WITHDRAWN: Coping Healthfully but Still Distressed: A Mixed Methods Study of Distress and Coping Styles during the COVID-19 Pandemic

Background and Purpose: Research to date on the impacts of the COVID-19 pandemic on psychological distress has identified increases in the prevalence of several mental health issues stemming from life stressors such as economic insecurity, work/life imbalance, and loss of access to healthcare, childcare, and social support. In particular, higher levels of average stress, hopelessness, and depression in the general population are of paramount concern. Because different coping strategies may be associated with psychological distress, it is necessary to understand the strategies that Americans are employing to cope and the subsequent associations between these coping strategies and indicators of distress such as acute stress, hopelessness, and depression. This work will allow mental and public health professionals to better understand the short- and long-term psychological impacts of the COVID-19 pandemic while identifying adaptive coping strategies to inform the development and implementation of prevention and intervention efforts.

Methods: US residents (n = 2,380) were surveyed online in April 2020 as part of a larger longitudinal study on experiences and wellbeing during the COVID-19 pandemic. Baseline data were analyzed cross-sectionally. Study participants completed several validated scales like the Brief COPE, which assessed which coping skills they used, and responded to an open-ended question asking how they cope with stress in the context of the pandemic. Sequential mixed-methods data analysis was performed. Hierarchical regression was used to examine associations between coping strategies and mental health variables; open-ended responses were thematically analyzed.

Results: More than a third (37%) of our sample met criteria for depression and 59% for acute stress symptoms. Over 15% of our sample met criteria for moderate to severe hopelessness. Approach coping styles – including active coping, positive reframing, planning, acceptance, seeking emotional support, and seeking informational support – were reported more frequently than avoidant coping styles –including denial, substance use, venting, behavioral disengagement, self-distraction, and self-blame (p<.001). Approach coping was associated with lower levels of depressive symptoms and hopelessness (p<.001), and avoidant coping was associated with higher levels of depressive symptoms (p<.001). The open-ended responses provided rich detail on the specific coping strategies used, reasoning behind these choices, and self-reflection on the benefits and drawbacks of these coping styles.

Conclusion and Implications: Despite reporting higher levels of approach coping than avoidant coping, many participants reported high levels of depression, hopelessness, and acute stress. This may suggest that typical coping strategies have been less effective during the pandemic or that there are unmeasured modifiers of these associations; nonetheless, more research is needed to better understand the relationship between coping and distress. Elevated rates of depression, hopelessness, and acute stress signal a need to further monitor population-wide mental health, considering that mental health challenges may shift or escalate during the pandemic’s lengthy and uncertain course. Additionally, the high levels of distress in the population underscore the importance of preventing and reducing mental health concerns using a broad, destigmatizing public health model.