By Kate Kelland
Behind every suicide in crisis-stricken countries such as Greece there are up to 20 more people desperate enough to have tried to end their own lives.
And behind those attempted suicides, experts say there are thousands of hidden cases of mental illness, like depression, alcohol abuse and anxiety disorder, that never make the news, but have large and potentially long-lasting human costs.
The risk, according to some public health experts, is that if and when Greece's economic woes are over, a legacy of mental illness could remain in a generation of young people damaged by too many years of life without hope.
"Austerity can turn a crisis into an epidemic,» said David Stuckler, a sociologist at Britain's Cambridge University who has been studying the health impacts of biting budget cuts in Europe as the euro crisis lurches on.
"Job loss can lead to an accumulation of risks that can tip people into depression and severe mental illness which can be difficult to reverse - especially if people are not getting appropriate care,» Stuckler said.
"Untreated mental illness, just like other forms of illness, can escalate and develop into a problem that is much more difficult to treat later on."
Accumulation of risks
Youth unemployment in Greece is more than 50 percent and evidence of peoples' disaffection is becoming more visible.
The sight of groups of youths hanging around the streets getting high on illicit drugs is not uncommon in Athens, while a Greek pensioner who hanged himself in the capital on Wednesday was found with a note saying he had always worked hard but had got himself into debt.
Greece is in its fifth year of recession and the prospects for many are bleak. Economists reckon the austerity measures Greece is battling with -- cuts the health minister characterized as being made with a butcher's knife rather than a scalpel -- offer it slim hope of recovery any time soon.
Those who have jobs are being hit with wage cuts or pay freezes, and live in constant fear of being the next employee to face the chop. Research has found this feeling of profound insecurity can do more psychological damage than anything else.
Peter Kinderman, a professor of clinical psychology at Britain's University of Liverpool, says the mental health impact of all this turmoil will be rapid and dramatic.
"Instead of seeing a slow increase in the epidemiology of mental illness, what we're seeing is what we predicted - that these economic impacts have rapid significance for our way of thinking about the world,» he told Reuters.
And while economic crises may have mental health effects, mental illness in turn has increasingly significant economic effects - raising the prospect of a vicious cycle.
According to a paper prepared for the World Health Organisation (WHO) in 2011, the economic consequences of mental health problems - mainly in the form of lost productivity - are estimated to average between 3 and 4 percent of gross national product in European Union countries.
And because mental disorders often start in young adulthood, the loss of productivity can be long-lasting, experts say.
Stuckler says there is a «critical window» for connecting people in need of psychiatric help to the services that could benefit them, and talks of a «high risk phase» when vulnerable young people haven't been able to realize what they hoped to do, and then feel like they're being left behind in a recovery.
"You don't want them to sink into being chronically unemployed,» he said. «Because that ends up increasing the costs and pressure on the welfare system further down the line».
In Greece, suicide rates are already rising rapidly, albeit from a low starting point. Suicides rose by 17 percent between 2007 and 2009, and by 40 percent in the first half of 2011 compared with the same period in 2010, according to a report in the Lancet medical journal last year.
And judging from the experience of financial crises elsewhere, unemployment, poverty and insecurity will also lead to upward trends in demand for mental health services just as they are being cut back.
"Some people can be very profoundly affected ... and end up unhappy and depressed for very long periods for time,» said Kinderman. «And I suspect some of the casualties in an economic downturn may undergo such fundamental changes in the way they understand themselves and the world, that that way of thinking will last."
Peter Lloyd Sherlock, professor of social policy at Britain's University of East Anglia, suggests looking to history for lessons. He points out that in Argentina, which experienced a dire financial downturn from 1999 to 2002, there was a 40 percent increase in consultations in mental health facilities in 2002, according to government data, and there was also a sharp increase in prescriptions of antidepressants.
Previous research has found that people who fall into unemployment and poverty have a significantly greater risk of mental health problems -- and men are at especially increased risk of mental illness, suicide or alcohol abuse during hard times.
Evidence cited in the WHO report suggests the more debt people have, the more likely they are to have mental disorders.
"If the Greek economic woes were to continue for 10 years or more, probably the most important overall effect on mental and physical health will actually be a big increase in inequality,» Lloyd Sherlock said.
Do depressions always breed depression?
But does economic depression always mean more psychological depression?
Public health experts point to some countries, such as Sweden and Finland, which in times of crisis managed to avoid increases in mental illness and suicide rates by investing in employment initiatives to help get people back on their feet.
In the early 1990s, Sweden underwent a severe bank crisis which sparked a rapid rise in unemployment, but suicide rates were broadly unaffected. In contrast, Spain, which had multiple banking crises in the 1970s and 1980s, saw suicide rates rise as unemployment rates did.
Some experts say a key differentiating factor was the extent to which resources were budgeted for social protection, such as family support, unemployment benefit and healthcare services.
Looking ahead to what he hopes may be less fragile financial times for Greece, Kinderman sounds an optimistic note. While there's a risk of long-term psychological problems for some, he says, evidence also suggests the majority of people can bounce back if and when economic prospects brighten.
"If you have economic recovery, many people could spark back up into a more optimistic and more self-assured frame of mind relatively quickly,» he said. «The message for politicians is get the bloody economy right and we'll start functioning again."