Perceived Health and Stress among Primary Care visitors - a comparative cross-sectional study between Greece and Scandinavia

Background: Health behavior varies highly across European countries, and stress and stress-related disorders are commonly seen in European Primary Health Care. Greece has suffered deeply from the 2008 international financial crisis, whereas Scandinavian countries were less affected. Several reports of increasing mental health issues and poorer perceived health among the Greek population have been published. Self-reported health and stress are established public health indicators. A novel physiological marker of long-term stress, cortisol in hair, is at hand and applied in this study. Here, our aim was to study perceived health, including mental health, and self-reported and biological stress in Greece compared to Scandinavia. Methods: A cross-sectional comparative study of adult (18-65) Primary Health Care visitors from semi-rural areas in Greece (n=84) and Scandinavia (n=140). Data collection encompassed a questionnaire with a variety of health and stress indicators and hair samples for analyzes of cortisol levels. Results: The Greek sample reported significantly poorer overall health (p<0.0001) than the Scandinavians and significantly higher perceived stress (p<0.0001). The Greeks were also less hopeful of the future (p<0.0001), and to a larger extent fulfilled the HAD criteria for depression (p<0.0001) and anxiety (p=0.002). There were no significant differences in cortisol levels between the study-groups. The strongest predictors explaining ill health in logistic regressions were being Greek (p=0.001) and feeling hopeless about the future p=0.001, OR= 6.00 (CI; 2.10-14.88). Strong predictors in logistic regressions for high perceived stress were anxiety: high (p=<0.0001) and medium, (p=0.0001), as well as medium depression (p=0.02). Participants with either low or high cortisol levels, and those that reported ill health, had elevated self-reports of high stress, but these did not reach statistical significance.Conclusions: The results suggest that Greek adult Primary Health Care visitors perceived their health more negatively than the Scandinavians, including a higher presence of depression, anxiety, and a lower hope for the future. The Greeks also reported higher perceived stress, not reflected in higher cortisol levels. These findings could be interpreted against the background of socio-cultural differences in northern and southern Europe, and might also reflect the economic crisis that the Greek population experienced at that time.