Recently, in March 2013, a successful congress organized jointly by the World Federation for Mental Health and the Hellenic Psychiatric Association was held in Athens. The main theme of the congress was the Psychosocial Impact of Crises and Disasters. Within this context the impact of the current economic crisis was extensively discussed.

It is certainly not the first time that humanity is confronted with a serious financial crisis. We have all heard of the terrible “crush” that hit the American economy in 1929, the financial disaster that destroyed the soviet economy at the beginning of the 1990s and the serious economic crisis in Asia at the end of the 1990s.

The effects of financial crises on the mental health of the citizens share many similarities between countries but they also have many differences. It would be a mistake to disregard the similarities and not take advantage of the acquired experience but it would also be a mistake not to take into account the differences. For example, the recommendation of the WHO for alcohol price control1 for the purpose of limiting the availability of alcoholic drinks, can be useful for some countries in Northern Europe where many suicides were committed under the influence of alcohol during the period of the financial crisis. Yet, the implementation of this recommendation in the case of Greece would be superfluous2 because instead of increase, a reduction in the consumption of alcohol was noted during the period of the financial crisis3. On the contrary, support of the family, an institution that continues being alive in Greece and the other countries of the European South, is probably more useful than the programs of social support that have proved effective in some north, European countries.

The consequences of financial crises on mental health are multiple. They can be distinguished in personal morbidity, social morbidity and systemic morbidity. Additionally, there are often irreversible long-term effects and transgenerational effects that should be matters for very serious concern.

On a personal morbidity level the consequences concern poor mental health generally, depression, suicidality and suicide, homicide, drug abuse and the expected increase in the frequency of relapses (in view of the fact that a financial crisis represents a chronic stress).

The importance of depression is certainly great and in view of its atypical and protean clinical expression, its causative relationship with suicide and its increase during periods of economic crises, it is important to persistently screen for this potentially self-destructive disorder. On the other hand, attributing a nosological label to a natural and expected grief reaction should be avoided. The hyperboles that reach the conclusion that what we see is a “depressive society” and that Greece is a “depressive country” serve only mass media purposes. It is natural for the citizens of the country to experience grief. What would be unnatural and perhaps psychopathological would be not to experience this sadness (as a result of a mechanism of negation of a painful but present reality). It is therefore important to make a distinction between an adaptive response (grief) and a dysfunctional response (depression).

On the basis of published reports we know that financial crises are associated with unemployment, economic problems, income inequalities, lowering of the living standards of the population, and that they have collateral consequences like for example deficits in education. All these factors contribute to the poor mental health of the population.

As expected, the physical health of the citizens is also affected by financial crises (unemployment is associated with increased morbidity and mortality). It is worth mentioning in this respect that a great proportion of Greek people regard their physical health as “bad” or “very bad”.3 In view of the close inter-dependence of physical and mental health, poor physical health is likely to have an indirect negative impact on mental health.

Particular importance has been attached to the impact on mental health of poverty and debt (transculturally and diachronically). High income seems to provide some degree of protection from suicide whilst poverty and especially debt create circumstances of great vulnerability.

Cuts in the funding of mental health services that usually follow a financial crisis coupled with increased demand for services, owing to the crisis, leads to serious dysfunction of the system of mental health provision, especially when the system was already inadequately organized to start with. It is paradoxical that in all parts of the world the most extensive budget cuts concern the services for the people who need them more - like the vulnerable population groups and the persons who already suffer from mental disorders.

The close relationship of unemployment with suicide is well known. In view of the fact that financial crises lead to unemployment,one could expect an increase in suicide rate during periods of economic crises. Indeed, this has been the case in most countries (with the exception of some Scandinavian countries in which a strong social protection network is operating). In Greece the situation is not clear. It seems that there is an increase in suicidality (intension and attempts)5 but increase in actual suicide is uncertain. However, because suicidality eventually leads to suicide it is possible that an increase in actual suicide rate will be recorded in the near future. If this does not happen (or if it happens to a comparatively limited degree) it will probably mean that the Greek people manifest noteworthy resilience, possibly associated, among others, with the fact that the family institution is still strong in the country and continues offering protection to its members (on an emotional but also a material level).

What can be done to combat unemployment? The programs of social protection, engagement in some kind of occupational rehabilitation and enhancement of resilience applied in scandinavian countries, have been very effective. Additionally, programs of part-time employment in contrast to dismissal from work (“the lesser of two evils”) could be implemented in view of the fact that forced termination of employment impacts not only on income but also on the personal and social status of the person. The Family, as an Institution and Function should also be supported6 as well as the programs of adoptive families that are consistent with the culture of some countries (e.g. Greece).

It is worth noting that suicidal indexes are negatively associated with the efficiency of mental health services in personnel and substructure7 and that “investment” in mental health and especially in psychiatric prevention is cost-effective.4 These data are useful because they can enrich the set of arguments for adequate funding of mental health services (in fact these data have been used by the Hellenic Psychiatric Association in its correspondence with the Greek ministries of Health and Economy).

In all crises, natural or human-made, the key concept for the management of the psychosocial consequences is the concept of “solidarity”. The same stands for the current financial crisis. We believe that the Greek people have realized the importance of solidarity and have in fact implemented it. This may perhaps explain the considerable degree of resilience but also of απαντοχή (denoting resilience with hope) that characterizes the response of the citizens to the current financial crisis for the time being. Time will show whether this response will continue in the same direction.

George N. Christodoulou
Professor Emeritus of Psychiatry, University of Athens

Nikos G. Christodoulou
Clinical Lecturer in Psychiatry, University of Nottingham, UK


  1. World Health Organization. Impact of economic crisis on Mental Health. Regional office for Europe, Copenhagen, 2011
  2. Christodoulou NG, Christodoulou GN. Management of the psychosocial effects of economic crises. World Psychiatry 2013, 12:178
  3. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stückler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet 2011, 378:1457–1458
  4. Christodoulou NG, Christodoulou GN. Financial Crises: Impact on Mental Health and suggested responses. Editorial. Psychother Psychosom 2013 (In press)
  5. Economou M, Madianos M, Theleritis C, Peppou LE, Stefanis CN. Increased suicidality amid economic crisis in Greece. Lancet 2001, 378:1459
  6. Christodoulou NG, Anagnostopoulos DC. The financial crisis and the future of mental health in Greece. Intern Psychiatry 2013, 10:3–6
  7. Giotakos O, Tsouvelas G, Kontaxakis V. Suicide rates and mental health services in Greece. Psychiatriki 2012, 23:29–38

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