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

OBJECTIVES: To complete a 30-year interrupted time-series analysis of the impact of austerity-related and prosperity-related events on the occurrence of suicide across Greece. SETTING: Greece from 1 January 1983 to 31 December 2012. PARTICIPANTS: A total of 11 505 suicides, 9079 by men and 2426 by women, occurring in Greece over the study period. PRIMARY AND SECONDARY OUTCOMES: National data from the Hellenic Statistical Authority assembled as 360 monthly counts of: all suicides, male suicides, female suicides and all suicides plus potentially misclassified suicides. RESULTS: In 30 years, the highest months of suicide in Greece occurred in 2012. The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides (+35.7%, p<0.001) and male suicides (+18.5%, p<0.01). Sensitivity analyses that figured in undercounting of suicides also found a significant, abrupt and sustained increase in June 2011 (+20.5%, p<0.001). Suicides by men in Greece also underwent a significant, abrupt and sustained increase in October 2008 when the Greek recession began (+13.1%, p<0.01), and an abrupt but temporary increase in April 2012 following a public suicide committed in response to austerity conditions (+29.7%, p<0.05). Suicides by women in Greece also underwent an abrupt and sustained increase in May 2011 following austerity-related events (+35.8%, p<0.05). One prosperity-related event, the January 2002 launch of the Euro in Greece, marked an abrupt but temporary decrease in male suicides (-27.1%, p<0.05). CONCLUSIONS: This is the first multidecade, national analysis of suicide in Greece using monthly data. Select austerity-related events in Greece corresponded to statistically significant increases for suicides overall, as well as for suicides among men and women. The consideration of future austerity measures should give greater weight to the unintended mental health consequences that may follow and the public messaging of these policies and related events.

Relationship of suicide rates to economic variables in Europe: 2000-2011.

BACKGROUND: It is unclear whether there is a direct link between economic crises and changes in suicide rates. AIMS: The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates. METHOD: Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation. RESULTS: There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged. CONCLUSIONS: Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.

Suicide by pesticide poisoning: findings from the island of Crete, Greece.

BACKGROUND: The role of pesticides in suicidal acts has not yet received adequate attention in Greece despite an evident rise of 39% in pesticide use over the period 1990-1992 to 2002-2004. AIMS: To investigate the epidemiology of pesticide suicide on the Greek island of Crete, a largely rural agricultural area, and by further exploring the victim profiles, as well as patterns and trends of pesticide ingestion, to suggest probable preventive measures. METHODS: Self-poisoning suicides between 1999 and 2007 were reviewed and information gathered was entered into a computerized database. RESULTS: The overall incidence of intentional pesticide poisoning was 1.7 per 100,000, representing the second most frequently used suicide method after hanging. The victim profile was composed of the following features: middle aged male, rural habitant, who carried out a suicidal act by consuming primarily methomyl or paraquat (WHO toxicity class Ib and class II, respectively). As to the place of death, the vast majority was found dead in the place of intoxication. CONCLUSIONS: Pesticide self-poisoning accounts for a quarter of the suicides in Crete. More detailed research is required to identify aspects of these deaths amenable to prevention, but measures such as bans on the most toxic pesticides and changes in storage practice would appear to be sensible initial approaches.

Measuring health inequalities in Albania: a focus on the distribution of general practitioners.

BACKGROUND: The health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004. METHODS: With census data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini, Atkinson and Robin Hood indices and decile ratios, both before and after adjusting for mortality and consultation rates. RESULTS: The Gini index for the distribution of general practitioners in 2000 was 0.154. After adjusting for mortality it was 0.126, while after adjusting for consultation rates it was 0.288. The Robin Hood index for 2000 was 11.2%, which corresponds to 173 general practitioners who should be relocated in order to achieve equality. The corresponding figure after adjusting for mortality was 9.2% (142 general practitioners), while after adjusting for consultation rates the number was 20.6% (315). These figures changed to 6.3% (100), 6.3% (115) and 19.8% (315) in 2004. CONCLUSION: There was a declining trend in the inequality of distribution of general practitioners in Albania between 2000 and 2004. The trend in inequality was apparent irrespective of the relative inequality indicator used. The level of inequality varied depending on the adjustment method used. Reallocation strategies for general practitioners in Albania could be the key in alleviating the inequalities in primary care workforce distribution.

Inequalities in the distribution of rural primary care physicians in two remote neighboring prefectures of Greece and Albania.

INTRODUCTION: Inequalities in the distribution of primary care physicians are of great importance in the provision of health care. This becomes more apparent mainly in the rural and remote areas of each country. The objective of the present study was to evaluate and compare the degree of inequality in the provision of primary care physicians in two rural and remote prefectures of neighboring countries. We studied the cases of Ioannina, Greece and Gjirokaster, Albania during 2001. METHODS: In both prefectures, for all calculations made, we used the total number of physicians providing primary care in rural areas. This includes GPs, internal medicine specialists, non-specialised graduate physicians. All other physician specialties (eg. microbiologists) were excluded from the calculations of the present study. We calculated the population per physician ratio (PPR) for each health center in each prefecture. For the comparison of the inequality we used two relative inequality measures. We plotted the Lorenz curves and calculated the Gini coefficients for the distribution of physicians' workforce adjusted by population in the two districts. Finally, we calculated the difference in the inequalities in these distributions. The p values were two tailed and calculated for 95% confidence levels. RESULTS: The PPR for the whole prefecture of Ioannina, Greece was 1222. The lowest PPR, which corresponds to higher supply of human resources, was 205, while the highest (worst) was 8166. In the case of Gjirokaster the PPR was 2376 for the whole prefecture. The lowest PPR was 1323, while the highest was 4546 inhabitants per physician. Because the two curves do not intersect we can assume with certainty that primary care physicians in the prefecture of Ioannina were more unevenly distributed than those in the prefecture of Gjirokaster. The Gini coefficient for the distribution of primary care physicians in Ioannina was 0.489 (SD = 0.045), while that of the Gjirokaster district was 0.186 (SD = 0.034). The difference between the two Gini indices was 0.303 (p < 0.001). CONCLUSIONS: Primary care physicians in both prefectures were unevenly distributed. The inequality in the distribution of primary care physicians was significantly higher in the prefecture of Ioannina, Greece compared with that of the prefecture of Gjirokaster, Albania. Further investigations could be made using a need adjusted index instead of PPR. For this purpose, the number of physicians could be adjusted for mortality, morbidity of chronic diseases or limiting longstanding illness. Studying the inequality patterns in districts could be aided by the use of other disciplines, such as geographical information systems, giving a clearer picture of the situation of primary care provision in these districts. The results of the present study could be considered by health policy researchers. It seems that human resources' density and inequality in the distribution of health manpower are both needed as indicators for a more thorough investigation of health services, especially in the case of rural and remote areas. Furthermore, health policy makers should focus on the redistribution of the health manpower towards a more equitable situation, based on the results of similar studies. Finally, the documentation of inter-country differences would prove helpful in terms of international cooperation and sharing of knowledge by policy makers when the objective is the equality and quality of health services provision.

[Geographical inequalities in the distribution of general practitioners in Sweden]. / Geografiska ojämlikheter i Sverige i fördelningen av allmänläkare.

AIM: To estimate trends in the inequalities in the distribution of general practitioners in Sweden during the past fifteen years. METHODS: Relative inequality indicators. We plotted the Lorenz curves and calculated the Gini coefficients for the entire country during 1986, 1991, 1996 and 2001. RESULTS: During the past 15 years in all a declining trend was noted in the inequalities in the geographical distribution of general practitioners in Sweden, with the lowest level in 1996. CONCLUSIONS: The degree of inequality in the geographical distribution of general practitioners appeared rather stable during the period, although with some increase in the final year studied. Since equality is part of quality, policy makers in all levels--national, regional and local--should pay attention as to how human resources are distributed.