The analysis included the themes that were initiated by interviewers through the five open-ended questions: (a) Knowledge about coronavirus pandemic, (b) changes in everyday routine due to the pandemic, (c) children’s feelings about the pandemic, (d) children’s helpful thoughts and behaviors, and (e) practices of helping children and adolescents with their difficulties concerning the pandemic. Each theme is reported below, and examples of its content is illustrated with quotes from the participants.
Knowledge about the coronavirus pandemic
The concepts that emerged from the raw data and the wider conceptual categories are shown in Table 1. Information about the nature of the coronavirus was the most common answer between the participants concerning the coronavirus pandemic, including the definition of the coronavirus, the worldwide spread rate, the morbidity, the transmission risk/rate, the mortality, the outcome, previous knowledge about the pandemic and the origins of the virus.
… many people have died from all this… the older ones can easily die... (Participant 1)
…others go through it a little heavily, others lighter … I know that mostly older people get sick … children fortunately go through it very lightly… because, unfortunately, it is very easily transmitted by children mainly to adults (Participant 8)
A group of participants referred to the existing crisis management practices referring to the current condition in Greece and to the existing knowledge about treatment and disease prevention.
In Greece we have handled it quite well, so things are better than in other countries that have been hit harder (Participant 1)
... but fortunately, the deaths are few here in Greece (Participant 8)
... and unfortunately, it has not been found so far, at least as far as I know, a drug or a vaccine or something else… we hope to find a vaccine (Participant 2)
Whilst one participant referred to the psychosocial aftermath of the pandemic
They (infected) are afraid of the pandemic and they feel anxiety, isolation ...they can't see their beloved ones... even their friends, their relatives... unfortunately (Participant 9)
Changes in everyday life
The concepts that emerged from the raw data and the wider conceptual categories are shown in Table 2. Initially, three main conceptual categories emerged from the participants’ interviews referring to changes in everyday life: positive changes, negative changes and non-important changes.
Regarding the positive changes, only two participants recognized some positive aspects impact of the pandemic on everyday life. The first one referred to precautionary measures, mentioning the existence of strict measures, the necessity of the measures and the observed compliance, as well as a sense of transience, which are considered more as helpful thoughts and beliefs to cope with his stress through the pandemic, rather than truly positive aspects of the pandemic.
... unless we consider the general condition worldwide, the strict measures that each country has taken... I understand these measures that have been taken and I believe all this is happening for our own good, so I comply with them like any other citizen… and I believe that all this will pass and we will continue our daily routine as it was before... (Participant 2)
A second participant recognized as a positive aspect of the pandemic the increased contact with beloved ones during home restriction.
... so, we are all together again... it’s been a long time since we’ve been all together like that... it was an opportunity to spend time together... (Participant 1)
Nearly every participant mentioned negative changes in everyday life, referring to new obligatory protective behaviors, social life restraint, restriction of freedom and prohibitions, and negative aspects of increased contact with beloved ones during home restriction.
Regarding the adaptation of new obligatory protective behaviors some participants referred to new hygiene rules that must be followed and to a necessary modification of social encountering.
We have to be far from each other, we don't hug each other too much… (Participant 3)
Limitations on social life were the most commonly referred to negative change. More specifically, nearly all participants referred to the decreased contact with beloved ones, the restrictions on socializing opportunities, home confinement and school closure.
Another particularly interesting concept that emerged from quite a few participants' responses was that of restriction of personal freedom.
... obviously I can't go out whenever I want (Participant 1)
… we have to stay in the house, and we can only go out when... for some important reason, such as the pharmacy or the supermarket, and still one person at a time, etc. (Participant 2)
... we have to send a text message if we need to go out... (Participant 6)
In addition, one participant recognized a negative aspect related to the increased contact with beloved ones.
... there can sometimes be disagreements or fights, around many issues... (Participant 1)
Finally, some participants didn’t acknowledge important changes in everyday life, in light of their pre-existing confinement in the inpatient unit before the pandemic began.
Personally, my daily life has not changed that much (Participant 2)
Ehm... of course in here, ok, things have changed very little ... (Participant 6)
Feelings about the pandemic
The concepts that emerged from the raw data and the wider conceptual categories are presented in Table 3. The four main conceptual categories that emerged from participants’ answers were: negative feelings, positive feelings, ambivalence, and non-important changes in feelings.
Half of the participants expressed worries about possible harm to their loved ones, and one adolescent also considered the psychological impact.
I feel a bit anxious because my mum unfortunately belongs to a vulnerable group ...and I want to know that she is well, all the time... I am very concerned about my grandparents who are old... about the people who I love and care for (Participant 8)
I see my brother, who is a student and obviously was going out very often, being more irritable and getting mad easily... (Participant 1)
Possible harm to self was referred to much less by the participants:
... but ok, I can’t say I am really worried about contracting it myself... (Participant 1)
Three participants expressed worry about the future and the unknown:
I’m worried how things will evolve, meaning how will I go to school next year ... what will happen with the exams ... all this stresses me out ... I like to know my program, not be like "we will see"... (Participant 1)
I have anxiety about when this thing will come to an end… (Participant 6)
I feel very... uncomfortable… (Participant 7)
Whereas two participants talked about concerns regarding the management of the pandemic from a global perspective:
In other countries cases are increasing daily or are too many... (Participant 2)
Deaths are unfortunately quite a few in some other countries –here in Greece not that many (Participant 8)
Few participants expressed sadness about the deceased or affected people in general:
I’m sad about all these people who have died, or those who are ill, and we still don’t know their outcome… (Participant 2)
I also feel very bad about the other people who were free before, and now they are all homebound... (Participant 8)
However, more expressed their sorrow with regard to the lack of contact with their beloved ones.
I feel a bit sad that I can’t see my dad because he is not allowed to get around since he is a high-risk individual ... (Participant 3)
I also feel sorrow that I do not see my family... (Participant 9)
Sadness was also associated with anger and boredom in some instances:
I feel sadder because I’m mainly bored... (Participant 6)
... I feel at the same time anger... and some sadness... (Participant 9)
Four of the participants reported extensively feeling confined or ‘trapped’ and of being deprived of their freedom. Some referred to hospitalisation as keeping their routine unchanged, and others as a condition aggravating their feelings of confinement and loneliness.
I don’t feel very well ... but I manage. Everybody must feel like that, that they are boxed in a house (Participant 5)
... It would help me to be out, not in here... to be with my brothers, my family, with the ones I love. ... I cannot do the things I want when I’m shut in here, and I feel like being on my own. (Participant 7)
Several participants expressed optimism:
...well ok, I know that they (family) are cautious so I am calmer... (Participant 1)
This will not be for too long, now that the temperature is rising and it’ll be warm, it will go (Participant 3)
...on the other hand, I’m happy to hear on the news that cases are decreasing daily, at least in Greece... I believe everything will be fine... (Participant 2)
Two of the participants reported positive feelings about the lockdown, referring to the increased time spent with their beloved ones.
I enjoy the days spent with my parents, because I know that when we go back to normality my mum will work until late, my dad will return to his shifts and all that... so it was a chance to be all together (Participant 1)
... but I feel some joy as well, because in this way I have more free time to be with my family, to play several games ... (Participant 9)
Some inpatients expressed ambivalence when asked about their feelings associated with the current situation. Apart from mixed feelings, two participants referred to non-significant changes in their emotions.
I feel like the other times... ok. I can play with my sisters and watch TV... (Participant 4)
Helpful thoughts and behaviors
The concepts that emerged from the raw data and the wider conceptual categories are shown in Table 4. Initially, two main conceptual categories emerged from the participants’ interviews referring to things they could do to help them feel better: helpful thoughts and helpful behaviors.
Some participants referred to avoiding rumination about the pandemic as a helpful way of thinking during the pandemic. In addition, focusing on the positive aspects of the current situation, such as the low morbidity- mortality rates in Greece and knowing that beloved ones are healthy, appear to have been helpful to some participants. Another particularly interesting finding was that many participants mentioned that looking towards the future, by maintaining a belief that the situation is transient, looking forward to an upcoming return to previous daily routine, to the cessation of restrictions and making plans for the future, proved helpful to them. Moreover, two participants acknowledged the feeling that they are not alone, meaning that this is a shared experience, as a useful thought in order to help them cope with their worries.
…and generally, not to feel like I'm alone in all this… (Participant 1)
Finally, regarding the thoughts that adolescents found helpful, confidence in authorities and community seems crucial, as many participants referred to the sufficient functioning of State institutions in Greece, the citizens’ compliance with the measures and their trust in the scientific community.
…and I think that Greece has taken precautionary measures early compared to other countries, and that we are one of the safest countries at the moment (Participant 6)
… there aren't many violations (Participant 1)
... we have taken our precautions ... well, and that reassures me... (Participant 6)
... both doctors and experts do as much as they can to help people feel safe... (Participant 2)
Regarding the helpful behaviors, few participants recognized that calibrating the amount of incoming information is significantly helpful. More specifically, two participants referred to their need to hear good news about the pandemic in order to feel better, whilst one participant focused on his need for limited media information and pointed out his concurrent need to keep informed about what is going on.
I generally don't sit and watch the news all the time… this doesn’t help me obviously… I watch very little, just enough so as not to live in a bubble (Participant 1)
Additionally, nearly all participants referred to their need for creative leisure activities and their need to relate to others by maintaining contact with beloved ones, as well as appealling to them for comfort when needed:
Obviously, it helps to talk to my friends and not to self-isolate, and to talk as much as I can with my grandparents via Skype.... and when I'm feeling anxious, to go to my parents and be encouraged ... I believe this... (Participant 1)
Practices of helping adolescents deal with the situation
The concepts that emerged from the raw data and the wider conceptual categories are shown in Table 5. Some participants found the overflow of information to be unhelpful and referred to their need to calibrate the flow of information received. However, they acknowledged their need to be informed about the latest developments of the pandemic. Others stated that adults offering to answer their queries and hearing positive updates was helpful.
Obviously [family] not to hide things from me, not to tell me ‘everything is fine’, because, ok, I wouldn’t like not knowing what is going on... but I wouldn’t also like them to overanalyze all this and have aimless discussions (Participant 1)
A balanced approach and mode of thinking in the adolescent’s environment was identified as a helpful strategy by several adolescents, who focused on their family’s positive attitude and avoidance of excessive panic:
... if a family’s or the relative’s, or the wider environment’s general perception is positive and right, then the child does not worry that much and is relieved (Participant 2)
Just others not to feel sad and not give up (Participant 5)
Not to exaggerate... not to bring the end of the world… (Participant 1)
Emotion regulation within the adolescent’s environment was also recognised as helpful by half of the participants, in particular a calm emotional climate, the family’s ability to manage their own stress, having the chance to express painful feelings and receiving reassurance through discussion.
... that there will be no tension... and others not to be stressed because stress is transmittable, so I can perceive when my parents feel anxious (Participant 1)
... that I could talk to my parents or my sister about the problems that worry me (Participant 9)
... and they would tell me things like “this will go away soon”, “it will not last too long, and then things will be like before (Participant 3)
The family’s positive emotional climate proved to be the most commonly reported helpful aspect for the majority of the adolescents, meaning family and other people providing opportunities for discussion, showing empathy, and children feeling close to others and supported, thus avoiding loneliness. Some participants reported the physical proximity to their beloved ones as quite helpful.
When for example my relatives discuss with me, this helps me a lot (Participant 6)
... and when they understand to a great extent how we feel (Participant 2)
What I need now, I believe, is for my family to stand by me... because I don’t feel alone in that way (Participant 1)
It would help me very much, if the hospital staff could press the institution staff to come and get me... as soon as possible... and then, if they could bring my brothers here to see them for a bit, but they can’t actually considering where they live... (Participant 7)
Another helpful way to deal with the coronavirus pandemic, mentioned by two participants, was opportunities for shared leisure time and distractions coming from others.
... to spend our time creatively, not to have many moments that I would sit and think on my own about what will happen... so when others are next to me and draw my attention away from all this coronavirus issue, I believe this helps me a lot (Participant 1)
... when I discuss together with the people with whom I share the same space, this helps to take our minds off this (Participant 6)
One participant talked about future plans and the removal of restrictions as being comforting.
... it helps for others to tell me several things we can do and arrange when the pandemic ends, for example, discussing where we can go out, or where to spend the summer holidays (Participant 6)
Another female reflected on her thoughts that people’s compliance with the strict measures would help her feel better:
Maybe if all people would isolate themselves in their home, this would be helpful for me, because there are people who don’t abide by the measures and go out, and unfortunately that’s how the virus is being transmitted (Participant 8)
Notably, the same participant reported that there is nothing that could help her:
I think there is nothing that could help me think a bit different about the coronavirus (Participant 8)
Which was similar to another participant:
No, I don’t have anything… (Participant 4)
Two more adolescents initially could not think of any helpful practices, but soon they were able to identify specific ways through which others could help them feel better.