Quality of Life Research

, Volume 28, Issue 12, pp 3237–3247 | Cite as

Health-related quality of life in adult population before and after the onset of financial crisis: the case of Athens, Greece

  • Chrysoula BeletsiotiEmail author
  • Dimitris Niakas



Trends of person-oriented indices with respect to the general population have not been adequately investigated. In Athens, two Health Surveys in 2003 and 2016 provide the opportunity to analyze HRQL in the general adult population. The objectives of this study were to investigate changes in HRQL of adults in the broader area of Athens between 2003 and 2016 and their association with certain socio-demographic determinants.


We compared participants from pre- and during-crisis cross-sectional surveys. We used data from 982 and 1060 adult residents of Athens from 2003 and 2016 surveys, respectively. Income-related missing data were treated using three alternative methods. Subscale and summary component SF-36 scores were compared with Mann–Whitney tests and linear regression analyses were used to estimate the effect of demographic and socio-economic variables on HRQL before and after the onset of crisis.


The analysis was based on the results of the procedure of handling missing income data as a separate income group and showed that physical component summary score (PCS) has improved and Mental Component Summary score has deteriorated. The most important predictors of HRQL were being widowed and during the crisis not being employed. Additionally, socio-demographic characteristics explained a higher proportion of variance of HRQL after the onset of crisis, especially for PCS.


Decline in mental and improvement in physical HRQL were observed between 2003 and 2016. HRQL has been certainly affected by the recession, but it is difficult to estimate the exact impact of the financial crisis on HRQL.


Health-related quality of life (HRQL) Trends Financial crisis Greece 



Collection of data for 2003 and 2016 surveys was funded by the Greek Ministry of Health and the 1st Regional Health Authority of Attica, respectively. The funders had no role in study design, data analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that no competing interests exist.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No physical samples were collected as part of this study. The 2003 study protocol was approved by the Review Board of the Hellenic Open University and the 2016 study protocol by the Ethics Committee of the 1st Regional Health Authority of Attica.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2019_2281_MOESM1_ESM.docx (49 kb)
Supplementary material 1 (DOCX 49 kb)


  1. 1.
    Ghosh, R. K., Ghosh, S. M., & Ganguly, G. (2010). Health-related quality of life and its growing importance in clinical practice. New Zealand Medical Journal,123(1313), 99–101.PubMedGoogle Scholar
  2. 2.
    Romero, M., Vivas-Consuelo, D., & Alvis-Guzman, N. (2013). Is health related quality of life (HRQoL) a valid indicator for health systems evaluation? SpringerPlus,2(1), 664. Scholar
  3. 3.
    Yin, S., Njai, R., Barker, L., Siegel, P. Z., & Liao, Y. (2016). Summarizing health-related quality of life (HRQOL): Development and testing of a one-factor model. Population Health Metrics,14, 22. Scholar
  4. 4.
    Filippidis, F. T., Gerovasili, V., Millett, C., & Tountas, Y. (2017). Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece. Scientific Reports,7, 46423. Scholar
  5. 5.
    Pappa, E., Kontodimopoulos, N., & Niakas, D. (2005). Validating and norming of the Greek SF-36 Health Survey. Quality of Life Research,14(5), 1433–1438.CrossRefGoogle Scholar
  6. 6.
    Mavridis, S. (2018). Greece’s economic and social transformation 2008–2017. Social Sciences,7(1), 9.CrossRefGoogle Scholar
  7. 7.
    Rotarou, E., & Sakellariou, D. (2019). Access to health care in an age of austerity: Disabled people’s unmet needs in Greece. Critical Public Health,29(1), 48–60.CrossRefGoogle Scholar
  8. 8.
    Chantzaras, A. E., & Yfantopoulos, J. N. (2018). Income-related health inequalities among the migrant and native-born populations in Greece during the economic crisis: A decomposition analysis. European Journal of Public Health,28(Suppl. 5), 24–31.CrossRefGoogle Scholar
  9. 9.
    Ruckert, A., & Labonté, R. (2014). The global financial crisis and health equity: Early experiences from Canada. Globalization and Health,10, 2. Scholar
  10. 10.
    Baumbach, A., & Gulis, G. (2014). Impact of financial crisis on selected health outcomes in Europe. European Journal of Public Health,24(3), 399–403. Scholar
  11. 11.
    Economou, M., Angelopoulos, E., Peppou, L. E., Souliotis, K., Tzavara, C., Kontoangelos, K., et al. (2016). Enduring financial crisis in Greece: Prevalence and correlates of major depression and suicidality. Social Psychiatry and Psychiatric Epidemiology,51(7), 1015–1024.CrossRefGoogle Scholar
  12. 12.
    Brall, C., Schröder-Bäck, P., & Brand, H. (2016). The economic crisis and its ethical relevance for public health in Europe—an analysis in the perspective of the capability approach. Central European Journal of Public Health,24(1), 3–8. Scholar
  13. 13.
    Bonovas, S., & Nikolopoulos, G. (2012). High-burden epidemics in Greece in the era of economic crisis. Early signs of a public health tragedy. Journal of Preventive Medicine and Hygiene,53(3), 169–171.PubMedGoogle Scholar
  14. 14.
    Filippidis, F. T., Schoretsaniti, S., Dimitrakaki, C., Vardavas, C. I., Behrakis, P., Connolly, G. N., et al. (2014). Trends in cardiovascular risk factors in Greece before and during the financial crisis: The impact of social disparities. European Journal of Public Health,24(6), 974–979.CrossRefGoogle Scholar
  15. 15.
    Simou, E., & Koutsogeorgou, E. (2014). Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review. Health Policy,115(2–3), 111–119.CrossRefGoogle Scholar
  16. 16.
    Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. Journal of the American Medical Association,273(1), 59–65.CrossRefGoogle Scholar
  17. 17.
    Ferrans, C. E., Zerwic, J. J., Wilbur, J. E., & Larson, J. L. (2005). Conceptual model of health-related quality of life. Journal of Nursing Scholarship,37(4), 336–342.CrossRefGoogle Scholar
  18. 18.
    World Health Organization. (2007). International classification of functioning, disability, and health: Children and youth version: ICF-CY. Geneva: World Health Organization.Google Scholar
  19. 19.
    Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston: New England Medical Center.Google Scholar
  20. 20.
    Anagnostopoulos, F., Niakas, D., & Pappa, E. (2005). Construct validation of the Greek SF-36 Health Survey. Quality of Life Research,14(8), 1959–1965.CrossRefGoogle Scholar
  21. 21.
    Pappa, E., & Niakas, D. (2006). Assessment of health care needs and utilization in a mixed public-private system: The case of the Athens area. BMC Health Services Research,6, 146. Scholar
  22. 22.
    Kim, S., Egerter, S., Cubbin, C., Takahashi, E. R., & Braveman, P. (2007). Potential implications of missing income data in population-based surveys: An example from a postpartum survey in California. Public Health Reports,122(6), 753–763.CrossRefGoogle Scholar
  23. 23.
    Li, K. H., Raghunathan, T. E., & Rubin, D. B. (1991). Large-sample significance levels from multiply imputed data using moment-based statistics and an F reference distribution. Journal of the American Statistical Association,86(416), 1065–1073.Google Scholar
  24. 24.
    Suhrcke, M., & Stuckler, D. (2012). Will the recession be bad for our health? It depends. Social Science and Medicine,74(5), 647–653.CrossRefGoogle Scholar
  25. 25.
    Catalano, R., Goldman-Mellor, S., Saxton, K., Margerison-Zilko, C., Subraraman, M., LeWinn, K., et al. (2011). The health effects of economic decline. Annual Review of Public Health,32, 431–450.CrossRefGoogle Scholar
  26. 26.
    Bartoll, X., Toffolutti, V., Malmusi, D., Palència, L., Borrell, C., & Suhrcke, M. (2015). Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001–2012). BMC Public Health,15, 865.CrossRefGoogle Scholar
  27. 27.
    Frasquilho, D., Matos, M. G., Salonna, F., Guerreiro, D., Storti, C. C., Gaspar, T., et al. (2016). Mental health outcomes in times of economic recession: A systematic literature review. BMC Public Health,16, 115.CrossRefGoogle Scholar
  28. 28.
    Petrelli, A., Di Napoli, A., Rossi, A., Costanzo, G., Mirisola, C., & Gargiulo, L. (2017). The variation in the health status of immigrants and Italians during the global crisis and the role of socioeconomic factors. International Journal for Equity in Health,16(1), 98. Scholar
  29. 29.
    Clause-Verdreau, A. C., Audureau, É., Leplège, A., & Coste, J. (2019). Contrasted trends in health-related quality of life across gender, age categories and work status in France, 1995–2016: Repeated population-based cross-sectional surveys using the SF-36. Journal of Epidemiology and Community Health,73(1), 65–72.CrossRefGoogle Scholar
  30. 30.
    Davalos, M. E., & French, M. T. (2011). This recession is wearing me out! Health-related quality of life and economic downturns. Journal of Mental Health Policy and Economics,14(2), 61–72.PubMedGoogle Scholar
  31. 31.
    Milner, A., Spittal, M. J., Page, A., & LaMontagne, A. D. (2014). The effect of leaving employment on mental health: Testing ‘adaptation’ versus ‘sensitisation’ in a cohort of working-age Australians. Occupational and Environmental Medicine,71(3), 167–174. Scholar
  32. 32.
    Molarius, A., Berglund, K., Eriksson, C., Eriksson, H. G., Lindén-Boström, M., Nordström, E., et al. (2009). Mental health symptoms in relation to socio-economic conditions and lifestyle factors: A population-based study in Sweden. BMC Public Health,9, 302.CrossRefGoogle Scholar
  33. 33.
    Drydakis, N. (2014). The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: A longitudinal study before and during the financial crisis. Social Science and Medicine,128, 43–51. Scholar
  34. 34.
    Zavras, D., Tsiantou, V., Pavi, E., Mylona, K., & Kyriopoulos, J. (2013). Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece. European Journal of Public Health,23(2), 206–210.CrossRefGoogle Scholar
  35. 35.
    Vandoros, S., Hessel, P., Leone, T., & Avendano, M. (2013). Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach. European Journal of Public Health,23(5), 727–731.CrossRefGoogle Scholar
  36. 36.
    Hessel, P., Vandoros, S., & Avendano, M. (2014). The differential impact of the financial crisis on health in Ireland and Greece: A quasi-experimental approach. Public Health,128(10), 911–919.CrossRefGoogle Scholar
  37. 37.
    Minelli, L., Pigini, C., Chiavarini, M., & Bartolucci, F. (2014). Employment status and perceived health condition: Longitudinal data from Italy. BMC Public Health,14, 946.CrossRefGoogle Scholar
  38. 38.
    Kondo, N., Subramanian, S. V., Kawachi, I., Takeda, Y., & Yamagata, Z. (2008). Economic recession and health inequalities in Japan: Analysis with a national sample, 1986–2001. Journal of Epidemiology and Community Health,62(10), 869–875.CrossRefGoogle Scholar
  39. 39.
    Regidor, E., Barrio, G., Bravo, M. J., & de la Fuente, L. (2014). Has health in Spain been declining since the economic crisis? Journal of Epidemiology and Community Health,68(3), 280–282. Scholar
  40. 40.
    Aguilar-Palacio, I., Carrera-Lasfuentes, P., & Rabanaque, M. J. (2015). Youth unemployment and economic recession in Spain: Influence on health and lifestyles in young people (16–24 years old). International Journal of Public Health,60(4), 427–435. Scholar
  41. 41.
    Rajmil, L., Medina-Bustos, A., Fernandez de Sanmamed, M.-J., & Mompart-Penina, A. (2013). Impact of the economic crisis on children’s health in Catalonia: A before-after approach. British Medical Journal Open,3(8), e003286. Scholar
  42. 42.
    Donovan, R. J., Holman, C. D., Corti, B., & Jalleh, G. (1997). Face-to-face household interviews versus telephone interviews for health surveys. Australian and New Zealand Journal of Public Health,21(2), 134–140.CrossRefGoogle Scholar
  43. 43.
    Ekholm, O., Gundgaard, J., Rasmussen, N. K., & Hansen, E. H. (2010). The effect of health, socio-economic position, and mode of data collection on non-response in health interview surveys. Scandinavian Journal of Public Health,38(7), 699–706.CrossRefGoogle Scholar
  44. 44.
    Sosnowski, R., Kulpa, M., Ziętalewicz, U., Wolski, J. K., Nowakowski, R., Bakuta, R., et al. (2017). Basic issues concerning health-related quality of life. Central European Journal of Urology,70(2), 206–211.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Medicine, School of Health SciencesNational and Kapodistrian University of AthensAthensGreece

Personalised recommendations