Suicide is a worldwide phenomenon and is a major problem in social and health care. For many decades, there has been a growing interest in developing suicide prevention strategies. Suicide is recognized as a serious, worldwide public health concern and has been proven to be the tenth leading cause of death worldwide. The approximate international burden of suicide is one million deaths a year and public awareness is needed to effectively prevent suicide. Suicide rates varyby region and country, and the risk of suicide varies according to gender, age, employment status and quality of physical and mental health. A considerable number of substantial studies have been conducted to investigate risk factors that predict suicidal ideation and behavior. In particular, studies have shown that demographic factors such as gender and age have been found to be essential risk factors associated with suicide. Numerous studies have also investigated the association between chronic medical disease and Greek financial crisis with the existence and increased risk of suicidal behavior. The cross-sectional study had the following objectives: 1) To evaluate mental stress, suicide beahavior, patients' illness perception, sence of coherence, resilienceand religiousness of patients with chronic medical diseases. The prospective study had the following objectives: 1) to assess the course of mental stress and quality of life of patients with chronic medical diseases during a semester 2) to identify the factors associated with suicide behavior in the overall sample but also separately in patients and in the control group 3) to identify factors for improving suicide beahior in patients and in the control group 4) to identify factors affecting the relationship of suicide behavior with perceived influence of financial crisis. In the cross-sectional study participated 821 subjects, 629 of whom were in the group of patients with chronic medical diseases and 129 in the control group. In the prospective study, 464 patients with chronic medical diseases and 110 healthy subjects participated in the first phase of the study, participated in the second assessment 6 months later. The data were collected through semi-structured psychiatric interview, as well as by completing questionnaires. The findings of the 150 study showed a high prevalence of major depressive disorder, suicidal ideation and behavior and Generalized Anxiety Disorder (GAD) in patients with chronic medical diseases visiting the University Hospital of Ioannina during the Greek financial crisis. At the same time, a significant proportion of the healthy sample had depressive symptoms, however smaller than the patient sample. In addition, the results ofcurrent research verify the association between chronic physical illness and comorbidity with major depressive disorder and suicidal behavior. In addition, analyses occurred six months after baseline found that all outcomes (ie, severity of depressive symptom, risk of suicide, quality of life relatedto health) were significantly improved. The results of the prospective study on factors related to suicidality during follow-up showed that psychiatric history was significantly associated with suicidality in the overall sample of patients and healthy subjects (control group) participated in the study. Specifically, the high RASS Suicide Score and the diagnosis of depression (PHQ> 10) at baseline seem to be positively correlated with suicide scores on the follow up. On the contrary, depression improvement is negatively related to suicide on follow up assessment. Regarding theimprovement of suicide in the patient sample, three variables were found statistically significant: RASS suicidality and PHQ-9 depression diagnosis at baseline, and improvement in depression measured with the PHQ-9 scale during 6 months. These variables are same with the variables identified as important for predicting suicidality in the second measurement after a 6-month follow-up throughout the study sample. In the healthy population sample, age, diagnosis of depression (PHQ>10), and lower RASS scores were found to be negatively correlated with improved suicidality. Finally, the most important new finding is that the impact of the current financial crisis is linked to the risk of suicide, but this correlation is moderated by the presence of a psychiatric disorder: the greater the impact of the crisis, the greater the risk of suicide only when a psychiatric disorder or generalized anxiety disorder is diagnosed. In this light, as the rates of depression, anxiety disorder, and suicide in patients with chronic medical diseases were significant in the present study,clinicians should be aware that referral for psychiatric intervention is important in patients with chronic medical diseases.
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