Mental health burden among criminal defendants in a rural Greek court setting

Introduction

Judicial proceedings are associated with considerable psychological stress, particularly for individuals involved as criminal defendants. This burden may be amplified in rural regions, where structural limitations, including reduced access to mental health services, geographical isolation, and socioeconomic disparities, can negatively affect psychological well-being and access to care. Legal uncertainty, social stigma, and financial strain may further contribute to emotional distress in this population. In Greece, despite ongoing challenges within the judicial and healthcare systems, these interacting factors remain insufficiently explored, particularly within forensic mental health and applied neuroscience contexts.

Aims

This study aimed to evaluate the mental health status of defendants attending the District Court of Kalavryta in Western Greece. Specific objectives included the assessment of psychiatric history, addictive behaviours, and subjective psychological burden, alongside the standardized measurement of depression, anxiety, and stress. Additionally, the study examined demographic and psychosocial factors associated with increased psychological distress.

Methods

A total of 81 defendants participated (mean age 45.6 years; 77.8% male). Data were collected between January and June 2025 using a structured questionnaire covering sociodemographic characteristics, psychiatric history, substance use, and perceived mental strain. Psychological symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21), a validated self-report instrument. Statistical analyses were conducted using appropriate descriptive and inferential methods, including chi-square tests and independent samples t-tests, to examine associations between mental health outcomes and demographic or clinical variables. Statistical significance was set at p < 0.05.

Results

Only 14.8% of participants reported a formal psychiatric diagnosis, whereas 81.5% disclosed at least one addictive behaviour, most commonly tobacco use (74.1%), alcohol consumption (48.1%), and illicit substance use (19.8%). A majority (77.8%) reported experiencing psychological strain related to prosecution, and 29.6% anticipated that judicial outcomes would negatively impact their mental health. According to DASS-21 scores, 29.6% of participants exhibited depressive symptoms (3.7% mild, 11.1% moderate, 14.8% severe). Anxiety levels were notably elevated, with 70.4% scoring above the normal range (22.2% mild, 22.2% moderate, 3.7% severe, 22.2% extremely severe). Stress levels were also increased, with 44.4% reporting symptoms (7.4% mild, 7.4% moderate, 11.1% severe, 18.5% extremely severe). Despite these findings, only 4.9% had previously accessed psychological support, although 27.2% expressed a current need. Statistical analyses indicated significantly higher levels of distress among individuals with low income, unemployment, and prior psychiatric history (p < 0.001), while no significant associations were observed for age or gender.

Conclusions

The findings indicate a substantial burden of psychological symptoms among criminal defendants, despite low rates of formally diagnosed psychiatric disorders. Socioeconomic disadvantage and prior mental health history appear to be key contributing factors. While the cross-sectional design limits causal interpretation, the results highlight the potential value of integrating systematic mental health screening and accessible psychological support services within judicial settings, particularly in underserved rural areas.

References

No