Research Environment

(Numbers in parentheses refer to the reference list and numbers in brackets refer to the Scientific Supervisor’s (TH) publications [see ‘CVs section’])

The function of our C-L Unit and our previous research efforts have established continuous and fruitful research collaboration with most departments of our General Hospital. The Scientific Supervisor is the Principal Investigator of the ongoing project ARISTEIA-ABREVIATE, funded by the Greek Ministry of Education and the EU. This 3-year programme runs since 2012 in our AED and aims to apply effective and beneficial strategies to reduce urgent visits of patients with LTCs to AED, and its findings is expected to be coupled with the results of the present study.

Psychological factors associated with long term conditions and poor health outcomes

In 41 studies over the last years, the Scientific Supervisor has assessed psychological factors associated with a wide range of chronic physical illnesses and their impact on several health outcomes [12-14,16-18,21,25,27,29-35,39,40,42,45,47,50-56,61,63,66,67,72,74,81,85,87,88,89]. He has focused on rheumatologic disorders [16,18,21,31,33,34,40,50,51,53,56,67,81,85,88,89], cancer, [25,30,33,34,42,44,66,72,75,80], inflammatory bowel disease and irritable bowel syndrome [7,12,29, 33,35], COPD [52,87] and diabetes [14,59,87], and he has performed the standardization study of the screening for depression and somatic symptom severity inventories PHQ-9 and PHQ-15 for use within Greek patients with LTCs [53,87]. He has confirmed the high incidence of psychiatric comorbidity in Greek patients with LTCs [16,18,27,29,40,50,53,87] and its relationship with impairment of health-related quality of life (HRQoL) [21, 29-31,34,44,45, 50-52,63,67,72,81,88,89], poor compliance with and adherence to treatment [14,17], treatment decisional preferences [17,39, 42,72] or other ill-prone behaviours [35]. He has also highlightened the role of the underlying psychological defensive and coping profile including religious coping in the formation of a number of disease’s outcomes [12,14,16,17,21,29-31,33,39,40,44,50-52,54,72,89], and he has established the usually underestimated but crucial role of the somatization process in the formation of health outcomes in cancer, IBD, glaucoma, COPD and rheumatologic disorders [29,34,52,74].

Greek social and financial crisis and health, mental health and suicidality

Scientific Supervisor's recent reports derived from the ARISTEIA-ABREVIATE project have shown that, in people with LTCs, income reduction during the last two years and perceived impact of current recession is associated with impaired mental health, interpersonal sensitivity, impaired social relations HRQoL and increased risk of suicidality (10,39). He has also published a description of the current state of the mental health services in the era of recession [70].

Genetic predisposition and other biological markers relative to mental illness

KA has an established experience in CNS translational studies, stress and depression-modeling. Her research focuses on the behavioural profile, the serotonergic neurotransmission and the HPA axis function following the implementation of animal models of depression such as forced swim test and chronic mild stress. This research has resulted in new findings and led to more than 20 publications (please see KA's attached CV). Modeling of CNS disorders has been recently coupled with clinical studies with the collaboration of this project's Scientific Supervisor aiming to shed more light in our understanding of the relationship between psychosocial variables, personality traits and neurobiology of mental illness. These findings showed a complex interplay between BDNF serum concentrations, BDNF Val66Met polymorphism, HSPA8 gene (rs1136141), neuroticism and psychotic symptomatology [68,79), suggesting a contributory role of genetic polymorphism on mental illness and underlining the importance of including psychosocial variables and personality traits in the study of the factors associated with the development of CNS disorders.

Predictors of health care utilisation

The Scientific Supervisor has been recently awarded by the American Academy of Psychosomatic Medicine for his study revealing that LTCs patients’ illness perceptions along with MDD are associated with AED use (16). EG has measured consultation rates in primary and/or secondary care and identified predictors of healthcare use (40,41). In a recent systematic review, EG reported that depression is associated with increased urgent healthcare use (11).

Reducing costs and health care utilisation

EG has carried out two randomised controlled trials of the cost effectiveness of psychological interventions in patients who are high utilisers of health care;  both showed that  treatment resulted  in improved health status and a reduction in health care costs (42,43).

Improving outcome in long term conditions

Scientific Supervisor and EG have evaluate in an RCT study psychological treatment in patients with severe irritable bowel syndrome [32]. EG has also evaluated in RCTs psychological treatment in patients after self harm (44). All interventions led to improved outcomes. Scientific Supervisor and AFC have also recently reviewed management procedures in the treatment of resistant depression [78], in cognitive dysfunction in depression (45) and in treatment of MDD in breast cancer [75].

Feasibility

EG’s study of psychological and social factors associated with the onset and persistence of medically unexplained symptoms (46) has demonstrated the feasibility of using a detailed psychological questionnaire in the medical environment in Manchester, UK, and we have no reasons to doubt that the same applies in Greece. Scientific Supervisor’s previous studies with patients with LTCs and his collaborative studies with the Department of Pharmacology for the study of the patients’ genetic profile, further support the feasibility of the proposed methodology.  

Programme Management

TH is the Scientific Supervisor with responsibility for the management of the programme, study implementation, analysis of results and writing up. The fraction of his research effort that will be devoted to this project is 30%. The Greek applicants will form the programme management team which will meet regularly (monthly) to ensure the programme of research is effectively prosecuted. KA, PB and MS will lead on all aspects of research regarding genetic studies. AD, SC and VT will lead on all aspects of research in the respective departments' routine care and in the AED. EG and AFC will provide supervision on the clinical prediction rule study and training and supervision of key staff for the intervention study. This proposal will keep a high ratio of women being involved and will ensure the equality of oppurtunities. It should be addresed that gender related differentiations will be taken into account  in our target group, namely LTCs patients. Given that  depression is mainly characterized by gender differentiation, our proposal will focus on the role of gender in psychosocial and genetic variables linked to depression in order to provide all the gender-related information in terms of psychosocial, psychopathological and biological evaluation. These findings will extend previous knowledge in the observance and enforcement of rights, norms and values, in the management of different needs and policies concerning the health care of women suffering from LTCs (see also Phase 2 and 3 of our work plan).