Dissertation committee:
Πλουμπίδης Δημήτριος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αναγνωστόπουλος Δημήτριος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δικαίος Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τουλούμη Παναγιώτα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σύψα Βασιλική – Αναστασία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ψάρρος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πανταζής Νικόλαος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Common mental disorders account for about 12% of the global burden of disease, causing extremely significant patient dysfunction and significantly increasing global health care costs. In Greece, few population-level epidemiological studies have been conducted and of those available, none provide a comprehensive picture that is comparable to the European level. At the same time, the involvement of socioeconomic parameters in the development of psychopathology and, at the same time, the coexistence of physical symptoms and diseases, lead patients to doctors of various specialties in 70-80% of cases. However, the detection rates of depression and anxiety in primary health care range below 50% on average, since there are few reliable data on the existing easy-to-use and brief detection tools for these conditions and, in our country, they have not been used to date, resulting in many patients remaining undiagnosed and hence untreated. Furthermore, particularly in studies with a large population sample, the use of appropriate epidemiological tools is of central importance. The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report screening scale for depression and anxiety with promising psychometric properties; however, its reliability and validity have not been yet investigated in Greece.
The purpose of this study was 1. To assess the prevalence of depression and anxiety in the general adult population (≥ 18 years old) and to investigate its association with the demographic and socio-economic characteristics of the participants. 2. To assess the co-morbidity of physical symptoms and conditions with depression and anxiety in the general adult population. The specific objectives of the study included 3. to investigate the reliability and validity of the PHQ-4 and to establish a cut-off score to identify depression and anxiety in the Greek general population.
Context of the research: The study was conducted in the context of the first National Morbidity and Risk Factor Study (EMENO), which was conducted in a representative sample of the permanent adult population of Greece (5,807 individuals), combining questionnaires, which included the short tools PHQ-2, GAD-2 and PHQ-4, with medical examinations. A subset of the population (591 individuals) was additionally administered part of the MINI International Neuropsychiatric Interview while the 2 short instruments were administered twice within one week to 204 undergraduate and postgraduate students from 5 different universities in Athens.
Results: The sample consisted of 5,807 individuals. Of these, 51.35% were female, the mean age was 49.27 years, 47.19% were secondary school graduates and 61.39% were married or cohabiting. Also, 84.08% were working and for 40.27% the monthly household income did not exceed 900 euros. 29.3% had one chronic disease, 39.52% two or more and 44.32% metabolic syndrome. Categorizing anxiety and depression into 2 levels, 23.09% had some form of Anxiety Disorder (AD) and 16.73% had some form of Depressive Disorder (DD).
Regarding anxiety disorders it was shown that: Women had higher prevalence rates than men (27.83% and 18.09% respectively). Those in the 70+ age category were 55% less likely to experience AD than those in the 18-29 age category. Higher educational level was associated with a lower incidence rate (18.35% versus 29.05%). Unemployed persons had higher incidence rates compared to the employed (28.33% and 22.05% respectively). Those with an income of more than 1700 euros were 31% less likely to suffer from an anxiety disorder than those earning up to 900. Those with one or two or more chronic diseases were 1.31 and 1.7 times more likely to develop AD than those without a chronic disease, respectively.
In relation to depressive disorders, it was found that: Higher incidence rates were found in those over 70 years of age in both sexes (16.93% for men and 27.2% for women). The occurrence of DD was 1.63 times more likely in females compared to males (20.37% and 12.88%, respectively). Those who were single (unmarried) were 1.51 times more likely to experience depression compared to those who were married. Higher educational level was associated with a lower incidence of DD (11.32% compared to 25.13%). Unemployed people were 1.72 times more likely to experience depression compared to the employed (23.96% and 15.28% respectively). Higher income was also associated with reduced rates of DD (22% for income <900 vs. 8.95% for income > 1700). Those who were covered by social security experienced DD at a rate of 15.55%, while those who were not experienced DD at a rate of 24.85%. Those with one or two or more chronic diseases had DD at rates of 13.8% and 24.92%, respectively, while those with no disease had DD at 8.84%. Of the 591 people who were additionally interviewed through the MINI, 16.6% had a current major depressive episode and 11.7% had experienced a major depressive episode in the past. 12.7% were experiencing dysthymic disorder, 9.3% had generalized anxiety disorder, 5.8% had panic disorder, 9.5% social phobia, and 9,7 obsessive-compulsive disorder. The percentage of those with agoraphobia was smaller and equal to 4.1%. In addition to the epidemiological data, the study provided evidence for the reliability of the PHQ-4. Internal reliability was acceptable and test-retest reliability was excellent.
Conclusions: Overall, the rates of depression and anxiety in the Greek population are extremely high (16,73% & 23,09% respectively), and a particularly high comorbidity between common mental disorders and physical diseases was observed. Women, single people, divorced or widowed people, pensioners and unemployed people have higher morbidity, while people with higher education and people with high family income have lower morbidity. Our findings suggest that the PHQ-4 is a reliable and valid screening scale for depression and anxiety in the Greek general population.
Keywords:
Anxiety, Depression, Greek general population, Patient Health Questionnaire-4 (PHQ-4), Screening, comorbidity, Validation
