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Coping strategies in young people during the COVID-19 pandemic: rapid review

Published online by Cambridge University Press:  30 July 2024

Ranjita Howard Open the ORCID record for Ranjita Howard [Opens in a new window] ,
Harshini Manohar Open the ORCID record for Harshini Manohar [Opens in a new window] ,
Shekhar Seshadri  and
Aditya Sharma
Ranjita Howard*
Affiliation:
NHS England Education North East, Newcastle upon Tyne, UK
Harshini Manohar
Affiliation:
National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Shekhar Seshadri
Affiliation:
National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Aditya Sharma
Affiliation:
Translational and Clinical Research Institute, Newcastle University, UK
*
Correspondence to Ranjita Howard (ranjitahoward@gmail.com)
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Abstract

Aims and method

To better understand factors supporting young people's (age <18 years) mental health during pandemic-type conditions, we aimed to identify whether coping strategies adopted during the COVID-19 pandemic could be dichotomised according to manifesting positive or negative psychological outcomes. Medline, EMBASE, CINAHL, PsycINFO, Scopus and ASSIA databases were used to identify empirical studies that examined coping strategies used by young people experiencing psychological challenges during COVID-19.

Results

Twenty-five international studies were included, identifying that coping strategies adopted could be significantly dichotomised according to reducing or exacerbating psychological challenges. Positive coping strategies were proactive and solutions-oriented, whereas negative coping strategies were more avoidant and emotion-oriented.

Clinical implications

An internal locus of control may account for why adolescents exercised more proactive coping compared with their younger counterparts, although parents of younger children may offset the impact of stressors by drawing on a proposed coping framework emphasising proactivity and engagement. This would be an invaluable addition to future pandemic preparedness planning cycles.

Keywords

COVID-19coping strategiespsychological challengeschild and adolescent mental health services
Type
Review Article
Information
BJPsych Bulletin , First View , pp. 1 - 10
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Although less physically affected by the COVID-19 pandemic than adults, the rising levels of anxiety,Reference Lavigne-Cerván, Costa-López, Juárez-Ruiz de Mier, Real-Fernández, Sánchez-Muñoz de León and Navarro-Soria1–Reference Zhou, Zhang, Wang, Guo, Wang and Chen7 depression,Reference Magson, Freeman, Rapee, Richardson, Oar and Fardouly2,Reference Xie, Xue, Zhou, Zhu, Liu and Zhang6–Reference Chen, Zheng, Liu, Gong, Guan and Lou8 stress,Reference Carmassi, Foghi, Dell'Oste, Cordone, Bertelloni and Bui9–Reference Saurabh and Ranjan11 suicidal ideation,Reference Wasserman, Iosue, Wuestefeld and Carli12,Reference Isumi, Doi, Yamaoka, Takahashi and Fujiwara13 attention-deficit hyperactivity disorderReference Breaux, Dvorsky and Becker14,Reference Bobo, Lin, Acquaviva, Caci, Franc and Gamon15 and autismReference Kreysa, Schneider, Kowallik, Dastgheib, Dogdu and Kühn16–Reference Mutluer, Doenyas and Aslan Genc18 during the peak of the pandemic suggest that the mental health of young people (aged <18 years) was more affected.Reference Holmes, O'Conner, Perry, Tracey, Wessely and Arseneault19,Reference Racine, Cooke, Eirich, Korczak, McArthur and Madigan20 Given this impact, it is imperative to understand those factors that may help young people better manage through pandemic-like conditions and beyond, and one of the burgeoning areas of research is how young people cope with the stressors they face. Coping behaviour has been characterised by one's capacity to either engage a stressor or avoid it completely via the adoption of specific coping strategies.Reference Lazarus21 Originating from Lazarus and Folkman,Reference Lazarus and Folkman22 such coping strategies are generally dichotomised as yielding positive outcomes, through exercising solutions-oriented, help-seeking or adaptive cognitive resources; or negative outcomes, through exercising avoidant-oriented, emotion-focused or maladaptive cognitive resources.Reference Lazarus and Folkman22–Reference Moos, Schaefer, Goldberger and Breznitz26 More specifically, coping strategies that engage a stressor involve either proactive practices (primary control coping), such as listening to and taking advice from experts, or cognitive practices (secondary control coping) that allow one to adapt their response to the stressor, such as positively appraising or reframing its impact.Reference Carver and Connor-Smith27,Reference Compas, Jaser, Dunn and Rodriguez28 Conversely, strategies that avoid or disengage one from a stressor involve efforts to orientate away from such, including denying a stressor's existence, suppressing one's emotions, withdrawal from others and substance misuse.Reference Gerhold24,Reference Carver and Connor-Smith27

In relation to child and adolescent research, both primary and secondary control coping have been significantly associated with the reduction of a range of psychological challenges in young people, including stress, anxiety, depression and loneliness,Reference Aldao, Nolen-Hoeksema and Schweizer29–Reference Schäfer, Naumann, Holmes, Tuschen-Caffier and Samson31 compared with avoidant strategies, which tend to exacerbate such.Reference Compas, Jaser, Bettis, Watson, Gruhn and Dunbar30,Reference Schäfer, Naumann, Holmes, Tuschen-Caffier and Samson31,Reference Kahraman and Demirci63,Reference Rose, Carlson and Waller64 Moreover, this dichotomy may also extend to differences among children and adolescent populations who may manifest their coping behaviours differently, given that adolescents utilise more complex cognitive processes (i.e. internal locus of control) compared with younger children, who tend to cope more incidentally and are more reliant upon external sources (i.e. parental reactivity).Reference Thompson, Goodman, Kring and Sloan32–Reference Zimmer-Gembeck and Skinner35

Method

Aim

The aim of this review was to identify whether coping strategies employed by young people during the pandemic could be positively or negatively dichotomised in terms of significantly reducing or exacerbating psychological challenges, and whether there was a difference between children and adolescents in terms of the adoption of specific coping strategies. The development of a coping framework to offset the impact of tumultuous stressors as a consequence would no doubt be an invaluable addition to any future pandemic preparedness planning cycle.

Search methodology

Medline, EMBASE, CINAHL, PsycINFO, Scopus and ASSIA databases were searched in March 2021. With respect to the coping strategies adopted, we used the following keywords: ‘coping’, ‘support’, ‘avoidance’, ‘help-seeking’, ‘problem-solving’, ‘stress management’, ‘distraction’, ‘escapism’, ‘resilience’, ‘adjustment’, ‘adaptive’ and ‘cognitive restructuring’ (Supplementary File 1 available at https://doi.org/10.1192/bjb.2024.49). Papers were included if they were empirical, peer-reviewed, available in English, published during the pandemic, included participants aged <18 years who were experiencing psychological challenges, and recorded data relevant to any coping strategies adopted.

Screening and quality assessment

Following electronic and manual searches and consistent with Cochrane guidelines for rapid reviews, articles were independently screened by the first (R.H.) and second author (H.M.), and filtrated to potentially relevant papers, which were fully reviewed by R.H. and H.M. according to the inclusion criteria. Study quality, completed by R.H. and cross-checked by H.M., were assessed according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines (Supplementary File 2 available at https://doi.org/10.1192/bjb.2024.49). Any discrepancies or non-consensus during the screening and quality assessment process were resolved collaboratively and with the entire research team when necessary.

Search outcome

A total of 7014 studies were found from the original electronic search, of which 25 met the inclusion criteria and were included in this review (see Fig. 1).

Fig. 1 Flow diagram illustrating search strategy for the review.

Results

Countries of origin

Studies originated from China,Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Wang, Liu, Wang, Lin, Lin and Wang55,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Liu, Jiang and Zhang60 the USA,Reference Corbett, Muscatello, Klemencic and Schwartzman39,Reference Hussong, Midgette, Thomas, Coffman and Cho45,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48,Reference Mueller, Richer, Callina and Charmaraman49,Reference Tambling, Tomkunas, Russell, Horton and Hutchison54 Spain,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference Orgilés, Espada and Morales51 Italy,Reference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53 Canada,Reference Ellis, Dumas and Forbes43 India,Reference Dumbre, Ramesh, Chavan and Jabade42 Turkey,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38 the UK,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 Belgium,Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37 Philippines,Reference Agbing, Agapito, Baradi, Bernadette, Guzman and Ligon36 Russia,Reference Gerasimova and Kholmogorova44 HollandReference Achterberg, Dobbelaar, Boer and Crone58 and Qatar.Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56 Two studies involved a combination of countries: the USA and Puerto Rico;Reference O'Brien, Parra and Cederbaum50 and Spain, Italy and Portugal.Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52

Populations

The total number of participants from included studies was 25 157 (aged 0–18 years). Five studies sampled children exclusively (aged <13 years),Reference Agbing, Agapito, Baradi, Bernadette, Guzman and Ligon36,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Wang, Liu, Wang, Lin, Lin and Wang55,Reference Achterberg, Dobbelaar, Boer and Crone58 11 sampled adolescents exclusively (aged 13–18 years)Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Corbett, Muscatello, Klemencic and Schwartzman39,Reference Dumbre, Ramesh, Chavan and Jabade42–Reference Gerasimova and Kholmogorova44,Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Mueller, Richer, Callina and Charmaraman49,Reference O'Brien, Parra and Cederbaum50,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 and nine sampled both children and adolescents.Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Hussong, Midgette, Thomas, Coffman and Cho45,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48,Reference Orgilés, Espada and Morales51,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Tambling, Tomkunas, Russell, Horton and Hutchison54,Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56,Reference Liu, Jiang and Zhang60 Regarding psychological challenges, 15 studies assessed symptoms of anxiety,Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37–Reference Corbett, Muscatello, Klemencic and Schwartzman39,Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Gerasimova and Kholmogorova44,Reference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Orgilés, Espada and Morales51–Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53,Reference Wang, Liu, Wang, Lin, Lin and Wang55–Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59,Reference Liu, Jiang and Zhang60 14 assessed symptoms of decreased moodReference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Ellis, Dumas and Forbes43–Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Mueller, Richer, Callina and Charmaraman49,Reference Orgilés, Espada and Morales51,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Wang, Liu, Wang, Lin, Lin and Wang55–Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Liu, Jiang and Zhang60 and eight assessed symptoms of stressReference Agbing, Agapito, Baradi, Bernadette, Guzman and Ligon36,Reference Corbett, Muscatello, Klemencic and Schwartzman39,Reference Dumbre, Ramesh, Chavan and Jabade42,Reference Mueller, Richer, Callina and Charmaraman49,Reference O'Brien, Parra and Cederbaum50,Reference Tambling, Tomkunas, Russell, Horton and Hutchison54,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 . Internalisation and externalisation of emotions, adjustment, cognitive and behavioural alterations, irritability and self-harm were also assessed.

Study aims

The aim of included studies were to explore the efficacious employment of coping strategies generally,Reference Agbing, Agapito, Baradi, Bernadette, Guzman and Ligon36,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40–Reference Dumbre, Ramesh, Chavan and Jabade42,Reference Hussong, Midgette, Thomas, Coffman and Cho45,Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53,Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 and regarding specific coping strategies, including communicating with family,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference Ellis, Dumas and Forbes43,Reference Gerasimova and Kholmogorova44,Reference Tambling, Tomkunas, Russell, Horton and Hutchison54 communicating with friends,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference Ellis, Dumas and Forbes43,Reference Gerasimova and Kholmogorova44 utilising social media or internet use,Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Ellis, Dumas and Forbes43,Reference Gerasimova and Kholmogorova44 engaging in schoolwork/online learning,Reference Ellis, Dumas and Forbes43,Reference Li, Tang, Wu, Sun, Wang and Li47,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48,Reference Wang, Liu, Wang, Lin, Lin and Wang55 self-care practices,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference O'Brien, Parra and Cederbaum50 pet relations,Reference Ding and Yao3 physical activityReference O'Brien, Parra and Cederbaum50 and mindfulness.Reference Liu, Jiang and Zhang60 Additional areas included the influence of parental reactivity;Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference Wang, Liu, Wang, Lin, Lin and Wang55,Reference Achterberg, Dobbelaar, Boer and Crone58 demographic characteristics, including ageReference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40 and geography;Reference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52 coping and resilience training;Reference Orgilés, Espada and Morales51 and pre-existing challenges, such as neurodevelopment difficultiesReference Corbett, Muscatello, Klemencic and Schwartzman39,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48 and physical health difficulties.Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38

Measures

Measures predominantly assessed coping style/strategy, and symptoms relating to anxiety, depression, emotional regulation and life satisfaction. Two studies measured coping style/strategy using the Brief Coping Orientation to Problems Experienced (COPE) Scale,Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 two used the KidCOPE inventory,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48 two used a scale based on Parker and Endler's (1992) theoremReference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52 and others utilised the Children's Coping Strategies Checklist,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40 the Coping Style Scale,Reference Duan, Shao, Wang, Huang, Miao and Yang41 the Coping Strategies Inventory,Reference Hussong, Midgette, Thomas, Coffman and Cho45 the Trait Coping Style Questionnaire,Reference Liu, Jiang and Zhang60 the Coping Inventory to COVID-19 and Home Confinement in Children and Adolescents,Reference Orgilés, Espada and Morales51 the Coping with Children's Negative Emotions Scale (CCNES),Reference Wang, Liu, Wang, Lin, Lin and Wang55 the Coping Style Questionnaire (CSQ)Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 and a scale influenced by Edge and Sherwood.Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56 The remaining studies assessed coping style/strategy with bespoke instrumentation.

Regarding anxiety symptoms, the State-Trait Anxiety Inventory for Children (STAI-C),Reference Corbett, Muscatello, Klemencic and Schwartzman39 the Spence Child Anxiety Scale (SCAS),Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56 the Swine Flu Anxiety ScaleReference Ellis, Dumas and Forbes43 and the Generalised Anxiety Disorder-7 (GAD-7)Reference Li, Tang, Wu, Sun, Wang and Li47 scales were used, and decreased mood symptoms were assessed with several pre-existing scales, including the Child Depression Inventory,Reference Duan, Shao, Wang, Huang, Miao and Yang41 the UCLA Loneliness Scale,Reference Ellis, Dumas and Forbes43 the Kutcher Adolescent Depression Scale (KADS)Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56 and the Patient Health Questionnaire-9 (PHQ-9).Reference Li, Tang, Wu, Sun, Wang and Li47 Stress symptoms were assessed by the Responses to Stress Questionnaire (RSQ)Reference Corbett, Muscatello, Klemencic and Schwartzman39 and the Perceived Stress Scale (PSS).Reference Achterberg, Dobbelaar, Boer and Crone58

Pre-existing measures were also used to assess symptoms relating to emotional regulation, resilience and poor well-being. These included the Cognitive Emotion Regulation Questionnaire (CERQ)Reference Achterberg, Dobbelaar, Boer and Crone58 and Difficulties in Emotion Regulation Scale-COVID-19Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48; the Connor–Davidson Resilience ScaleReference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40 and Brief Resilience ScaleReference Zhang, Ye, Fu, Yang, Luo and Yuan57; and the Satisfaction with Life Scale (SWLS)Reference Gerasimova and Kholmogorova44 and Well-Being Index (WHO-5),Reference Gerasimova and Kholmogorova44 respectively.

The utilisation of a range of bespoke instrumentation to evaluate symptoms of anxiety,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53 low mood,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52 stressReference Agbing, Agapito, Baradi, Bernadette, Guzman and Ligon36,Reference Mueller, Richer, Callina and Charmaraman49 and lonelinessReference Mueller, Richer, Callina and Charmaraman49 were also utilised.

Synthesis of results

Positive coping strategies

Of the 25 studies reviewed, 17 identified positive coping strategies among children and adolescents that were significantly responsible for the reduction of a psychological challenge (see Table 1). The majority of coping strategies adopted were proactive, problem-oriented and engaging with respect to the pandemic stressor, and associated with reduced symptoms of anxiety, depression, loneliness, stress, sleep problems, and behavioural and cognitive alterations, at the noted significance levels.

Table 1 Positive psychological changes when a coping strategy is adopted by children and adolescents post COVID-19 onset

* P = 0.001, **P = 0.005, ***P = 0.01, ****P = 0.05.

Solutions-oriented coping strategies

Complying with regulations, taking appropriate medication and vaccines, help-seeking and drawing on legitimate resources were solutions-oriented strategies that were found to be significant. For example, Zainel et alReference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56 found that the majority adhered to governmental regulations during quarantine and sought out accurate information from official channels, strategies that were significantly associated with the reduction of depressive symptoms. Cenk et al,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38 in their comparison of 132 youths with cystic fibrosis with 135 healthy equivalents, found that through following infection control guidelines such as wearing masks and washing hands, the former presented with lower anxiety symptoms than their healthy peers. Although not reporting on a significant association, Tambling et al,Reference Tambling, Tomkunas, Russell, Horton and Hutchison54 in their qualitative analysis of parent-reported interactions with their children, demonstrated the positive role of parenting with respect to parents being sources of coping socialisation through making personal hygiene fun and engaging for their children.

Positive appraisal and cognitive restructuring

Acceptance of the situation, reframing the problem, seeing the advantages of being at home and using humour online were also found to be significantly efficacious. Liang et al,Reference Liang, Delvecchio, Buratta and Mazzeschi46 for example, found that acceptance of the situation (62%), seeking affection (36%) and positively appraising the benefits of being at home (36%) were responsible for the reduction of anxiety and mood symptoms for those in the least affected areas. Similarly, Corbett et al,Reference Corbett, Muscatello, Klemencic and Schwartzman39 who compared typically developed youths and those with autism spectrum disorder, found that typically developed youths adopted more acceptance, reframing and positive thinking strategies than those with autism spectrum disorder, resulting in significant reductions of stress and anxiety.

Communicating with family and friends

Drawing on support and advice from friends via social media, and spending more time with loved ones were also positively significant. Ellis et al,Reference Ellis, Dumas and Forbes43 for example, found that spending time with family, whether face to face or via video messaging, and virtually connecting with friends, was significantly associated with a reduction in loneliness and depression. Additionally, Gerasimova and KholmogorovaReference Gerasimova and Kholmogorova44 found that regular interaction with family was significantly associated with less loneliness and better psychological well-being, and Pigaiani et alReference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53 found that better well-being was associated with receiving support from family, allowing individuals to share their feelings and re-evaluate family relationships.

Engaging in structured activities

Activities such as schoolwork, taking on a new hobby, exercising more and engaging in mindful or spiritual activities were also significantly associated with reduced psychological challenges across our sample. Pigaiani et al,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53 for example, found that engaging in structured activities (schoolwork) and developing new interests (physical activity) was significantly associated with better well-being. Liu et al,Reference Liu, Jiang and Zhang60 who reported on the effects of a logotherapy-based mindfulness intervention on internet addiction, found that, as well as reducing internet addiction, the mindfulness intervention also significantly alleviated anxiety and depression levels compared with the those in the control group. Regular engagement in spiritual activities (Zainel et alReference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56) exercise and the establishment of a routine (O'Brien et alReference O'Brien, Parra and Cederbaum50) were also related to positive well-being, although O'Brien et al's findings were based on thematic analysis and thus not grounded in significantly statistical data with respect to any psychological outcome.

Negative coping strategies

Of the 25 studies reviewed, 14 identified negative coping strategies among children and adolescents that were significantly responsible for the increase of a psychological challenge (see Table 2). The majority of coping strategies adopted were emotion-oriented, self-critical and avoidant with respect to the pandemic stressor, and associated with the exacerbation of anxiety, depression, mood disturbances, stress, internalisation and externalisation of emotions, and behavioural and cognitive alterations, at the noted significance levels.

Table 2 Negative psychological changes when a coping strategy is adopted by children and adolescents post COVID-19 onset

* P = 0.001, **P = 0.005, ***P = 0.01, ****P = 0.05.

Avoidance-oriented coping strategies

Denying the pandemic's existence, suppressing one's feelings, changing the topic of conversation and emotionally disengaging from events constituted avoidance-oriented strategies that were found to be significant. Zhang et al,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 for example, found that keeping feelings to oneself and avoiding the situation were significantly associated with depression, anxiety, stress and trauma-related stress. Moreover, Liang et alReference Liang, Delvecchio, Buratta and Mazzeschi46 found that trying not to worry, denying the pandemic's existence and emotionally disengaging from the negative emotions exhibited by parents was associated with worsening levels of anxiety, mood and cognitive disturbances for those in the more affected areas. Employing avoidant responses to parental reactions to the pandemic (i.e. parental over-reactivity, parental fear of the future and punitive parenting) was common across several of our studies, responses that were again significantly associated with negative psychological implications.Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference Wang, Liu, Wang, Lin, Lin and Wang55,Reference Achterberg, Dobbelaar, Boer and Crone58

Negative appraisal and rumination

Expressing anger with the situation, blaming oneself, being self-critical and rumination were also found to be significantly efficacious. Hussong et al,Reference Hussong, Midgette, Thomas, Coffman and Cho45 for example, found that engaging in negative self-appraisal and self-criticism was significantly associated with a higher risk of internalisation and externalisation of emotions, and Dewa et alReference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 found that self-blame and a fastidious personality were significantly associated with anxiety and stress. Rumination was also found to be significantly associated with increased stress (Achterberg et alReference Achterberg, Dobbelaar, Boer and Crone58), anxiety and depression (Orgilés et alReference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52), and mood disturbances (Ellis et alReference Ellis, Dumas and Forbes43). Indeed, Ellis et alReference Ellis, Dumas and Forbes43 attributes the high levels of depression found among their adolescent sample to co-rumination or the excessive discussion of problems and concerns with friends on social media.

Social withdrawal

Withdrawal from loved ones, spending more virtual time with friends than face-to-face time with family and regarding pets as their primary social companion, were also negatively significant. Ellis et al,Reference Ellis, Dumas and Forbes43 for example, found that although time on social media and other virtual connections had increased, 36% of adolescents spent less than 30 min a day face to face with family, which may account for the significantly high levels of depression among their sample. Moreover, Mueller et alReference Mueller, Richer, Callina and Charmaraman49 found that despite spending more time with their pets to deal with loneliness, such adolescents experienced significantly higher levels of loneliness compared with pre-pandemic levels, possibly because it was at the expense of using more adaptive strategies such as spending time with family and friends.

Maladaptive activities

Substance misuse, excessive internet usage, excessive smartphone usage and spending less time on schoolwork and physical activity also significantly exacerbated respective psychological challenges across our sample. Ellis et al,Reference Ellis, Dumas and Forbes43 for example, found low levels of physical activity among their adolescent sample (<60 min per day), which was significantly associated with high levels of loneliness. Duan et alReference Duan, Shao, Wang, Huang, Miao and Yang41 found that smartphone and internet addiction (more than 5 h per day), evident within 30% of respondents, was associated with significant increases in depression. Substance misuse (Dewa et alReference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59), spending less time on schoolwork (Ellis et alReference Ellis, Dumas and Forbes43), playing video games, sleeping and excessive television, alcohol and drug use (O'Brien et alReference O'Brien, Parra and Cederbaum50) were also found to be significantly maladaptive on young people's mental health, although O'Brien et al's findings were again not based on a statistically significant data-set with respect to any psychological outcome.

Differences between children and adolescents

A difference between children and adolescents in terms of the adoption of specific coping strategies was also indicated. Indeed, 64% of included studies that sampled adolescents exclusively were associated with the adoption of positive or more controlled coping strategies (i.e. solution-oriented coping,Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 positive appraisal and restructuring,Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Corbett, Muscatello, Klemencic and Schwartzman39,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 communication with family,Reference Ellis, Dumas and Forbes43,Reference Gerasimova and Kholmogorova44 structured activitiesReference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53). This compares with 80% of included studies that sampled preadolescents and children exclusively and were associated with the adoption of negative or more avoidant coping strategies (i.e. parental reactivity,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40 avoidance,Reference Liang, Delvecchio, Buratta and Mazzeschi46 ruminationReference Achterberg, Dobbelaar, Boer and Crone58).

Discussion

The findings of this review suggest that the coping strategies adopted by young people during the peak of the pandemic could be significantly dichotomised according to either positive or negative psychological outcomes. Indeed, the adoption of solution-oriented coping strategies (following guidelines, information gathering),Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Hussong, Midgette, Thomas, Coffman and Cho45–Reference Li, Tang, Wu, Sun, Wang and Li47,Reference Orgilés, Espada and Morales51,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53,Reference Tambling, Tomkunas, Russell, Horton and Hutchison54,Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 cognitive strategies (positive appraisal, reframing interpretation),Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Corbett, Muscatello, Klemencic and Schwartzman39,Reference Hussong, Midgette, Thomas, Coffman and Cho45,Reference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Orgilés, Espada and Morales51,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 supportive strategies (time with family, online peer support)Reference Cauberghe, Van Wesenbeeck, De Jans, Hudders and Ponnet37,Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference Ellis, Dumas and Forbes43,Reference Gerasimova and Kholmogorova44,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53,Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57 and adaptive structure/distractions (schoolwork, exercise, spirituality, mindfulness)Reference Cenk, Yegit, Ergenekon, Aksoy, Bilicen and Gokdemir38,Reference Ellis, Dumas and Forbes43,Reference McFayden, Breaux, Bertollo, Cummings and Ollendick48,Reference Pigaiani, Zoccante, Zocca, Arzenton, Menegolli and Fadel53,Reference Zainel, Qotba, Al-Maadeed, Al-Kohji, Al Mujalli and A56,Reference Liu, Jiang and Zhang60 were significantly associated with a reduction of respective psychological challenges. Comparatively, the adoption of avoidant-oriented strategies (denying the pandemic, suppressing emotions, parental reactivity),Reference Domínguez-Álvarez, López-Romero, Isdahl-Troye, Gómez-Fraguela and Romero40,Reference Liang, Delvecchio, Buratta and Mazzeschi46,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Wang, Liu, Wang, Lin, Lin and Wang55,Reference Zhang, Ye, Fu, Yang, Luo and Yuan57,Reference Achterberg, Dobbelaar, Boer and Crone58 negative appraisal strategies (blaming oneself, being excessively self-critical, rumination),Reference Ellis, Dumas and Forbes43,Reference Hussong, Midgette, Thomas, Coffman and Cho45,Reference Orgilés, Morales, Delvecchio, Francisco, Mazzeschi and Pedro52,Reference Achterberg, Dobbelaar, Boer and Crone58,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 social withdrawalReference Ellis, Dumas and Forbes43,Reference Mueller, Richer, Callina and Charmaraman49 and excessive indulgences (internet and smartphone usage, reduced exercise and schoolwork, substance misuse)Reference Duan, Shao, Wang, Huang, Miao and Yang41,Reference Ellis, Dumas and Forbes43,Reference O'Brien, Parra and Cederbaum50,Reference Dewa, Crandell, Choong, Jaques, Bottle and Kilkenny59 were significantly associated with an exacerbation of respective psychological challenges.

Such findings are consistent with research showing that proactivity and engagement when dealing with stressors reduces a range of psychological challenges in young people, including stress, anxiety, depression and loneliness,Reference Aldao, Nolen-Hoeksema and Schweizer29,Reference Compas, Jaser, Bettis, Watson, Gruhn and Dunbar30,Reference Li, DiGiuseppe and Froh61,Reference Manczak, Ordaz, Singh, Goyer and Gotlib62 whereas being avoidant and disengaging tends to exacerbate psychological challenges.Reference Compas, Jaser, Bettis, Watson, Gruhn and Dunbar30,Reference Schäfer, Naumann, Holmes, Tuschen-Caffier and Samson31,Reference Kahraman and Demirci63,Reference Rose, Carlson and Waller64 Compas et al,Reference Compas, Jaser, Bettis, Watson, Gruhn and Dunbar30 for example, in their meta-analytic review of 212 studies (age range 5–19 years), found that both primary and secondary means of engaging a stressor significantly reduced internalising and externalising psychopathology. Conversely, Schäfer et al,Reference Schäfer, Naumann, Holmes, Tuschen-Caffier and Samson31 in their meta-analytic review of 35 studies (age range 13–18 years), found that maladaptive coping strategies, such as avoidance, rumination, suppression and denial, significantly increased symptoms of psychopathology.

To explain such findings, it may be fruitful to draw on the control-based model of copingReference Compas, Connor-Smith, Saltzman, Thomsen and Wadsworth65–Reference Gross, Thompson and Gross67 and the notion of locus of control,Reference Rotter33 which proclaim that those able to maintain a sense of volition, self and coherence are more equipped at adapting to stressors that are tumultuous and emotionally disorienting.Reference Compas, Malcarne and Fondacaro68–Reference Vohs, Baumeister, Schmeichel, Twenge, Nelson and Tice71 Indeed, being informed by a more constructive and consciously engaged cognitive process may underpin the efficacy of the positive coping strategies adopted by the youths sampled in this review,Reference Farley and Kim-Spoon69,Reference Russell, Rosenthal and Thomson70 whereas more impulsive and insecure cognitive processes may underpin those adopting negative coping strategies.Reference Thompson, Zalewski and Lengua72,Reference Lengua, Sandler, West, Wolchik and Curran73 Such models may also explain why the majority of our studies that exclusively sampled adolescents were associated with the adoption of positive coping strategies, whereas the majority that exclusively sampled preadolescents and children were associated with the adoption of negative strategies. Indeed, in having a greater internal locus of control, it may be the case that adolescents have a greater sense of control over life events, resulting in the adoption of more proactive means of coping. This compares with younger children whose life events are influenced by factors externally, and thus are dependent on and reactive to the people around them, such as parents.Reference Rotter33

In short, the findings of this review suggest that when dealing with stressors, particularly those that are as tumultuous as pandemic-like events, it is imperative that young people are encouraged to be as proactive and engaging as possible. Adherence to guidelines, help-seeking, spending time with family, socialising with friends, positively appraising events and engagement in healthy routines appear to represent a set of practices that should maintain a young person's well-being during such stressors (see Box 1). Given the difficulties for younger children to engage so constructively, it is critical that parents with younger children are able to provide them with cognitive, behavioural and emotional scaffolding through possibly drawing on the set of coping strategies mentioned. Indeed, interventions that can reduce parental psychopathology, that build parental resilience and compassionate expression, and that increase internal locus of control among parents themselves, may go a long way toward ensuring that younger children can also maintain a ‘sense of coherence’ when facing stressors that are incredibly tumultuous and disorienting.

Box 1 Coping best practice for young people during pandemic-type events

  • • Solutions-oriented

    • ◦ Adherence to guidelines

    • ◦ Help-seeking

    • ◦ Drawing on legitimate news sources

    • ◦ Healthy habits, e.g. exercise

  • • Positive appraisal/restructuring

    • ◦ Acceptance

    • ◦ Reframing the problem

    • ◦ Consider circumstantial advantages

    • ◦ Using humour

  • • Communicating with family and friends

    • ◦ Spending time with loved ones

    • ◦ Seeking online support from friends

  • • Engaging in structured activities

    • ◦ Schoolwork

    • ◦ Hobbies

    • ◦ Healthy habits, e.g. exercise

    • ◦ Spiritual/metacognitive activities

Strengths and limitations

This review represents one of the few that explores the coping strategies adopted by young people during the peak of the COVID-19 pandemic. It presents evidence from a range of countries, provides data from a good number of studies, a range of age groups across childhood and adolescence, and conclusions are based on largely significant data-sets. Moreover, data collection and quality assessment adhered to the Cochrane and STROBE levels of scrutiny, respectively. Limitations include the restriction of studies accessible in English and the limited number of studies comparing an intervention with a control group, suggesting a lack of high-quality research in this area. Given that the data taken from the vast majority of studies were based on self-reported questionnaires, this also presents the problem of self-report bias and accuracy of recall. The heterogeneity of instruments used to assess coping strategy, as well as the conceptual frameworks that informed such, also made it difficult to compare across studies, thus jeopardising generalisable conclusions.

In conclusion, proactive and engaged coping appeared effective in reducing a range of psychological challenges among young people during the peak of the COVID-19 pandemic, whereas avoidant-oriented coping appeared to exacerbate such challenges. Advanced cognitive processes such as an internal locus of control may account for why adolescents tended to exercise coping strategies that are more proactive and constructive. Conversely, less secure cognitive processes based on an external locus of control may explain why younger children are drawn to more incidental coping means when facing extreme life stressors, although their sense of coherence could potentially be maintained by a degree of cognitive and behavioural scaffolding from their parents. Follow-up research that considers such variations and potential others (i.e. cultural, neuro-developmental vulnerabilities) would further elucidate coping differences across the child and adolescent mental health literature. However, this review also draws attention to the heterogenous nature of how coping as a body of research is defined and therefore measured, and this needs to be addressed to offset the methodological and conceptual stagnation the field of coping still finds itself in (see Compas et alReference Compas, Jaser, Bettis, Watson, Gruhn and Dunbar30). Nevertheless, based on the findings of this review at least, a coping framework that is inherently proactive and engaging would serve as a protective factor towards the onset or exacerbation of psychological distress during pandemic-like episodes for children and adolescents, and this would serve as an invaluable addition to any future pandemic preparedness planning cycle.

About the authors

Ranjita Howard is an ST6 Specialist Registrar with Child and Adolescent Mental Health Services, NHS England Education North East, Newcastle upon Tyne, UK. Harshini Manohar is an Assistant Professor in Child and Adolescent Mental Health Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Shekhar Seshadri is a Professor in Child and Adolescent Mental Health Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Aditya Sharma is a Clinical Senior Lecturer and Honorary Consultant Psychiatrist in Child and Adolescent Psychiatry at the Translational and Clinical Research Institute, Newcastle University, UK.

Supplementary material

Supplementary material is available online at https://doi.org/10.1192/bjb.2024.49

Data availability

The data that support the findings of this study are available on request from the corresponding author, R.H.

Author contributions

R.H. was the lead author and was responsible for the project's conceptualisation and drafting the original manuscript. R.H. and A.S. contributed to the formulation of the research question and review design. R.H. and H.M. conducted the data analysis, and all authors revised the content of manuscript and approved the final version for submission. Supervision for the project was provided by S.S. and A.S.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Declaration of interest

None.

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Figure 0

Fig. 1 Flow diagram illustrating search strategy for the review.

Figure 1

Table 1 Positive psychological changes when a coping strategy is adopted by children and adolescents post COVID-19 onset

Figure 2

Table 2 Negative psychological changes when a coping strategy is adopted by children and adolescents post COVID-19 onset

Supplementary material: File

Howard et al. supplementary material 1

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