There are few countries that the global economic crisis has hit as hard as Greece. The European nation's problems have been widely documented, but underneath the country's attempts at economic recovery lies a sharp rise in suicides that researchers attribute to austerity measures.
A new study, published in BMJ Open, tracks the rates of suicide in Greece from 1983 until the end of 2012 - a 30-year period marked by prosperous highs and tragic lows.
"Despite historically having one of the lowest suicide rates in the world, Greece is thought to have been more affected by the global financial downturn than any other European country," write the authors of the study.
"The strain on the Greek public that has persisted for several years now has prompted academic discussion of the potential health effects of the austerity measures."
In 2012, Dimitris Christoulas, a retired pharmacist, shot himself outside Parliament in the Greek capital Athens. In his suicide note, Christoulas blamed the government's austerity policies for his decision to take his own life.
This tragedy was one of several that the study authors selected to use within a 30-year interrupted time-series analysis of highly publicized events to see how austerity affected suicide rates. Several prosperity-related events such as the 2004 Olympic Games were also selected as points of comparison.
June 2011 saw a sharp increase in suicides
Suicide figures were obtained from national death certification data from the Hellenic Statistical Authority. A total of 11,505 people took their own lives between 1983 and 2012 - 9,079 men and 2,426 women.
Austerity measures were introduced in June 2011 and coincided with an increase in suicides of over 35% - an average of an extra 11.2 suicides a month - which was sustained all the way into the following year.
No other events were associated with such a dramatic shift in reported suicides.
Overall, the suicide rate in men began to increase by around 13% in 2008, when the economic recession first took hold. Christoulas' suicide was associated with a short-lived rise of just under 30% - an extra 9.8 suicides a month.
In contrast, the launch of the Euro in Greece in January 2002 - a significant prosperity-related event - was associated with an abrupt yet brief fall in suicides by 27% among men.
Economic instability primarily affected men who were the main family income generators compared with women, the authors write. However, suicides among women also increased alongside events associated with austerity, with an increase of just under 36% occurring in May 2011. Again, this increase was sustained until 2012.
'Greater weight should be given to unintended mental health consequences' of policies
"Relative to other months in which a new series of austerity measures were passed by the Greek government, June 2011 may have been most significant because it was the first part of a larger austerity plan that passed by a very narrow vote," suggest the authors, adding:
"This passage occurred despite polls suggesting that the vast majority of the Greek public were opposed to the austerity plan."
The authors acknowledge their study may be limited by bias that could lead to the misclassification of suicide and possible under-reporting. For example, the Greek Orthodox Church considers suicide to be a sin and condemns those who take their own lives to be interred without a burial service.
However, further analyses that included adjusting for potential under-reporting demonstrated the same increases in suicide in June 2011, suggesting further that the austerity measures introduced at this time were particularly significant.
"As future austerity measures are considered, greater weight should be given to the unintended mental health consequences of these measures. Greater attention should also be paid to the public reporting of austerity measures and any subsequent suicide-related events that may follow," conclude the authors.
With the Syriza party now in government and pledging to end austerity measures in the country, will the country see an improvement in its collective well-being as well as its economy? Only time will tell.
In November, Medical News Today reported on a study finding that short-term psychosocial counseling could reduce rates of suicide attempts among people who have already tried to take their own lives.