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BackgroundIn Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice.MethodsA prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021.ResultsThe inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed “clandestine” visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19.ConclusionThese results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.

Background A subset of adolescents with mental disorders are likely to have decision-making capacity that facilitates their therapy engagement. However, there are high rates of drop-out in mental health settings. Aim This study aims to identify perceived barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece. Methods A qualitative study was conducted using semi-structured interviews of adolescents with a wide range of mental health problems. In addition, two psychometric assessment measures were used to define who to include or exclude from the study sample. Results Positive attitudes and experiences with therapy were reported as strong (“major”) facilitators of therapy engagement for adolescents with mental disorders, whereas negative experiences with therapy were reported as strong barriers to it. Furthermore, and most importantly, a “good” adolescent-therapist relationship was reported as a strong facilitator, whereas negative experiences of participants with their therapist were reported as strong barriers. Moreover, goals such as getting rid of symptoms, improving personal well-being, and improving social skills and relationships (especially with peers) emerged as strong facilitators of therapy engagement. Importantly, the early remission of symptoms emerged from the study as a strong barrier to therapy engagement for participants. Among the weaker (“minor”) perceived facilitators were goals such as confessing to a trustworthy person, becoming able to achieve personal expectations and life goals, enhancing independence and self-esteem, and developing a positive self-image. The (active or supportive) role of family emerged as a facilitator. The stigma related to mental health emerged as both a (“minor”) facilitator of and barrier to therapy engagement for participants. Friends were reported as having a role ranging from neutral to mildly supportive. Conclusion A number of more or less strong barriers and facilitators were identified that, for the most part, were consistent with prior literature. However, the authors identified some nuances that are of clinical importance. For instance, adolescents are most likely to terminate the treatment prematurely if they experience early symptom remission. Highlighting the role of therapy in achieving their goals or improving their families’ well-being might be used by therapists to reduce the attrition rate.

Background: A subset of adolescents with mental disorders maintain their ability to be fully engaged in shared clinical decision making process in the context of their psychiatric treatment engagement, thereby promoting an effective therapeutic process. Aim: This paper aims at exploring the epidemiological profile of adolescents who are already engaged in mental health treatment while maintaining their ability to be fully engaged in shared decision making process.Method: A single-center cross-sectional cohort survey was conducted. A sample of fifty participants recruited from Child and Adolescent Psychiatry outpatient setting of a tertiary hospital of Thessaloniki, the second largest city in Greece. An intelligence test (Wechsler Intelligence Scale for Children, WISC III) and a self-report measure of depression (Beck Depression Inventory, BDI II), in combination with a clinical assessment of participants’ practical wisdom. The mental disorders were defined and diagnosed using the ICD-10 (1992) (International Classification of Diseases), which is under a process of revision and the new edition of IDC-11 is expected to be put in effect in January 2022. At present, the last edition of ICD-10 is in use since 1992. Results: The largest percentage of adolescents (44,9%) were found to suffer from mood (affective) disorders, while 20,4% suffered from neurotic disorders. We also found pessimism (32,7%), reduction of energy (28,6%) and difficulty in concentration (32,7%) in high frequency. 22,4% of adolescents complained of sleep disorders. For the most part, the findings of our study were consistent with prior studies. However, a limited interest in sex was noted, a fact coming in contrast with international and Greek data, where interest and experimentation around sex seems to preoccupy an essential percentage of adolescents. Furthermore, sleep disorders, either as a symptom of an underlying disease, or as an independent clinical condition, seem to preoccupy adolescents and this may be a motive for their treatment engagement.Conclusion: For the most part, the findings enhanced prior studies which, however, did not exclusively include decision competent adolescents with mental disorders who were engaged in psychotherapy (for at least two months). Interestingly, however, we identified some nuances related to interest in sex and sleep disorders. Further research is recommended for the investigation of possible correlations between the lack of interest in sex or sleep disorders and the fact that the adolescents of our sample were decision making competent and engaged in psychotherapy.