Unique associations between strategies of coping with COVID-19-related stress and internalizing symptoms in a clinical sample of adolescents

Youth internalizing symptoms increased significantly during COVID-19, suggesting a need for more knowledge on how to prevent youth mental health problems during future widespread societal health crises. This cross-sectional study examined coping strategies and how these were associated with internalizing problems in a clinical sample of youth during COVID-19. Youth (13-19 years) referred to mental health treatment for internalizing problems were assessed 6-18 months into the pandemic. Participants (N = 160, mean age = 15.8 years, SD = 1.2; 80% female, 5% non-binary) completed the Response to Stress Questionnaire, assessing COVID-19 stress, coping strategies, and involuntary stress responses. Internalizing symptoms were evaluated by the Spence Children's Anxiety Scale and the Short Mood and Feelings Questionnaire. Results showed that coping strategies were associated with internalizing symptoms, after controlling for sex, age, and COVID-19-related stress. Youth using primary control coping had lower levels of anxiety whereas those using secondary control coping strategies had fewer depressive symptoms and fewer involuntary disengagement responses. Secondary control coping (i.e., adapting to the situations) was the most frequent strategy. The highest COVID-19 stressors reported were insecurity about the future, and having to change, postpone or cancel important plans/events. Thus, in a clinical sample of youth, unique associations were found between the type of coping strategy and levels of anxiety and depressive symptoms. During future pandemics and societal health crises, measures to reduce unpredictability in everyday life and insecurity about the future should be implemented, followed by interventions to support adaptive coping strategies.