Greek Debt Crisis: Tragic Spike in Suicide Rates

Pam Harrison

June 23, 2015

ATHENS, Greece — Tough financial austerity measures in Greece have led to a 35% jump in suicide rates in a little less than 2 years, new research shows.

"Our main finding was that after 2010, when harsh austerity measures were implemented in Greece, we noted a significant increase in suicide rates for the years 2011 and 2012 in comparison to the period between 2003 and 2010," George Rachiotis, MD, PhD, assistant professor of epidemiology and occupational hygiene, University of Thessaly, Larissa, Greece, told Medscape Medical News.

"In addition, we found that there was a significant correlation between suicide rates with an increase in unemployment in Greece, where unemployment has almost doubled [since 2009] and is now approaching 30%."

Dr Rachiotis was interviewed here during the 12th World Congress of Biological Psychiatry. The findings were published online March 25 in BMJ Open.

Greece Hit Especially Hard

The economic crisis that has affected many European countries has hit Greece especially hard.

Already saddled with a high debt burden before the economic downturn began in 2008, Greece was forced to implement severe austerity measures starting in 2010 in return for a series of bailouts from the European Commission, the European Central Bank, and the International Monetary Fund ― the so-called "troika."

Specifically, the Greek government was required to cut spending by €28 billion ($31.24 billion) in 2010-2011, with a further cut of €13 billion ($14.5 billion) in 2012-2014.

The first three austerity packages, beginning in 2010, included cuts to public sector jobs and salaries and to pensions, Dr Rachiotis noted, as well as increases in indirect taxes and privatization of state-owned industries.

"By February 2012, 20,000 additional Greeks had been rendered homeless, and 20% of shops in the historic center of Athens were empty," Dr Rachiotis notes in his study. "And an estimated 1 in about 10 of the population of greater Athens was visiting a soup kitchen daily."

The group most affected by the hard economic hits were working-aged men between 20 and 59 years of age, in whom the suicide rate increased from 6.56 to 8.81 per 100,000 population in 2011- 2012.

"We observed that each 1 percentage point rise of unemployment rates in men aged 20 to 59 was associated with a 0.19/100,000 population rise in suicide," Dr Rachiotis noted.

Although not statistically significant, "we also found an increase in suicide rates among individuals over the age of 65 years," he added.

"And this reflected the particular difficulties of pensioners in Greece, because pensions have been dramatically reduced for older Greek workers."

The suicide rate also rose among women in 2011-2012, although less markedly so than for men.

"Austerity heightens suicide risks directly by creating job losses, especially among public sector workers, and by increasing economic insecurity," Dr Rachiotis stated.

Indeed, the 35% increase in suicide rates in 2011-2012 recorded in Greece mirrors a very similar increase in suicide rates from 1989-1994 in Russian men when the so-called "shock therapy" programs were being implemented.

The shock therapy programs also resulted in major increases in unemployment and economic suffering in Russia.

Spain, which has been an economically disadvantaged country for a number of years, has also seen an 8% increase in the suicide rate as unemployment rose to 24% from 8% prior to the economic downturn.

Findings from Dr Rachiotis' study are alarming enough, but they have been corroborated by a number of other studies, including a study by Charles C. Branas, MD, and colleagues that was published February 2, 2015, in BMJ Open.

Having tracked the suicide rate in Greece for more than 30 years, Dr Branas and coworkers found that the highest monthly rates 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%) and male suicides (+18.5%)," the investigators write.

Suicides among men in Greece also underwent a significant, abrupt, and sustained increase in October 2008, when the Greek recession began along with an abrupt albeit temporary increase in suicides in April 2012, when a pharmacist publicly shot himself to protest the austerity measures.

Women have not been left untouched by austerity either, as an increase in suicides among women in Greece has been documented following the introduction of austerity measures in 2011 as well.

In contrast, the launch of the Euro in Greece in 2002 marked an abrupt, although temporary, decrease in the suicide rate among Greek men, which gradually returned to historic highs.

"Economic Suicides"

Commenting on the findings for Medscape Medical News, Angelos Halaris, MD, PhD, professor of psychiatry and behavioral neurosciences, Loyola University Medical Center, Chicago, Illinois, said financial concerns are commonly linked to mental health problems.

Born and raised in Athens, Dr Halaris said he has never witnessed the bleak sight of pensioners going through open trash bins to look for food, as they do now, not even after World War II, when most of Europe was plunged into poverty.

In his own practice in Chicago, Dr Halaris has found that financial concerns are a common theme among the patients he treats, often through the charity program his medical center offers to patients who have no other means of paying for their healthcare.

"The state provides Medicaid coverage, and there are mental health centers for outpatient mental health care, but they are all full to capacity, and the waiting time to get to see somebody can be months, which obviously doesn't do patients any good because the vast majority of them have acute mental health issues that need to be addressed within a week or two, not within 6 months," he told Medscape Medical News.

With the funding cuts that Greece has had to absorb in exchange for bailout funds, "cuts have hurt everybody in healthcare, and mental health care in particular has been seriously impacted by these cuts," Dr Halaris observed.

It is also difficult to prevent what are being called "economic suicides," because often, people who kill themselves out of economic despair do not have a preexisting mental illness.

"It's a very tough position for any psychiatrist to be in because patients who commit suicide out of total and utter desperation have not established contact with a mental health care provider previously, so they are basically on their own," Dr Halaris suggested.

"And if people are totally beyond any hope, they aren't going to talk to anybody — not even their relatives — they are just going to jump off a bridge or shoot themselves," he said.

Experts predict that if Greece is forced to leave the Euro Zone, which now appears to be a distinct possibility, their exit will be nothing short of a financial disaster for the citizens of the country.

"One of the terms that the government of Greece has to accept is additional cuts to pensions if current negotiations come to a conclusion," Dr Halaris observed.

"So you are going to bring even more people down to a level below the poverty line if you start cutting pensions from 'higher' income pensioners."

"It is time for the Greek people to choose their politicians more wisely," Dr Halaris concluded.

Dr Rachiotis, Dr Branas, and Dr Halaris report no relevant relationships.

BMJ Open. Published online March 25, 2015. Abstract

12th World Congress of Biological Psychiatry.

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