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Published in: BMC Psychiatry 1/2021

Open Access 01-12-2021 | Psychotherapy | Research

Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece

Authors: E. Tsamadou, P. Voultsos, A. Emmanouilidis, G. Ampatzoglou

Published in: BMC Psychiatry | Issue 1/2021

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Abstract

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.
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Literature
9.
go back to reference Radoilska L. Autonomy and Mental Disorder. Oxford: Oxford University Press; 2012. p. 328.CrossRef Radoilska L. Autonomy and Mental Disorder. Oxford: Oxford University Press; 2012. p. 328.CrossRef
11.
go back to reference Hermann H, Hermann H, Trachsel M, Elger BS, Biller-Andorno N, et al. Emotion and value in the evaluation of medical decision-making capacity: a narrative review of arguments. Front Psychol. 2016, 2016;7:–765. Hermann H, Hermann H, Trachsel M, Elger BS, Biller-Andorno N, et al. Emotion and value in the evaluation of medical decision-making capacity: a narrative review of arguments. Front Psychol. 2016, 2016;7:–765.
19.
go back to reference Roberson AJ, Kjervik DK. Adolescents' perceptions of their consent to psychiatric mental health treatment. Nurs Res Pract. 2012;2012:379756.PubMedPubMedCentral Roberson AJ, Kjervik DK. Adolescents' perceptions of their consent to psychiatric mental health treatment. Nurs Res Pract. 2012;2012:379756.PubMedPubMedCentral
22.
go back to reference Dickens B, Cook RJ. Adolescents and Consent to Treatment. International Journal of Gynecology and Obstetrics, 2005; 89: 179–184. U Toronto Legal Studies Research Paper No. 14–05, Available from SSRN: https://ssrn.com/abstract=862384. last access 9 Sept 2020. Dickens B, Cook RJ. Adolescents and Consent to Treatment. International Journal of Gynecology and Obstetrics, 2005; 89: 179–184. U Toronto Legal Studies Research Paper No. 14–05, Available from SSRN: https://​ssrn.​com/​abstract=​862384. last access 9 Sept 2020.
41.
43.
go back to reference Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation; 1996. Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation; 1996.
44.
go back to reference Georgas DD, Paraskeupoulos ΙN, Mpezevegkis ΗG, Giannitsas ΝD. Greek WISC-III, Wechsler: cognition scales for children. Athens: Ellinika Grammata; 1997. [in Greek] Georgas DD, Paraskeupoulos ΙN, Mpezevegkis ΗG, Giannitsas ΝD. Greek WISC-III, Wechsler: cognition scales for children. Athens: Ellinika Grammata; 1997. [in Greek]
45.
go back to reference Giannakou Μ, Roussi P, Kosmidou ΜΕ, Kioseoglou G, Adamopoulou Α, Garifallos G. Adaptation of Beck-II depression scale in Greek population. Hellenic Journal of Psychology. 2013;10:120–46. Giannakou Μ, Roussi P, Kosmidou ΜΕ, Kioseoglou G, Adamopoulou Α, Garifallos G. Adaptation of Beck-II depression scale in Greek population. Hellenic Journal of Psychology. 2013;10:120–46.
46.
go back to reference Zhang Y, Wildemuth BM. Qualitative Analysis of Content, In: B. M. Wildemuth, Ed., Applications of Social Research Methods to Questions in Information and Library Science, Libraries Unlimited, 2009. pp. 1–12. Zhang Y, Wildemuth BM. Qualitative Analysis of Content, In: B. M. Wildemuth, Ed., Applications of Social Research Methods to Questions in Information and Library Science, Libraries Unlimited, 2009. pp. 1–12.
49.
go back to reference Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985.CrossRef Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985.CrossRef
50.
go back to reference Guba EG, Lincoln YS. Competing paradigms in qualitative research. In N. K. Denzin and Y. S. Lincoln (Eds.), Handbook of qualitative research 1994, p. 105–117. Guba EG, Lincoln YS. Competing paradigms in qualitative research. In N. K. Denzin and Y. S. Lincoln (Eds.), Handbook of qualitative research 1994, p. 105–117.
60.
go back to reference Hardoff D. Legal and ethical issues in adolescents' health care. Georgian Med News. 2012; (210):18-23. English, Georgian. Hardoff D. Legal and ethical issues in adolescents' health care. Georgian Med News. 2012; (210):18-23. English, Georgian.
67.
go back to reference Ijadi-Maghsoodi R, Bonnet K, Feller S, Nagaran K, Puffer M, Kataoka S. Voices from minority youth on help-seeking and barriers to mental health services: Partnering with school based health centers. Ethnicity & Disease 2018;28(Supp): 437–444. Ijadi-Maghsoodi R, Bonnet K, Feller S, Nagaran K, Puffer M, Kataoka S. Voices from minority youth on help-seeking and barriers to mental health services: Partnering with school based health centers. Ethnicity & Disease 2018;28(Supp): 437–444.
76.
go back to reference Greene S, Hill M. Researching children’s experience: Methods and methodological issues. In S. Greene S, Hogan D, editors. Researching children’s experience. Approaches and methods. London: Sage, 2005, pp.1–21, DOI: https://doi.org/10.4135/9781849209823. Greene S, Hill M. Researching children’s experience: Methods and methodological issues. In S. Greene S, Hogan D, editors. Researching children’s experience. Approaches and methods. London: Sage, 2005, pp.1–21, DOI: https://​doi.​org/​10.​4135/​9781849209823.
77.
go back to reference Michaud PA. Assessing adolescent capacity for decision making in clinical care: the practical application of bioethics and human rights principles. In: Cherry A, Baltag V, Dillon M, editors. International handbook on adolescent health and development. Switzerland: Springer; 2017. p. 359–72. https://doi.org/10.1007/978-3-319-40743-2_18.CrossRef Michaud PA. Assessing adolescent capacity for decision making in clinical care: the practical application of bioethics and human rights principles. In: Cherry A, Baltag V, Dillon M, editors. International handbook on adolescent health and development. Switzerland: Springer; 2017. p. 359–72. https://​doi.​org/​10.​1007/​978-3-319-40743-2_​18.CrossRef
78.
go back to reference Cox A, Brannigan C, Martyn H, Townend M. The factors that influence decision making by 8-12 year olds in child and adolescent mental health services (CAMHS): a systematic review. Research, Policy and Planning: The Journal of the Social Services Research Group. 2016;31(3):195–209. Cox A, Brannigan C, Martyn H, Townend M. The factors that influence decision making by 8-12 year olds in child and adolescent mental health services (CAMHS): a systematic review. Research, Policy and Planning: The Journal of the Social Services Research Group. 2016;31(3):195–209.
83.
go back to reference Parsapoor A, Parsapoor MB, Rezaei N, Asghari F. Autonomy of children and adolescents in consent to treatment: ethical, jurisprudential and legal considerations. Iran J Pediatr. 2014;24(3):241–8.PubMedPubMedCentral Parsapoor A, Parsapoor MB, Rezaei N, Asghari F. Autonomy of children and adolescents in consent to treatment: ethical, jurisprudential and legal considerations. Iran J Pediatr. 2014;24(3):241–8.PubMedPubMedCentral
86.
go back to reference Braconnier A., Marcelli D. [The thousand faces of adolescence]. Athens: Kastaniotis, 2002, pp: 30 et seq. [in Greek]. Braconnier A., Marcelli D. [The thousand faces of adolescence]. Athens: Kastaniotis, 2002, pp: 30 et seq. [in Greek].
89.
go back to reference Tsiantis et al. [Adolescence, a transitional stage in a changing world.] Athens: Kastaniotis, 1994, pp: 94 et seq [in Greek]. Tsiantis et al. [Adolescence, a transitional stage in a changing world.] Athens: Kastaniotis, 1994, pp: 94 et seq [in Greek].
92.
go back to reference Dreger A. One of us: conjoined twins and the future of Normal. Cambridge MA: Cambridge University Press; 2004. Dreger A. One of us: conjoined twins and the future of Normal. Cambridge MA: Cambridge University Press; 2004.
93.
Metadata
Title
Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece
Authors
E. Tsamadou
P. Voultsos
A. Emmanouilidis
G. Ampatzoglou
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Psychotherapy
Published in
BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-021-03471-0

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