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Background: The pandemic has increased the rates of violent behavior towards women by their partners worldwide. Increased time spent living with the abusive partner, working at home and limited social contact combined with socioeconomic characteristics contributed to the increase in this type of violence., Objective: To investigate the impact of pandemic COVID-19 and social determinants of health (SDOH) on the intimate partner violence (IPV) experienced by women from their partners., Methods: A systematic review was conducted to investigate the impact of COVID-19 and social determinants of health on violence experienced by women from their partner(s) as a consequence of incarceration. The Pubmed and Scopus databases were searched during December 2022, using the keywords "intimate partner violence", "women", "COVID-19", "socioeconomic factors", "social determinants of health"., Results: Of the 917 studies initially retrieved, 38 studies found an increased prevalence of women's reported violence by their partners, 10 found a low prevalence, and 9 found no difference in prevalence before and during restraint. The most common forms of violence were psychological, physical and sexual. In 30 studies, social determinants such as socioeconomic level, education and living conditions were found to be associated with the prevalence of violence., Conclusion: There was an increase in violence against women during quarantine which was associated with the effect of social determinants. However, due to research limitations of the studies, additional research is needed to draw firm conclusions that can be generalized to the population., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2023 Athanasios Pitis, Maria Diamantopoulou, Foteini Tzavella.)

Introduction: The international literature presents a significant gap in the study of the factors affecting caring behaviors as perceived by nurses. This gap requires the study of the factors of nurses' caring behavior., Aim: The translation and the cultural adaptation of the Factors of Nurses Caring Behaviors (FNCB) scale in the Greek language, the validity, and internal consistency of the scale., Methods: Between November- December 2019, 329 Greek nurses from six public general hospitals completed the FNCB scale consisting of 32 items rating on a 5-point Likert scale. The scale was firstly translated in the Greek language, then back-translated in the English language and culturally adapted. To investigate the construct validity of the scale, exploratory factor analysis was carried out with principal component analysis. The test-retest reliability was performed while the internal consistency was checked through Cronbach's alpha coefficient. Statistical analysis was performed via the Statistical Program SPSS version 21.0. The statistical significance level was set up at 0.05., Results: The final Greek version of the FNCB Scale includes six factors which were revealed from the exploratory factor analysis: Workplace Circumstances, Workload/Management, Interest/Perceptions on Nursing Job,Nurse's Educational Background, Patient's Demographic Characteristics, and Patient's Clinical Characteristics. The internal consistency of the scale was excellent (Cronbach's alpha 0.95)., Conclusions: The Greek version of the FNCB Scale is a valid and reliable questionnaire which can be used for the measure of factors affecting nurses' caring behavior., Competing Interests: There are no conflicts of interest., (© 2021 Victoria Alikari, Evangelos C. Fradelos, Natalia Giannakopoulou, Georgia Gerogianni, Flora Efstathiou, Maria Lavdaniti, Sofia Zyga.)

Introduction: Elderly suffering from hypertension may also experience other psychological disorders in their daily life, such as depression and anxiety. Moreover, they use spiritual practices to relieve symptoms or comorbidities of hypertension. All these practices produce a calming effect on them., Aim: This study aims at investigating the relation between spirituality and mental health among older adults with hypertension and their sociodemographic characteristics., Methods: A descriptive, cross-sectional study was conducted in Greece. A questionnaire consisting of the sociodemographic characteristics, the FACIT-Sp-12 scale and the General Health Questionnaire-28 (GHQ-28) was completed by a total of 134 hypertensive elderly (≥65 years of age) persons. Descriptive and inferential statistical methods were used., Results: The sample consisted of 42,5% males and 57,5% females, aged 65 to 95 years, with a mean age of 78,38 years (SD= 6,68). A statistically significant correlation was found between FACIT-Sp-12 total score and the "physical discomfort (r=-0,562 p<0.001), "anxiety" (r=-0,735 p<0.001), "social disfunctioning" (r=-0,650 p<0.001), "depression" (r=-0,735 p<0.001) and the total score of GHQ-28 (r=-0,735 p<0.001). Specifically, the higher the total score of spirituality among older hypertensive adults the lower the rates of psychosomatic disorders and the total burden of mental health (and vice versa)., Conclusion: Results showed that younger elderly, living in urban areas and not experiencing any other chronic health conditions, have higher levels of spirituality compared to older. Also, a negative correlation was found between spirituality and mental health., Competing Interests: There are no conflicts of interest., (© 2020 Ioanna V. Papathanasiou, Chrysoula Papathanasiou, Foteini Malli, Konstantinos Tsaras, Dimitrios Papagiannis, Lamprini Kontopoulou,Lambrini Kourkouta Areti Tsalogliodou, Foteini Tzavella, Evangelos C. Fradelos.)

Introduction: Childhood obesity is a significant problem nowadays, with breastfeeding being one of many factors responsible for this issue. Breastfeeding as a natural way of feeding infants has many benefits for the child, the mother, and society., Aim: The present study aimed to investigate the association between overweight children in preschool age and breastfeeding duration., Methods: The current study included 674 preschool children aged 2-5 who attended various municipal kindergartens in South Athens. Questionnaires were given to parents where they recorded the child's personal and body data, parenting, and questions about pregnancy and lactation. The effect of BMI on the duration of breastfeeding in children was examined by the chi-square independence test. Fisher's and Monte Carlo simulations were also used. For data processing, Z scores and percentiles BMI for the first, second until fifth year of the child were found and based on these values the following categorization was performed; for values below -2 as low weight, values from -2 to 1 as normal weight, from 2 to 3 as overweight and over 3 as obese children. The Corresponding categorization was based on the 3rd, 85th, 97th, and 99.9th percentage position., Results: The percentage of children at preschool age who have been breastfed for over six months and had normal weight was higher than those who breastfed below six months. Moreover, the proportion of children who were low weight, overweight and obese was lower in children who had been breastfed more than six months compared to those who breastfed for a shorter period. Additionally, a statistically significant difference was found for the effect of breastfeeding on childhood obesity in children aged 2 to 5 years., Conclusion: There is a statistical association between breastfeeding duration and body weight in preschool age. Breastfeeding for more than six months has a positive impact on the child's weight., Competing Interests: There are no conflicts of interest., (© 2020 Ermioni Palaska, Aikaterini Lykeridou, Sofia Zyga, Georgios Panoutsopoulos.)

Introduction: It is estimated that 5.7% of the total Greek population suffers from depressive disorders. Elderly may be particularly prone to depression compared to younger people. In Greece, there is a paucity of literature regarding the correlation between the existence of chronic diseases, sociodemographic features, participation in open/ closed structures, and the presence of depression or depressive symptoms, among seniors. The purpose of this study was to explore potential correlations between the above- mentioned variables, as a whole., Methods: This was a cross- sectional, questionnaire survey of 200 elderly aged 65 or above and were members of 12 Open Care Centers for the Elderly (OCCE) or residents in 2 nursing homes located in the rural region of Epirus, in Greece. Data collection took place in the form of structured individual interviews. For the identification of independent factors associated with the existence of depressive symptoms, stepwise logistic regression analysis was performed., Results: A total of 81 (40.5%) seniors experienced depressive symptoms, though only 39 of them (19.5%) had been diagnosed for depression. Depression rates were higher for those with more chronic diseases (p=0.01) and at divorced, widowed and single seniors compared to married ones (50.5% vs. 28.1% respectively, p=0.002). The prevalence of depression was higher among the elderly who lived in nursing homes compared to the participants who were registered members of the OCCE (50% vs. 35.6% respectively, p=0.049), while elderly who often participated in the social activities of OCCE, had significantly lower rates of depressive symptoms compared to those who scarcely were involved in these activities (23% vs. 46.2% respectively, p=0.019). Participants who suffered from osteoporosis were more likely of displaying depressive symptoms compared to those who didn't; OR (95% Confidence Interval) = 2.61 (1.28-5.33), p=0.009., Conclusions: The existence of an action plan that includes education and training of health professionals on mental health of the elderly and the satisfactory operation of public facilities to promote the wellbeing of seniors and offer more incentives for activity participation, may reduce depression rates and the under-diagnosis of the disease., Competing Interests: There is no conflict of interest to declare, (© 2020 Katerina Kouvatsou, Maria Iliadou, Panagiota Kalatzi, Sakellari Evanthia, Prapas Christos, Kalafati Maria, Styliani Tziaferi.)

Introduction: Organisational climate generally refers to issues such as information sharing climate, appreciation and recognition, concern for employee well-being, ethics and quality performance. In hospitals, it represents the shared beliefs and values that may affect the quality of care in health care groups and which could be managed to improve the quality of care., Aim: Aim of the study was the translation of the Spiritual climate Scale (SCS) in Greek language and the validation of the scale for the Greek population., Methods: The SCS is an anonymous self-administered questionnaire that contains four, five-point Likert scale, closed questions. The questionnaire was translated into Greek language and then back translated in the English in order to be checked for any inconsistencies. The sample of the study was 275 nurses, working in two public hospital in Athens. Exploratory factor analysis, with principal components analysis was performed for checking the construct validity of the questionnaire. The test-retest reliability and the internal consistency were also examined. Statistical analysis performed by the use of SPSS 25.0. Statistical significance level was set at p=0.05., Results: From the total 275 of the participants 238(86.5%) were women and the mean age was 43.8±8.7. The final Greek version of the questionnaire includes all of the four questions and one factor was exported from the exploratory factor analysis. The Cronbach-α coefficient was 0.902 for the total questionnaire., Conclusions: The SCS is a valid and reliable questionnaire that can be used for assessing spiritual climate in Greek clinical areas., Competing Interests: None declared., (© 2020 Evangelos C. Fradelos, Foteini Tzavella.)

Introduction: Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with inflammatory bowel disease (IBD). Cytomegalovirus (CMV) infection can cause severe disease and complications in immunocompromised patients in consequence of disease or therapy., Aim: Our aim was to describe the prevalence and clinical outcomes of CDI with concomitant CMV infection in IBD patients hospitalized for flare-ups in association with the disease itself and medication used., Methods: We prospectively identified consecutive patients referred for CDI management during 2015-2017. Stool samples were tested for Clostridium difficile toxin A and/or B and Glutamate Dehydrogenase in patients with clinical symptoms. CDI patients with IBD history were tested for anti-CMV IgG and IgM antibodies by chemiluminescent microparticle immunoassay and underwent histological analysis for CMV on colon biopsies. Data were collected for demographic characteristics, treatment and outcome., Results: 125 patients with CDI were enrolled. Among these patients, 14 (11.2%) were diagnosed with IBD. The mean patient age of IBD patients was 52.5±15.4 years at diagnosis of CDI, 85.7% had UC, 14.3% CD, while the age of patients was shared. Eleven of the total of 14 patients (78.6%) tested positive for anti-CMV IgG. Of these, 3 patients (21.4%) exhibited high CMV IgG avidity, without detectable anti-CMV IgM and biopsy-proven CMV colitis. Of the 14 IBD patients with CDI, 8 patients (57.1%) were receiving anti-tumor necrosis factor (anti-TNF) therapy (21.4 % infliximab or golimumab, 7.1% vedolizumab or adalimumab) and 43.5% of patients were being treated with systemic corticosteroids. Four UC patients (28.6%) on steroids of the 14 CDI patients underwent a colectomy whereas none of the not on steroids patients underwent colectomy (p=0.25). Among them, 1 patient (7.1%) had recurrent CDI after 5 months from the first episode of CDI.These patients were treated with vancomycin, metronidazole and fidaxomicin. The mean age of patients that had a colectomy 65.5±9.32 (n=4) was higher than the mean age of those 47.30±14.49 (n=10) who improved (U Mann-Whitney =6. p=0.04)., Conclusions: Immunosuppressive medications and older age are associated with increased risk of CDI and poor outcome. Although, CMV is a rare colonic pathogen in the immunocompetent patient, it should be included and screened when exacerbation of IBD occurs in patients receiving any type of immunosuppressive therapy., Competing Interests: None declared., (© 2020 Maria Kosmidou, Nicoletta T. Karavasili, Maria Saridi, Alexandros Skamnelos, Athanasios Kavvadias, Anna Batistatou, Konstantina G. Gartzonika, Stavroula Tsiara, Konstantinos H. Katsanos, Dimitrios K. Christodoulou.)

Introduction: Psychological health is the expression of harmonic expression of human's personality and is often disrupted by multiple factors. Especially during academic years, human has to confront various stressful situations that endanger his Psychological health. Enhanced levels of Emotional Intelligence and Spirituality may act protectively enhancing his ability to manipulate his emotions and his existential anxieties., Aim: The present study aims to assess psychological distress in university students and test if emotional intelligence and spirituality are related., Methods: A cross-sectional study design was employed. The sample comprised 206 students attending in different Departments of the University of Thessaly., Results: From the total of 206 students the majority were women (n=157, 76,2%) while 23,8% were men. Regarding the mean of age of the participants was found to be 30.1 ±7.15 with a minimum 18 and maximum at 44 years. Factors such as gender, living arrangement and financial frustration can affect psychological distress. The results indicated, a positive link was found among Emotional Intelligence and various factors of Spirituality and Psychological health., Conclusions: The contribution of Emotional Intelligence and Spirituality is crucial to the acquisition of well-being, happiness and meaning in life., Competing Interests: There are no conflicts of interest., (© 2019 Athanassios Papazisis, Alexandra Koreli, Evdokia Misouridou.)

Introduction: A modifiable factor related to breastfeeding is breastfeeding attitudes. The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate this factor. Although the breastfeeding rates in Greece are declined there is not available any validated instrument to evaluate infant feeding attitudes., Aim: to determine the psychometric properties of the Greek adaptation of the IIFAS in a sample of pregnant women., Materials and Methods: Pregnant women (N=203) from a University Hospital in Athens, Greece, were administered the Greek version of the IIFAS, while being in hospital, and their infant feeding mode at six months postpartum was recorded by telephone. The reliability of the scale was assessed by using corrected item-total correlations and Cronbach's alpha. Construct validity of the scale was assessed by using confirmatory factor analysis and predictive validity by using t-tests. Multiple linear regression analyses in a stepwise method (p for removal was set at 0.1 and p for entry was set at .05) was performed in order to find variables independently associated with IIFAS total score., Results: The mean IIFAS score was 70.0 (SD=7.6). The corrected item-total correlation ranged from 0.22 to 0.51. Cronbach's alpha was equal to 0.71. The confirmatory factor analysis indicated an adequate fit of the one-factor model. Concerning the predictive validity of IIFAS it was significant for breastfeeding at six months. The mean IIFAS score was significantly greater (p=0.001) for women that had exclusive breastfeeding at six months (mean (SD): 68.4(6.6)) as compared with those that did not (mean (SD): 64.0(7.5)). Higher IIFAS scores were found in older women, with higher educational level and in those that had breastfed children in their social environment., Conclusion: The Greek version of the IIFAS demonstrated satisfying reliability and validity for measuring women's infant feeding attitudes in the Greek context. Also, the results of the present study provide further evidence of the international applicability of the IIFAS., Competing Interests: The authors declare no conflict of interest., (© 2019 Maria Iliadou, Katerina Lykeridou, Panagiotis Prezerakos, Chara Tzavara, Styliani G. Tziaferi.)

Introduction: Anxiety management is one of the most important health issues which is being faced by humans today. Biofeedback, as a method of neurophysiology, has been added to the methods recommended for this purpose., Aim: The aim of the study was to measure the effectiveness of biofeedback method by using Brain Boy Universal Professional in the treatment of anxiety disorders., Methods: The sample of this research study consisted of 50 individuals, suffering from symptoms of anxiety, who underwent biofeedback therapy. For the purposes of this study, the self-administered questionnaire Hamilton Rating Scale for Anxiety was completed by the individuals both before the initiation of the therapy and after individuals had completed ten sessions of treatment with biofeedback., Results: Prior to biofeedback, 26% of the participants showed mild to moderate anxiety, 12% a medium severity of anxiety and the remaining 62% severe anxiety. After the completion of 10 sessions of biofeedback, 78% of the participants was found to experience mild to moderate anxiety, 12% a medium severity of anxiety and only 10% of severe anxiety., Conclusion: Biofeedback can be a therapeutic method for the treatment of anxiety disorders, giving treatment to patients who do not respond to drugs but also to patients who want to apply to undergo such treatment alongside other therapeutic methods including drugs., Competing Interests: There are no conflicts of interest.

Introduction: Health-related quality of life is a major issue among patients with Multiple sclerosis (MS)., Aim: To explore the effect of fatigue and pain self-efficacy on health-related quality of life among patients with MS., Methods: Between March and May 2018, 85 MS patients from a large Hospital of Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001., Results: Fatigue might predict the dimension of quality of life "Function" while Pain Self-Efficacy might, also, predict the dimension of quality of life "Interpersonal". A strong correlation was found between the dimensions of quality of life "Well-being" and "Transcendent" and between "Interpersonal" and Pain Self-Efficacy. The total score of fatigue was strongly correlated with Physical Fatigue and very strongly correlated with Mental Fatigue., Conclusion: Fatigue and Pain Self-Efficacy are important predictors of the dimensions of quality of life among patients with MS. Pain in MS has to be taken into serious consideration in every patient with MS., Competing Interests: There are no conflicts of interest.

Introduction: Exclusive breastfeeding is the optimal mode of feeding for the first six months of a child's life. Modifiable factors associated with increased breastfeeding, may be addressed through antenatal breastfeeding education. In Greece, the rates of exclusive breastfeeding remain rather low., Aim: The aim of the current study was to evaluate the effectiveness of a structured in-hospital midwife-led antenatal breastfeeding educational programme on breastfeeding knowledge and self-efficacy, attitudes towards breastfeeding and perceived-barriers of breastfeeding., Patients and Methods: This was a quasi-experimental study with two study groups: an intervention group (following a four-hour midwife-led antenatal breastfeeding programme) and a control group. All nulliparous women attending antenatal care at the tertiary hospital in Athens, Greece during May 2016-January 2017 were invited to participate, of which 203 nulliparous pregnant women took part. Demographic data forms, the Breastfeeding Self-efficacy Scale, the Iowa Infant Feeding Attitude Scale, the Breast Feeding Knowledge Questionnaire and the Perceived Breast Feeding Barriers Questionnaire were used for data collection., Results: Post-intervention, women in the intervention group had a more positive attitude towards breastfeeding (73.5% versus 66.1%, p<0.001), greater knowledge (14.6% versus 13.1%, p<0.001) and more breastfeeding self-efficacy (51.4% versus 45.6%, p<0.001) compared to the control group. Furthermore, they had significantly less perceived barriers regarding breastfeeding (27.4% versus 31.0%, p<0.001)., Conclusion: The four-hour antenatal breastfeeding education intervention which occurred and was evaluated for the first time in the Greek female population was effective in increasing breastfeeding knowledge, self-efficacy and a positive attitude towards breastfeeding. The intervention was furthermore effective in lowering perceived breastfeeding barriers. This midwife-led antenatal breastfeeding education programme could be suitable for integration to routine antenatal care in health care services in Greece.

Introduction: The financial crisis in Greece had its strongest impact on unemployment, which led to exacerbation of shrinking incomes and depression symptoms., Aim: To investigate the combined effects of unemployment and economic distress on the Greek population mental health in times of economic crisis., Material and Methods: A cross-sectional study was conducted in the Piraeus Manpower Employment Organization (OAED), during September-December 2017, with 21,600 unemployed people records. A random sample was selected among unemployed who attended this entity. A questionnaire was structured including questions on the unemployed' sociodemographic characteristics, the Index of Personal Economic Distress (IPED), and the CES-D (Center for Epidemiological Studies -Depression) scale. Descriptive and inductive statistics were performed in order to find the statistical significance of differences. Binary logistic regression was realized to investigate the associations of unemployment and economic distress as prognostic factors for the experience of symptoms associated with depression., Results: Totally, 130 unemployed participated in the study. 67.7% was female, the mean age was 37.8 years and 47.7% had a secondary educational level. A significant reduction in household monthly income before and after unemployment was observed (p=0.001). The majority of sample was long-term unemployed and 42.3% was short-term. The mean score of IPED was 12, meaning great economic distress. Moreover, based on CES-D score 63.8% of unemployed presented elevated depression and 36.2% no symptoms of depression. Positive correlation was found between the duration of unemployment with IPED (r=0.565) and with CES-D score (r=0.173). The logistic regression showed that the likelihood of expressing depression was influenced by increasing IPED (OR=1.089) and duration of unemployment (OR=1.322)., Conclusions: The duration of unemployment and economic hardship led to a higher risk of depressive symptoms, thus policy actions must place greater emphasis on providing additional support through the creation of a more adequate and effective integrated social and health care network.

Introduction: People suffering from tendinopathies exhibit reduced mobility due to the pain caused by the movement of the tendons involved. Recently, shockwave therapy has been used as a treatment option, which is non-invasive, simpler, faster and safer., Aims: To record the intensity of the pain, the functionality of the upper and lower limbs and quality of life before treatment with shock waves, immediately after the treatment and the 4-week follow-up., Methodology: The sample consisted of 384 patients, suffering from a tendinopathy. 326 patients constituted the shockwave intervention groups and 58 patients made up the control groups. The researchers created a self-administered questionnaire (University of Peloponnese Pain, Functionality and Quality of Life Questionnaire) in which the intensity of pain, functionality and quality of life were evaluated on a five-point Likert scale, before, immediately after the treatment and at a 4-week follow-up., Results: The pain reduction and the improvement of functionality and quality of life after shockwave treatment increased by at least two points on the five-point Likert scale both post-treatment (p<0,001) and at a 4-week follow-up (p<0,001) compared to post-treatment in elbow tendinopathy, Achilles tendinopathy, plantar fasciitis and rotator cuff tendinopathy., Conclusions: Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice because of its effectiveness and safety.

Background: According to World Health Organization (WHO), spirituality is an important domain of quality of life especially in terminal, life threatens chronic diseases. For many people spirituality and religion are not just very important dimensions of their existence, but also a source of support that contributes to wellbeing and coping with everyday difficulties of life., Aim: Aim of the study was the translation of the Facit Spiritual Well Being Scale (Facit-Sp12) in Greek language and the validation of the scale for the Greek population., Material and Methods: The Facit-Sp12 questionnaire is an anonymous self-administered questionnaire that contains twelve, four point Likert scale, closed questions (0=Not at all, 1=A little bit, 2=Some-what, 3=Quite a bit, 4=Very Much). The questionnaire was translated into Greek language and then back translated in the English in order to be checked for any inconsistencies. The sample of the study was 183 chronic kidney disease patients, undergoing hemodialysis. Exploratory factor analysis, with principal components analysis with Varimax rotation was performed for checking the construct validity of the questionnaire. The test-retest reliability and the internal consistency were also examined. Statistical analysis performed by the use of SPSS 21.0. Statistical significance level was set at p=0.05., Results: The final Greek version of the questionnaire includes all of the twelve questions. The mean age of the participants was 61.81±13.9. Three factors were exported from the statistical analysis. The Cronbach-α coefficient was 0.77 for the total questionnaire and for each subscale was 0.70 for "meaning", 0.73 for "peace" and 0.87 for "faith". Between the three subscales "meaning" had the highest score (mean 12.49, SD=2.865)., Conclusions: The Facit Spiritual Wellbeing Scale-Facit-Sp12, is a valuable and reliable questionnaire of three dimensions that can be used for assessing spirituality and spiritual wellbeing in Greek population.

Introduction: The nursing profession is characterized as one of the most stressful professions. A significant number of international surveys prove that nurses experience anxiety that often is accompanied by intense symptoms that negatively affect their work performance and their psychological mood., Aim: To evaluate the ways of coping in stress adopted by the nursing staff and their relationship with sociodemographic and job characteristics., Methodology: A cross-sectional, quantitative study was conducted in seven hospitals of Peloponnese Region, Greece. The study took place between April 2013-June 2013 and 395 nurses completed the Ways of Coping questionnaire. Socio-demographic, educational and job characteristics of nurses were, also, recorded., Results: Strategies focused on the problem were adopted to a greater extent more by postgraduate nurses, head nurses, and nurses with greater working experience. Intensive Care Unit nurses mainly adopted the strategy of denial while strategies focused on emotions were mostly adopted by females. Age and marital status did not affect significantly the choice of coping strategies., Conclusions: According to our findings several demographic factors that affect coping in stressful situations can be investigated and such an investigation could offer useful research findings for consideration.

Introduction: Patients who suffer from chronic renal disease face problems in many aspects of their life; problems such as physical and social as well as mental such as stress, anxiety, depression. In addition, they exhibit an amount of spiritual needs, which relate and influence the psychological adaptation to the illness., Aim: The aim of this article is to examine evidence from the international literature regarding the possible relation of spirituality and health outcomes, mostly in the complex codex of a chronic and life treathing disease such as CKD., Results: Spirituality is a very debatable issue and the term has no single and widely agreed definition. The key components of spirituality were 'meaning', 'hope', 'relatedness/connectedness', and 'beliefs/beliefs systems'. Spirituality has been characterized as the quest for meaning in life, mainly through experiences and expressions of mind, in a unique and dynamic process different for each individual. For many individuals spirituality and religion are important aspects of their existence, constituting a source support contribute to wellbeing and coping with life's daily difficulties., Conclusion: Considering, assessing and addressing chronic kidney disease patient's spirituality and spiritual needs is necessary and it can have a positive outcome in health related quality of life, mental health and life expectancy.