highlights the need for designing and implementing appropriate preventive interventions, especially amid the ongoing financial crisis.

The state of psychiatry in Greece.

Greek psychiatry is presently in a transitional period. Following a large-scale reform effort that started in the mid 1980s, de-institutionalization and establishment of numerous community services has been achieved to a great extent. However, sectorization, development of primary care policies, inter-sectoral communication and long-range planning have not been achieved and deficiencies in the provision of care for children, adolescents, old people, individuals with autism, with intellectual disabilities and with eating disorders as well as deficiencies in forensic psychiatric services have been identified. Thus, the Greek psychiatric reform is an unfinished reform. The financial crisis that has recently hit the country has had a serious impact on the population and especially on vulnerable groups such as individuals with psychiatric disorders. Continuation of psychiatric reform to its desired extent has become problematic. This situation calls for re-orientation of the national mental health strategy towards more realistic and priority-orientated goals, i.e. securing a satisfactory level of function of the existing services, persisting in the implementation of the basic targets of psychiatric reform, creating the necessary infrastructure but avoiding the creation of expensive facilities of secondary importance.

Depressive symptomatology in high school students: the role of age, gender and academic pressure.

To clarify the prevalence of depressive symptomatology in high school students in Athens and to evaluate risk factors for depressive symptomatology the CES-D scale was administered to 713 students (age 15-18). Demographic, school performance and extracurricular activities data were collected. A high prevalence (26.2%) of depressive symptomatology (CES-D cut-off score >28) was found. Regression analysis showed depressive symptomatology to be associated to gender (girls had higher scores than boys), school record (students with a better record had lower scores) and the interaction of gender and grade (males were found to have higher depressive symptomatology scores as they grew older).

Parental attitudes and opinions on the use of psychotropic medication in mental disorders of childhood.

BACKGROUND: The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication. METHODS: A 20-item questionnaire was distributed to 140 parents during their first contact with an outpatient child psychiatric service. The questionnaire comprised of questions regarding the opinions, knowledge and attitudes of parents towards children's psychotropic medication. Sociodemographic data concerning parents and children were also recorded. Frequency tables were created and the chi-square test and Fisher's exact tests were used for the comparison of the participants' responses according to sex, educational level, age and gender of the child and use of medication. RESULTS: Respondents were mostly mothers aged 25-45 years. Children for whom they asked for help with were mostly boys, aged between 6 and 12 years old. A total of 83% of the subjects stated that they knew psychotropic drugs are classified into categories, each having a distinct mechanism of action and effectiveness. A total of 40% believe that there is a proper use of psychotropic medication, while 20% believe that psychiatrists unnecessarily use high doses of psychotropic medication. A total of 80% fear psychotropic agents more than other types of medication. Most parents are afraid to administer psychotropic medication to their child when compared to any other medication, and believe that psychotherapy is the most effective method of dealing with every kind of mental disorders, including childhood schizophrenia (65%). The belief that children who take psychotropic medication from early childhood are more likely to develop drug addiction later is correlated with the parental level of education. CONCLUSION: Parents' opinions and beliefs are not in line with scientific facts. This suggests a need to further inform the parents on the safety and efficacy of psychotropic medication in order to improve treatment compliance.

The synergy of the refugee crisis and the financial crisis in Greece: Impact on mental health.

BACKGROUND: The current global financial crisis that started in 2008 resulted in a significant decline in global trade, slowing/reversing economic growth worldwide, and a dramatic increase in public sector debt. At the same time, the global migrant/refugee crisis has reached extreme rates, with millions of people being forced to abandon their homes and communities because of war, political violence or related threats. There is a broad consensus about the deleterious consequences of these crises on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse and suicidal behavior. Although the separate consequences of economic recession and immigration are extensively discussed in previous research, we know very little about the processes through which the intersection of economic crisis and migrant crisis contributes to the vulnerabilities of natives and migrants during these crises. Of particular concern is the status of children, adolescents and their families, who constitute one of the most vulnerable groups in society. AIM: To discuss the contexts that economic and migrant crises shape and suggest possible effects of this intersection on mental health risks, especially among children, adolescents and their families, through reflecting on the recent experience in Greece. METHOD: Review of the literature and critical analysis of the effects of the confluent crises. CONCLUSION: The interactive effects of these two crises need further exploration. Novel and diverse models of psychological understanding need to be developed in order to manage the effects of the confluent crises. The role of mental health professionals is crucial in this respect, offering culturally flexible, accommodating and empathetic approaches, allowing healing and acceptance in the face of adversity.

Psychiatric reform in Greece: an overview.

Leros became infamous worldwide in the 1980s because of a scandal in its mental institution, the Leros asylum. The scandal provoked universal outrage and the international pressure triggered the Greek mental health reform. Under the reform projects Leros I and Leros II (1990-1994), numerous interventions took place in the Leros asylum as part of deinstitutionalisation. Following that, the Psychargos programme advanced developments for community-based services. Deinstitutionalisation and development of community mental health services have advanced significantly since the 1980s. However, this reform is still incomplete, given that sectorisation, adequate primary care policies, inter-sectoral coordination and specialised services are under-developed. This problematic situation is further complicated by the severe impact of the current financial crisis.

Stressful life events and psychosocial correlates of pediatric inflammatory bowel disease activity.

AIM: To investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease (IBD) activity in children and adolescents. METHODS: A total of 85 pediatric IBD patients (in remission or active state of the disease) and their parents completed a series of questionnaires and semi-structured interviews measuring life events, depression, anxiety, family dysfunction, and parent mental health. Differences between the remission and the IBD active group and the association of any significant variable with the disease activity state were examined. RESULTS: Parents of children being in active state of the disease reported more life events (P = 0.005) and stressful life events (P = 0.048) during the past year and more mental health symptoms (P < 0.001), while the children themselves reported higher levels of anxiety symptoms (P = 0.017) compared to the remission group. In the logistic regression multivariate analysis, the only predictor which had a significant positive effect on the probability of the patients being in active state was parent mental health symptoms (OR = 4.8; 95%CI: 1.2-25.8). CONCLUSION: Life events, child anxiety and parent mental health symptoms may be important correlates of pediatric IBD activity and targets of thorough assessment and treatment.

Psychopathology and mental health service utilization by immigrants' children and their families.

To investigate the psychopathology of immigrants' children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child's place of birth, current living conditions, parents' country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family's structure and parents' psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning 'cooperation with other services' No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psychopathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.

The financial crisis and the future of mental health in Greece.

The recent financial crisis in Greece has affected the mental health of the population as well as mental health service provision and planning. These new adverse circumstances call for the profession's swift response. In this paper we make evidence-based suggestions for urgent, as well as longer-term, mental health reform. We consider psychiatric prevention and mental health promotion to be the central principles to abide by in the long term. We also offer suggestions for important current issues, including the devolution and coordination of decision-making, the further development of community psychiatry and the implementation of sectorisation, support for service user involvement, the reform of psychiatric education and the creative integration of mental health service provision with Greek culture. We conclude that enhanced participation of the profession in decision-making and service planning can result in cost-effective, evidence-based reform.

Perspectives of intellectual disability in Greece: epidemiology, policy, services for children and adults.

PURPOSE OF REVIEW: The purpose of this review is to investigate the existing situation regarding how people with intellectual disability are treated in contemporary Greece. RECENT FINDINGS: The legal rights of people with intellectual disability are fully protected. Steady improvement of special education, along with development of educational services. Greater access of people with intellectual disability is being developed. There is, however, a lack of specialized health services. A relatively adequate social and financial support of families of individuals with severe intellectual disability. There is very limited access to employment for people with intellectual disability. Lack of rigorous research and representative studies on intellectual disability and insufficient epidemiological data. SUMMARY: The main conclusion of this review is that, since 1980, the situation of people with intellectual disability has been steadily improving in the areas of civil rights, social support, special education, and use of health services. However, the deficiency of official national data on intellectual disability does not allow a complete and documented evaluation of the situation in the country. Furthermore, the lack of epidemiological data undermines the development and establishment of evidence-based public policies.

Forced migration, adolescence, and identity formation.

Adolescence is a complex biopsychosocial phenomenon. All the inner-subjective changes in adolescents take place within the context of a specific social environment, which offers the necessary ideological setting that adolescents must confront in the course of their identity formation. Forced migration creates conditions under which the adolescent Ego may be traumatized more easily, resulting in the development of defensive mechanisms, which may interfere with the natural process of identity formation. The aim of this paper is to investigate how a traumatic situation such as forced migration may affect the mechanisms of identity formation in adolescence. For this purpose, clinical material, consisting of two cases of psychoanalytical psychotherapy of adolescents who were forced to immigrate to Greece, is presented and discussed in a psychoanalytical theoretical framework, along with the historical-sociological background.

Treatment compliance and early termination of therapy: a comparative study.

BACKGROUND: Compliance in therapy appears to be linked to the process of therapeutic alliance. A positive patient-therapist relationship usually leads to successful completion of therapy. The aim of this study was to compare evidence, collected at two time periods in a Community Mental Health Center in Athens, on factors affecting treatment compliance. The hypothesis was that by modifying the therapeutic team's functioning, noncompliance could be reduced. METHODS: Epidemiological data were collected from child and adolescent out-patient files at two time periods: time period A, 1990-1994, n = 455 (sample A) and time period B, 2000-2002, n = 476 (sample B). Variables pertaining to the patient, his family and recommended treatment were examined. Student's t test and the Pearson chi2 test were used in order to explore the correlation of the variables with treatment completion in each sample. Logistic regression analyses were used to determine whether the effect of each variable on treatment completion differed between the two samples. RESULTS: In sample A, most patients (58.6%) did not comply with therapy. The type of recommended treatment, the number of sessions, season of admission and the type of presented problem were found to correlate with treatment completion. Between the two time periods, certain modifications were implemented in the team's functioning (less diagnostic sessions, focused psychotherapy techniques, less time interval between referral and first diagnostic appointment). A significant reduction in the early termination rate (45.7%) was noted in sample B. The type of recommended treatment, the number of sessions, the family's situation, the mother's educational level and the patient's gender were related to treatment completion in sample B. The effect of the type of proposed treatment and the mean number of sessions of the completed treatments differed significantly between the two samples. CONCLUSIONS: Early termination rates in therapy decreased between two time periods. This decrease may be attributed to modifications in the team's functioning, aimed at improving the therapeutic relationship. The limitation of this study is that only those factors pertaining to the service's organization and functioning were investigated.

Evaluating mental health services in a Greek community. The factor of non-compliance to therapy.

This study aims to evaluate rendered mental health services for children and adolescents through the investigation of those factors which are related to non-compliance with therapy and which affect treatment outcome. Data were collected from the files of all new cases who applied to a Community Mental Health Centre in Athens during 2000-2002 (N = 363). For each case, the following factors were examined: age, sex, family situation, parents' educational level, referral source, child's psychiatric and psychosocial diagnoses, type of proposed therapy, phase at which termination of therapy occurred and outcome. Around 45.7% of the sample did not complete therapy. The probability of treatment compliance increased when the patient was male, with a diagnosis of a specific developmental disorder, treated in a well-structured therapy programme, was from a healthy family environment and his mother was better educated. On the contrary, an adverse family situation (one-parent family, inadequate parental supervision) and the female sex had a negative association with treatment compliance. Most of the cases discontinued their treatment upon completion of the diagnostic procedure. Referral source did not influence treatment compliance. Evaluation of our service has shown that more attention should be paid to less-educated families and those in adverse situations, particularly when the patient is female.