"I Manage By Keeping Busy and Taking My Meds" : A Qualitative Investigation of Coping Among Young Adults with Serious Mental Illnesses

Background: Coping is an essential part of managing a mental health condition. Individuals with serious mental illnesses (SMI) often lack coping resources and processes for managing the challenges of daily living (Taylor & Stanton, 2007). The number of young adults diagnosed with SMI is rising; thus, building knowledge on how they are coping can directly inform social work. The purpose of this study was to explore coping among young adults with SMI.

Method: The present study utilized qualitative data from a randomized trial (2018-2020) of multiply-marginalized young adults receiving services for SMI (N=59; Mean age=26.1, Range 18-34), 40.7% Black/African-American, 37.3% Latinx, 18.6% multiracial, and 3% White. Data are from a semi-structured interview, which included the question, “How do you manage your mental health?” Interviewers also used extensive probing. Thematic analysis steps were followed. Data was analyzed by four coders who met over a period of six months to discuss initial codes, grouped codes, and emergent themes (rigor was maintained through debriefing, resolving discrepancies with consensus, and reflexivity discussions). Two analysts reviewed the codes and themes in relation to the literature. Emergent themes are consistent with constructs in coping theories (coping resources, avoidant and approach coping), coupled with new salient themes and sub-themes.

Results: Individual characteristics related to coping were reported: optimism (“So I’m very optimistic about it. There’s no question in my mind that I will get better, and I’ll eventually go back to work”) and self-esteem (“...Keep my confidence up, don’t let nothing hold me down, like keep my head up high. I always have high self-esteem, never low self-esteem.”). Surprisingly, over 20% of the sample reported avoidance coping strategies, e.g., “don’t think about it”, “stay busy”. Many young adults reported approach focused coping, “I manage by keeping busy and taking my meds and staying focused and continuing program”. Providers commonly taught coping: (“I go to therapists and they teach me breathing exercises and visualization”). Participants also reported coping processes, e.g., patience and communication. For example, “I’m very patient...especially the patient part because you know mental health you have to have patience...you have to work on it.” Young adults also discussed expressive/ creative coping strategies, such as art, “I express my ways through art...” and music/dancing, “listening to music has helped me a lot. Writing my own music is helping me. Dancing, I love to dance. So dancing’s been helping me as well.” Importantly, a few participants discussed how coping is difficult,“Sometimes when something stressful happens, the symptoms get worse. And just coping with it. Like, sometimes it’s difficult.”

Conclusion/Implications: Data can be used to reimagine ways to embed coping resources, strategies and processes relevant to young adults in programs, such as dance, music and visual art. Also, data suggest classic approaches, such as coping effectiveness training (CET, Folkman et al., 1991) which helps people disaggregate global stressors into specific coping tasks could be adapted for young adults. Finally, data can inform policy-supported, locally developed resource guides for youth and families on ways to cope with SMI.