Coping in the Time of COVID-19: Buffering Stressors With Coping Strategies

Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study

BACKGROUND

The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care.

OBJECTIVE

This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes.

METHODS

A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness.

RESULTS

The findings indicated an evolving trajectory in students' mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=-2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=-2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=-5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=-7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=-8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=-10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03).

CONCLUSIONS

In this study, students' mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students' mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students' mental health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/29561.

Differential effects of COVID-19 stressor types on mental health and moderating roles of coping strategies

Stress exposure often leads to poor mental health, but whether certain types of stressors predict differential levels of mental health symptoms and whether coping differentially moderates these associations remain untested. This study examined whether COVID-19 stressor types (financial-, activity-, and infection-related) differentially predicted subsequent mental health (general distress, posttraumatic stress symptoms (PTSS), and positive states of mind) and whether different types of coping moderated these relationships. In April, 2020, questionnaires assessing the impact of COVID-19 on daily life were administered to an adult sample across the US (N = 1,546); 861 (55.7%) of whom completed questionnaires one month later. Nearly all stressor types independently predicted each aspect of mental health. Behavioral disengagement moderated links between both activity- and infection-related stressors and mental health. Seeking emotional social support moderated links between infection-related stressors and both general distress and positive states of mind as well as activity-related stressors and general distress. Positive reappraisal moderated links between financial-related stressors and positive states of mind. Acceptance coping predicted better mental health but was not a significant moderator. Stressor types and coping strategies are important determinants of effects of COVID-19 on mental health; our findings suggest possible screening and intervention implications and directions for future research.

Coping with depression: a narrative study of an online depression community in China

PURPOSE

The goal of this study was to explore the coping strategies of depression sufferers that have worked for them based on the study of an online depression community.

METHODS

We conducted a thematic narrative analysis of 120 stories posted by the members in the largest online depression community in China. MaxQDA version 18 was used to code the data, and the analytic approach was consistent with the category-centred approach of grounded theory.

RESULTS

The study found that the coping strategies mainly include self-reconciliation (e.g., perceiving/accepting feelings, accepting the present self, and holding hope for the future), actions (recreational activities, physical exercise, and engaging in volunteer work), addressing the stressors and symptoms (e.g., staying away from stressors, seeing the doctor), and seeking interpersonal support (e.g., seeking support from family, friends, and peers).

CONCLUSION

The findings revealed the coping strategies that were helpful and examined how they functioned for the affected members, which make up for the lack of attention to the individual experiences of depression sufferers in coping research. The findings also have practical implications for the related education and consultation, providing useful insights for doctors and patients. These ways of coping are based on depression sufferer' anonymous narratives, which can be convincing to clients.

Resilience resources, coping, and health outcomes in college students during the Covid-19 pandemic

Background: Resilience resources are predispositions that promote individuals' abilities to cope with stress. Objective: The current cross-sectional study used path analysis with parallel multiple mediators to test whether coping behaviors mediated associations between resilience resources and somatic, depression, and anxiety symptoms during the Covid-19 pandemic. Method: Undergraduates at a small Northeastern college (n = 193) completed online surveys assessing resilience resources, coping, and symptoms. Results: Results support significant indirect effects from resilience resources to somatic symptoms through positive reinterpretation and growth, mental disengagement, and substance use. Total indirect effects for depressive symptoms were driven by mental disengagement and substance use, with a direct effect of resilience resources. The effect of resilience resources on anxiety symptoms was mediated by mental disengagement, and there was a direct effect of resilience resources. Conclusions: Findings demonstrate that some coping strategies link resilience resources to better outcomes, potentially informing interventions for adaptive coping during public health crises.

Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic

Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.

Finding Strength in Times of Crisis? Post-Traumatic Growth During the Covid-19 Pandemic: A Saudi Arabian Perspective

This paper contributes to the Covid-19 literature by exploring the concept of post-traumatic growth (PTG) utilizing a mixed methods approach. The study examines to what extent the participants experienced positive growth and renewal arising from the prolonged period of lockdowns and emergency online learning. Exploring the experiences of 552 female undergraduate students in a private Saudi Arabian university, an online survey was utilized to gather the data. All the students had experienced online education as a result of the pandemic. The findings indicate the participants underwent a diversity of personal growth experiences. In addition, they also developed different coping mechanisms. The study provides insights into the responses of the students to the issues they were facing during the pandemic. It identifies ways in which participants experienced personal growth as well as a shift in perspective about their lives. There are implications for educators, counselors and policymakers emerging from this study.

Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study

BACKGROUND

The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described.

OBJECTIVE

This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic.

METHODS

A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic.

RESULTS

The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals.

CONCLUSIONS

To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19.

Individuals' Coping Styles and Levels of Depression, Anxiety, and Stress During the COVID-19 Pandemic in Turkey: A Web-Based Cross-Sectional Study

This cross-sectional study aimed to determine the correlation between the coping styles and depression, anxiety, and stress levels of individuals living in Turkey during the COVID-19 pandemic. The study was conducted using an online questionnaire (Socio-demographic Form; Depression, Anxiety, and Stress Scale-21; Coping Styles Scale) and it included 483 individuals. Descriptive statistics, ANOVA, Independent Samples t-test, Kolmogorov-Smirnov, Hosmer-Lemeshow and Scheffe tests, Pearson Correlation, and Binary Logistic Regression analyzes were used to analyze the data. There was a negative correlation between the participants' self-confident and optimistic coping styles mean scores and their depression, anxiety, and stress mean scores. There was a positive correlation between the participants' helpless, submissive, and seeking social support coping styles mean scores and their depression, anxiety, and stress mean scores. The regression analysis revealed that using the helpless coping style increased the depression, anxiety, and stress levels of the participants while using the optimistic coping style and visiting a physician during the pandemic decreased them. In addition, seeking social support coping style increased the level of depression while the testing during the pandemic increased stress levels. As a result, it is recommended to strengthen society's psychological resilience and expand mental health support services for such mental illnesses.

Coping Strategies and Trauma-Related Distress of College Students During Covid-19

Present-day college students are particularly impacted by the disconcerting effects of Covid-19 because of their vulnerability towards mental health struggles. The current study identified coping strategies used by students in the United States and how those strategies are associated with trauma-related distress. Results showed acceptance, emotional processing, and social support were the most commonly used coping strategies. Furthermore, avoidance coping related to higher distress than more helpful approaches (e.g., humor). Demographic findings revealed that Black students used more religious coping than did White and Asian students. Additionally, older and upper-year students used substances to cope more than did other students, including those with higher grade point averages. Our discussion focuses on how the findings of the present study can be used to enhance student support, resiliency, academic performance, and retention.

You can't do anything about it, but you can make the best of it: a qualitative analysis of pandemic-related experiences in six European countries

BACKGROUND

The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare.

OBJECTIVE

This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic.

METHOD

The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis.

RESULTS

Participants' accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life, Emotional distress, and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth, Opportunity for meaningful/enjoyable activities, and Benefits on interpersonal level. Key themes identified from participants' recommendations to cope with the pandemic included Beneficial behavioural adjustment, Beneficial cognitive-emotional strategies, and Social support.

CONCLUSIONS

Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond.

HIGHLIGHTS

We examined COVID-19-related experiences in 7309 adults from six European countries.Besides challenges, participants identified many positive pandemic consequences.Participants' recommendations to cope with COVID-19 included behavioural and cognitive-emotional strategies.