Pre-pandemic mental health and coping strategy usage during the COVID-19 pandemic: a cross-sectional analysis of the Southern Cities Study

Little is known about the usage of coping strategies recommended by the World Health Organization and the Centers for Disease Control and Prevention during the COVID-19 pandemic and whether coping strategy usage varies by pre-pandemic mental health. This study examined the prevalence of different coping strategies and associations of their usage with pre-pandemic mental health. Data were collected from adults residing in metropolitan areas of the U.S. South in May/June 2020 using random-digit-dialing and web-based surveys (n = 1,644). We estimated the prevalence of each coping strategy: (1) keeping up-to-date about COVID-19; (2) taking breaks from the news or social media; (3) taking care of physical health; (4) engaging in relaxing activities; (5) reaching out to and spending time with others; and (6) trying to find comfort in religious or spiritual beliefs. We examined the association between the use of each strategy and pre-pandemic mental health using modified Poisson regression, adjusting for covariates. We also analyzed the association between pre-pandemic mental health and the number of coping strategies employed using ordered logistic regression. The most prevalent strategies were: "keeping up-to-date about COVID-19" (53%), "taking care of physical health" (52%), and "reaching out to and spending time with others" (52%). Good pre-pandemic mental health was associated with an increased prevalence of "reaching out to and spending time with others" (adjusted prevalence ratio, 1.43; 95% confidence interval, 1.07-1.91). The use of other coping strategies and the number of coping strategies used during the pandemic did not vary by pre-pandemic mental health. Our findings suggest that people who had good pre-pandemic mental health were more likely to connect with other people during the COVID-19 pandemic. Given the well-documented impact of social support on mental health in disaster contexts, efforts to promote safe social connections for those with pre-existing mental health concerns are needed.