Heightened symptoms of depression and anxiety were common during the early weeks and months of the COVID-19-related quarantine orders last spring, and now, British behavioral scientists have found that these symptoms decreased quickly when people used socially supportive coping strategies, which involve turning to family and friends for emotional support, instrumental support — which offers help in a tangible or physical way — and venting.
Individuals dealt with the stress, fear and trauma of the beginning of the coronavirus pandemic in many different ways, including many different kinds of coping strategies. In a paper published April 22 in Social Science & Medicine, researchers from University College London studied the mental health progression of adults in the U.K. during COVID-19 and what coping strategies may have affected their symptoms. Coping refers to the cognitive and behavioral efforts used to manage stress.
The coping strategies they measured were categorized into four groups: problem-focused coping, which includes active coping and planning; emotion-focused coping, which includes positive reframing, acceptance, humor and religion; avoidant coping, which includes behavioral disengagement, denial and substance use; and socially supportive coping, which includes emotional support, instrumental support and venting.
"People can play an active role in supporting their own mental health by adopting different strategies to cope with these challenges," Feifei Bu, a co-author of the paper and a senior research fellow at University College London, told The Academic Times. "It is important to know which coping strategy is effective in supporting good mental health for the purpose of developing guidelines and interventions."
The data for this paper came from the COVID-19 Social Study, a larger ongoing project run by University College London. All authors of the paper are affiliated with the COVID-19 Social Study, which has been collecting survey data from more than 70,000 British adults since March 2020 and is the U.K.'s largest study into the psychological and social impact of the pandemic.
The current paper focused on responses from more than 26,500 participants, who were recruited between March 21, 2020, and August 14, 2020. During this period, the first national lockdown in the U.K. went into effect on March 23, 2020, and restrictions were first eased on May 10, 2020, before being further eased in June and July. The participants included had responded to a coping module offered in the COVID-19 Social Study.
"We analyzed the data to examine how people's mental health, measured by depressive and anxiety symptoms, changed over this period — increase, decrease or stable — and, in particular, how the adoption of different coping strategies was related to the longitudinal changes in mental health," Bu said.
Since the COVID-19 Social Study began, the research team has published several papers based on the collected data, but according to the current paper, this is the first study in the U.K. to examine how coping strategies were related to the growth trajectories of depressive and anxiety symptoms during the pandemic.
"Individuals' stress responses may have long-term health consequences," the authors said in the paper, giving the example that "avoidant strategies may help reduce short-term stress, but are generally considered harmful in the long term as no direct actions are taken to reduce the stressor, leading to prolonged exposures to high levels of stress."
Coping was measured using the Brief-COPE questionnaire, a 28-item short version of the Coping Orientation to Problems Experienced (COPE) Inventory that is designed to measure effective and ineffective ways to handle a stressful life event. Depressive symptoms in the participants were assessed using the Patient Health Questionnaire, and anxiety symptoms were measured with the Generalized Anxiety Disorder assessment.
At the beginning of the first U.K. lockdown due to the COVID-19 pandemic, depressive and anxiety symptoms were higher among people who reported a greater use of problem-focused, avoidant and socially supportive coping strategies. But people who used socially supportive coping more saw their depressive and anxiety symptoms decrease at a faster rate over the following weeks than people who used that strategy less.
Social support has been shown to help build resilience to stress over time, the authors said, which may have led to the participants in this study gradually recovering from their distress at the start of the lockdown mandate. "[Overall] depressive and anxiety symptoms decreased over the period between March and August 2020 in the U.K. Socially supportive coping was associated with a greater rate of improvement over time, but no evidence was found for other coping strategies," Bu explained, noting that socially supportive coping was the most popular strategy among the sample, and avoidant coping was the least popular.
Problem-focused coping involves actively seeking solutions to problems. "It is possible that problem-focused coping styles were less effective because opportunities to alter or remove the source of stress were not available in the face of an uncontrollable virus," the authors reported in the study. Emotion-focused coping attempts to manage the emotions associated with a stressor instead of fixing the problem; the authors suggested that in the context of COVID-19, emphasizing the emotions and challenges of the pandemic may have been too stressful for this coping strategy to work.
Surprisingly, the researchers found that women's symptoms for depression and anxiety also decreased at a faster rate over the study period when they reported a high use of avoidant coping. This pattern did not hold true among men.
"It is of note that the gender gap in symptoms of anxiety and depression was greater at the start of lockdown, suggesting women may have experienced higher levels of stressors earlier in the pandemic [such as] balancing childcare and work ... while potentially also being more reactive to those stressors," the authors said. "Consequently, avoidant coping may have helped reduce the negative appraisal of these stressors, thereby supporting faster mental health recovery in women."
Future studies on coping strategies could "examine individual propensities toward certain coping styles in combination with specific behaviors that have been shown to be either beneficial or detrimental to mental health," the authors suggested, noting that coping styles are not mutually exclusive, and people likely use multiple strategies to deal with different stressors.
"Although our data were collected in the context of the pandemic, our findings here could apply more generally to our understanding of how different coping strategies are related to longitudinal changes in mental health in face of other psychological challenges," Bu said.
The study, "Coping strategies and mental health trajectories during the first 21 weeks of COVID-19 lockdown in the United Kingdom," published April 22 in Social Science & Medicine, was authored by Meg Fluharty, Feifei Bu, Andrew Steptoe and Daisy Fancourt, University College London.