Journal of Mental Health

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Coping strategies and mental health during

COVID-19 lockdown

Sanja Budimir, Thomas Probst & Christoph Pieh

To cite this article: Sanja Budimir, Thomas Probst & Christoph Pieh (2021): Coping
strategies and mental health during COVID-19 lockdown, Journal of Mental Health, DOI:
10.1080/09638237.2021.1875412

To link to this article: https://doi.org/10.1080/09638237.2021.1875412

Published online: 27 Jan 2021.

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JOURNAL OF MENTAL HEALTH
https://doi.org/10.1080/09638237.2021.1875412

ORIGINAL ARTICLE

Coping strategies and mental health during COVID-19 lockdown

Sanja Budimira,b , Thomas Probsta and Christoph Pieha
a
Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria; bDepartment of Work,
Organization and Society, Ghent University, Ghent, Belgium

ABSTRACT ARTICLE HISTORY

Background: COVID-19 pandemic lockdown measures changed the everyday lives of people around Received 17 June 2020
the world. Revised 18 November 2020
Aims: To evaluate the effects of different coping strategies on mental health during COVID- Accepted 3 December 2020
19 lockdown. Published online 15 January
2021
Methods: A representative sample for Austria was recruited through QualtricsV in a period of 4 weeks
R

after the lockdown started. Measurements were coping inventory (SCI), psychological quality of life KEYWORDS
(WHO-QOL BREF, psychological domain), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), COVID-19; coping strategies;
stress (PSS-10), and insomnia (ISI). Regression analyses were performed with coping strategies as pre- mental health
dictors and mental health measures as dependent variables.
Results: The representative sample included N ¼ 1,005 respondents (52.7% women). Positive thinking, SUBJECT CLASSIFICATION CODES
active stress coping and social support were found to be positive predictors for psychological life qual- Mental Health; COVID-19;
ity, well-being, and negative predictors for perceived stress, depression, anxiety, and insomnia. Alcohol coping strategies
and cigarette consumption was a negative predictor for psychological life quality, and well-being, and
a positive predictor for perceived stress, depression, anxiety, and insomnia. Support in faith was a posi-
tive predictor for perceived stress, depression, anxiety, and insomnia.
Conclusions: Coping strategies are significant predictors for mental health measures. Education about
positive thinking, active coping, and social support could be beneficial for dealing with a decrease in
mental health due to COVID-19 pandemic.

Within 3 months of the first occurrence of COVID-19 in
China, at the end of December of 2019, the spread of the
disease caused a global health pandemic (WHO Int, 2020).
As there was no available effective treatment, the WHO rec-
ommendation was to introduce quarantine to prevent a
potential spread of the virus, isolation for people with
COVID-19 symptoms, and social distancing for people with-
out symptoms (Nussbaumer-Streit et al., 2020). Like many
other governments around the world, the Austrian govern-
ment also accepted those recommendation, which officially
took place on 16th of March 2020, and lasted almost
7 weeks, until 1st of May. Despite easing the measures of
lockdown in Austria, to this day, a number of COVID-19
victims is continuing to increase in Austria as well as in
other world countries, leading to new lockdown measures.
On 15th of November, the number of COVID-19 infections
counted 53,766,728 in the world, and 1,308,975 deaths in
the world (COVID-19, WHO, 2020). Although the first
lockdown measures were beneficial for physical health by
stopping the spread of coronavirus, they had a damaging
effect on mental health (Brooks et al., 2020; Huang & Zhao,
2020; Kazmi et al., 2020; Pieh et al., 2020b; Rossi et al.,
2020; Wang et al., 2020a). Common reactions in time of
pandemics could include feeling stressed, worried, having
fear of disease and death, suffering because of social isola-
tion, and having fears of losing jobs (IFRC, 2020).
The pandemic situation required increased medical care
and significant reorganization of the living styles and rou-
tines, caused mostly by enforcement of a lockdown with a
limited movement. These changes raised concerns for men-
tal health, due to the fear of coronavirus transmission and
unknown definite treatments (Ho et al., 2020), especially for
people who contracted the disease, those with compromised
immune systems, prior mental health problems, different
disabilities, insecure living conditions and living in congre-
gate settings, lower income, etc. (Douglas et al., 2020;
Pfefferbaum & North, 2020). A negative effect of stress,
worries, and fears due to the COVID-19 restrictions on
mental health was shown to be associated with increased
anxiety, post-traumatic stress symptoms, depression, insom-
nia, high stress, adjustment disorder, and severe obsessive-
compulsive symptoms (Ahmad et al., 2020; Brooks et al.,
2020; Huang & Zhao, 2020; Kazmi et al., 2020;
Moghanibashi-Mansourieh, 2020; Moreira et al., 2020;
Pancani et al., 2020; Pieh et al., 2020a, 2020b; Rossi et al.,
2020; Ueda et al., 2020; Wang et al., 2020a; Zhang
et al., 2020).

CONTACT Sanja Budimir sanja.budimir@donau-uni.ac.at Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an
der Donau, Austria
ß 2021 Informa UK Limited, trading as Taylor & Francis Group
2 S. BUDIMIR ET AL.
Despite the social interaction limitations during the lock-
down, online interactions enabled social connections, con-
tinuation of education, many forms of businesses, and
communication of relevant information for physical and
psychological health. An accurate and updated information
about available treatments, local outbreak situations, import-
ance of adopting precautionary measures was found to be
associated with a lower levels of stress, anxiety, and depres-
sion (Wang et al., 2020a).
However, a lack of editorial control in social media can
also bring incorrect information, fake news, misconception,
and rumors (Allgaier & Svalastog, 2015), which are shaping
people’s perception of risks, decisions, and behaviors (Tang
et al., 2018), and possibly intensifying psychological fear and
rumination about contracting disease with an effect on
behavior and social interactions (Ho et al., 2020).
Identification of mental health protective factors is an
important step in understanding people who are faced with
health problems (Smith et al., 2008). The thoughts and
behaviors that people use to manage stressful internal and
external demands of situations are defined as coping
(Lazarus & Folkman, 1984). Most commonly, coping is
described from two main perspectives, by changing the rela-
tionship with the environment with coping actions (problem
focused coping), or by changing the interpretation of the
environment (emotion focused coping) (Lazarus, 1993).
Additionally, a third coping dimension is avoidance which
can be person oriented by seeking other people as social
diversion, or task oriented by seeking distraction (Endler &
Parker, 1990, 1994). Coping strategies are also often
described as adaptive or maladaptive, however, such cat-
egorization of any of the coping strategies depends on three
factors; long-term developmental consequences, subjective
experience, and their current qualities (Skinner et al., 2003).
Basically, the determination of a specific coping strategy as
beneficial or harmful for the individual depends on whether
the individual is able to handle the demand or is over-
whelmed by it (Skinner et al., 2003).
Coping strategies can contribute to the nature and
impact of psychological responses in stressful circumstances
(McPherson, 2003) and can have protective or damaging
effects on mental health. Emotion focused coping strategies
like rumination, thinking avoidance, denial, self-isolation,
emotion expression, and self-blame were shown to increase
the severity of posttraumatic stress disorder (PTSD), while
problem faced coping, like positive thinking had beneficial
an effect on PTSD (Rodr
ıguez-Rey et al., 2019; Sim et al.,
2010). Additionally, a negative impact on psychological
response can be associated with passive coping strategies,
rumination, thinking avoidance, self-isolation, self-blame,
pessimism, negative social interactions, lack of social sup-
port and communication, behavioral disengagement, denial
and using alcohol (Colville et al., 2017, 2017; Luo et al.,
2015; McPherson, 2003; Naushad et al., 2019; Rodr
ıguez-
Rey et al., 2019; Smith et al., 2008). Positive impact on men-
tal health was found to be associated with social support
and optimism which were found to be have protective role
for perceived stress, anxiety, and depression (Smith et al.,
2008). Protective coping strategies in stressful situations can
also include active coping strategy, looking for positive,
debriefing, positive thinking, optimism, acceptance, purpose
in life, humor, planning, positive reframing, and social sup-
port (G. Colville et al., 2015; Luo et al., 2015; McPherson,
2003; Rodr
ıguez-Rey et al., 2019; Smith et al., 2008).
As the negative psychological impact of the COVID-19
outbreak is evident, there is a need to address ways of
increasing protective coping mechanisms that can improve
mental health, and possibly be used as a prevention meas-
ure in the future. We measured effects of coping strategies
(positive thinking, alcohol and cigarette consumption,
active stress coping, support in faith, social support) on
mental health (psychological life quality, wellbeing, per-
ceived stress, depression, anxiety and insomnia), 4 weeks
following the COVID-19 lockdown in Austria. It is
expected that engagement of adaptive coping strategies
(positive thinking, active stress coping, support in faith
and social support) will have a protective role for mental
health during COVID-19 lockdown (higher psychological
life quality and wellbeing, and lower perceived stress,
depression, anxiety and insomnia), while it is expected that
maladaptive coping strategy (alcohol and cigarette con-
sumption) will be negatively correlated with negative pre-
dictive value for psychological life quality and wellbeing,
and positive for perceived stress, depression, anxiety,
and insomnia.
Materials and methods
Study design
Measurement of coping strategies and several mental health
indicators during COVID-19 lockdown was performed with
QualtricsV survey platform on an Austrian representative
R
sample (age, gender, education, and region). Qualtrics pro-
ject team performed recruitment and data collection on ini-
tially specified sample of N ¼ 1000. COVID-19 lockdown
was officially implemented in Austria on 16th of March
2020, and the survey started on 10th of April 2020.
Governmental restriction during the survey
During the obligatory COVID-19 lockdown in Austria in
March 2020, permitted activities outside home included:
averting an immediate danger to life, limb, or property; pro-
fessional activity (if home-office is not possible); errands to
cover necessary basic needs; care and assistance for people
in need of support; exercise outdoors (e.g. running, walking)
alone and with pets/people living in the same household.
Study sample
A representative sample according to age, gender, education
and region, total of N ¼ 1005 (Table 1) participants were
recruited by Qualtrics project team, and data were collected
during the lockdown, in the period from 10th of April until
30th of April. The majority of the sample was recruited
 JOURNAL OF MENTAL HEALTH 3

Table 1. Study sample characteristics (n ¼ 1005). values. Pearson coefficients of correlation were used to spe-
Variable f % cify relationships between coping strategies and mental
Gender health scales. Several simple linear regressions (enter
Women 530 52.7
Men 475 47.3
method) were carried out to predict mental health by cop-
Age ing strategies. Linear regression analyses were performed
18–24 118 11.7 with coping strategies as predictors (1. Positive thinking, 2.
25–34 166 16.5
35–44 185 18.4
Alcohol and cigarette consumption, 3. Active stress coping,
45–54 222 22.1 4. Support in faith, 5. Social support) and measures of men-
55–64 181 18.0 tal health as criteria variable (6. psychological life quality
65þ 133 13.2
Region
(WHOQOL BREF), 7. well-being (WHO-5), 8. perceived
Burgenland 35 3.5 stress (PSS-10), 9. depression (PHQ-9), 10. anxiety (GAD-
Lower Austria 187 18.6 7), 11. insomnia (ISI)). The tests were performed two-tailed
Vienna 218 21.7
Carinthia 66 6.6 and the p-value was set to p<.05.
Styria 149 14.8
Upper Austria 172 17.1
Salzburg 63 6.3 Ethical consideration
Tyrol 77 7.7
Vorarlberg 38 3.8 This study was conducted in accordance with the
Education
No school education 1 0.1
Declaration of Helsinki and approved by the Ethics
Secondary School 26 2.6 Committee of the Danube University Krems, Austria
Apprenticeship 321 31.9 (Ethical number: EK GZ 26/2018-2021). All participants
High School 288 28.7
University 369 36.7
gave electronic informed consent for participation before
Note: f: frequencies; %: percentage.
completing the questionnaires. Data were collected anonym-
ously without IP addresses or GPS tracking and this proced-
ure was approved by the data protection officer of the
within the first few days, followed by reaching niche seg- Danube-University Krems, Austria.
ments of the sample (e.g. older participants) in the following
days.
Results

Measures Sociodemographic characteristics of N ¼ 1,005 participants

 Stress and Coping Inventory (SCI): measures coping
strategies in the period of past two weeks: positive think-
ing, active stress management, social support, support in
faith, and alcohol and cigarette consumption
(Satow, 2012).
 WHOQOL-BREF: measures life quality (physical, psy-
chological, social relationships, and environment) during
the past 2 weeks (WHO, 1996). In this study, only a
measure of psychological life quality was used.
 The World Health Organization - Five Well-Being Index
(WHO-5): measures a well-being within the last two
weeks (WHO, 1998).
 Perceived stress (PSS-10): measures perceived stress over
the last month (Cohen et al., 1983).
 Patient Health Questionnaire (PHQ-9): measures depres-
sive symptoms over the period of previous two weeks
(Spitzer, 1999).
 Generalized Anxiety Disorder – 7 scale (GAD-7): meas-
ures anxiety symptoms in the past two weeks (Spitzer
et al., 2006).
 Insomnia Severity Index (ISI): measures insomnia and
sleep quality in the last two weeks (Morin et al., 2011).
Statistical analysis
All data were analyzed using SPSS version 24 (IBM Corp,
Armonk, NY). Descriptive statistics were conducted to
describe the demographic characteristics and scales mean
are presented in Table 1. The sample is representative for
Austrian population according to gender, age, education
and region.
Correlations between coping strategies and mental health
are shown in Table 2.
Higher mental health was correlated with coping strat-
egies: positive thinking (rWHOQOL ¼ .60, p < 0.001; rWHO-5
¼ .55, p < 0.001; rPSS-10 ¼ .54, p < 0.001; rPHQ-9 ¼ .51,
p < 0.001; rGAD-7 ¼ .52, p < 0.001; rISI ¼ .34, p < 0.001) ,
active stress coping (rWHOQOL ¼.37, p < 0.001; rWHO-5 ¼
.34, p < 0.001; rPSS-10 ¼ .41, p < 0.001; rPHQ-9 ¼ .35,
p < 0.001; rGAD-7 ¼ .35, p < 0.001; rISI ¼ .21, p < 0.001)
and social support (rWHOQOL ¼ .52, p < 0.001; rWHO-5 ¼
.46, p < 0.001; rPSS-10 ¼ .42, p < 0.001; rPHQ-9 ¼ .46,
p < 0.001; rGAD-7 ¼ .41, p < 0.001; rISI ¼ .28, p < 0.001).
Lower mental health was correlated with the coping strategy
alcohol and cigarette consumption (rWHOQOL ¼ .19, p <
.001; rWHO-5 ¼ .15, p < 0.001; rPSS-10 ¼ .15, p < 0.001;
rPHQ-9 ¼ .23, p < 0.001; rGAD-7 ¼ .20, p < 0.001; rISI ¼ .13,
p < 0.001), and coping strategy support in faith (rWHOQO
¼.12, p < 0.001; rWHO-5 ¼ .11, p < 0.001).
Linear regression analyses were performed with coping
strategies as predictors (Table 3).
All measured coping strategies were significant predic-
tors for all measured mental health scales, with the high-
est percentage of explained variance for psychological life
quality (WHOQOL BREF), 43% (F (5, 1008) ¼ 148.53;
p < 0.001; DR2 ¼ 0.43), followed with perceived stress
(PSS-10), 37% (F (5, 1008) ¼ 115.75; p < 0.001; DR2 ¼
4 S. BUDIMIR ET AL.

Table 2. Descriptive statistics and Pearson coefficients of correlations for coping strategies and mental health scales.
n M SD 1 2 3 4 5 6 7 8 9 10 11
1. Positive thinking 1005 11.25 2.49 –
2. Alcohol and cigarette consumption 1005 6.56 2.74 .13 –
3. Active stress coping 1005 11.77 2.30 .35 .11 –
4. Support in faith 1005 8.24 3.05 .18  .05 .12 –
5. Social support 1005 11.43 2.72 .61 .12 .25 .16 –
6. WHOQOL BREF 1005 69.83 18.70 .60 .19 .37 .12 .52 –
7. Wellbeing (WHO-5) 1005 15.05 5.40 .55 .15 .34 .11 .46 .77 –
8. Perceived stress (PSS-10) 1005 15.97 7.47 .54  .15 .41  .04 .42  .74 .73 –
9. Depression (PHQ-9) 1005 6.19 5.40 .51 .23 .35 .07 .46 .77 .72 .74 –
10. Anxiety (GAD-7) 1005 5.84 4.70 .52 .20 .35 .02 .41 .71 .69 .79 .81 –
11. Insomnia (ISI) 1005 8.31 5.70 .34 .13 .21 .01 .28 .54 .59 .56 .66 .59 –
p < 0.001, n: sample size, M: mean value, SD: standard deviation, WHO-QOL BREF psychological domain: Quality of Life questionnaire of the World Health
Organization (WHO); WHO-5: Well-being questionnaire of the World Health Organization (WHO); PSS-10: Perceived Stress Scale 10; PHQ-9: Patient Health
Questionnaire 9 scale; GAD-7 (Generalized Anxiety Disorder 7 scale); ISI: Insomnia Severity Index.

Table 3. Linear regressions analyses with mental health scales as dependent variables and coping strategies as predictors.
Variable B SE b t p 95% CI F R R2 DR2
Psychological quality of life (WHOQOL BREF)
(Constant) 7.67 3.24 2.39 .018 [1.31, 14.02] 148.53 .65 .43 .43
Positive thinking 2.90 0.24 0.38 12.23 .000 [2.43, 3.36]
Alcohol and cigarette consumption 0.62 0.17 0.09 3.71 .000 [.94, .30]
Active stress coping 1.33 0.21 0.16 6.36 .000 [.92, 1.74]
Support in faith 0.04 0.15 0.01 .274 .784 [.34, .25]
Social support 1.60 0.21 0.23 7.64 .000 [1.19, 2.02]
Wellbeing (WHO-5)
(Constant) 1.76 1.00 1.77 .077 [3.71, .19] 108.82 .59 .35 .35
Positive thinking 0.82 0.07 0.38 11.22 .000 [.67, .96]
Alcohol and cigarette consumption 0.12 0.05 0.06 2.44 .015 [.22, .02]
Active stress coping 0.38 0.06 0.16 5.87 .000 [.25, .50]
Support in faith 0.01 0.05 0.01 0.20 .845 [.10, .08]
Social support 0.36 0.06 0.18 5.56 .000 [.23, .49]
Perceived stress (PSS-10)
(Constant) 39.48 1.36 29.05 .000 [36.82, 42.16] 115.75 .61 .37 .37
Positive thinking 1.16 0.10 0.39 11.68 .000 [1.36, .97]
Alcohol and cigarette consumption 0.17 0.07 0.06 2.48 .013 [.04, .31]
Active stress coping 0.79 0.09 0.24 8.99 .000 [.96, .62]
Support in faith 0.20 0.06 0.08 3.11 .002 [.07, .32]
Social support 0.35 0.09 0.13 3.92 .000 [.52, .17]
Depression (PHQ-9)
(Constant) 20.97 1.00 21.06 .000 [19.02, 22.93] 107.8 .59 .35 .35
Positive thinking 0.67 0.07 0.31 9.16 .000 [.81, .52]
Alcohol and cigarette consumption 0.29 0.05 0.15 5.66 .000 [.19, .39]
Active stress coping 0.43 0.06 0.18 6.72 .000 [.56, .31]
Support in faith 0.09 0.05 0.05 2.03 .043 [.003, .18]
Social support 0.43 0.07 0.21 6.61 .000 [.55, .30]
Anxiety (GAD-7)
(Constant) 18.23 0.88 20.76 .000 [16.50, 19.95] 99.25 .58 .33 .33
Positive thinking 0.70 0.06 0.37 10.88 .000 [.82, .57]
Alcohol and cigarette consumption 0.20 0.05 0.12 4.45 .000 [.11, .29]
Active stress coping 0.38 0.06 0.19 6.69 .000 [.49, .27]
Support in faith 0.16 0.04 0.10 3.87 .000 [.08, .24]
Social support 0.24 0.06 0.14 4.13 .000 [.35, .12]
Insomnia (ISI)
(Constant) 17.97 1.21 14.91 .000 [15.61, 20.34] 34.32 .38 .15 .15
Positive thinking 0.55 0.09 0.24 6.20 .000 [.72, .37]
Alcohol and cigarette consumption 0.15 0.06 0.07 2.48 .013 [.03, .27]
Active stress coping 0.26 0.08 0.11 3.34 .001 [.41, .11]
Support in faith 0.16 0.06 0.09 2.88 .004 [.05, .27]
Social support 0.25 0.08 0.12 3.13 .002 [.40, .09]
Model 1; B: unstandardized coefficients, SE: standardized error, b – beta standardized coefficient,: t: t test, p: p-values (2-tailed); Cl: confidence interval, F: F
ratio, DR2: R square change; WHO-QOL BREF: Quality of Life questionnaire of the World Health Organization (WHO); WHO-5: Well-being questionnaire of the
World Health Organization (WHO); PSS-10: Perceived Stress Scale 10; PHQ-9: Patient Health Questionnaire 9 scale; GAD-7 (Generalized Anxiety Disorder 7 scale);
ISI: Insomnia Severity Index.

0.37), well-being (WHO-5), 35% (F (5, 1008) ¼ 108.82;
p < 0.001; DR2 ¼ 0.35), depression (PHQ-9), 35% (F (5,
1008) ¼ 107.84; p < 0.001; DR2 ¼ 0.35), anxiety (GAD-7),
33% (F (5, 1008) ¼ 99.25; p < 0.001; DR2 ¼ 0.33), and
insomnia (ISI), 15% (F (5, 1008) ¼ 34.32; p < 0.001; DR2
¼ 0.15).
Positive thinking was the strongest predictor for all meas-
ured mental health scales, followed by active stress coping
and social support. All three coping strategies, positive
thinking (PT), active stress coping (ASC), and social support
(SS) were found to be positive predictors for psychological
life quality (WHOQOL BREF), (bPT ¼ 0.38; t ¼ 12.23;

p < 0.001; bASC ¼ 0.16; t ¼ 6.36; p < 0.001; bSS ¼ 0.23;
t ¼ 7.64; p < 0.001), well-being (WHO-5) (bPT ¼ 0.38;
t ¼ 11.22; p < 0.001; bASC ¼ 0.16; t ¼ 5.87; p < 0.001; bSS ¼
0.18; t ¼ 5.56; p < 0.001). In other words, positive thinking,
social support and active stress coping contribute to higher
psychological life quality and higher wellbeing. The same
coping mechanisms were found to be negative predictors for
perceived stress (PSS-10) (bPT ¼ 0.39; t ¼ 11.68;
p < 0.001; bASC ¼ 0.24; t ¼ 8.99; p < 0.001; bSS ¼ 0.13;
t ¼ 3.92; p < 0.001), depression (PHQ-9) (bPT ¼ 0.31; t
¼ 9.16; p < 0.001; bASC ¼ 0.18; t ¼ 6.72; p < 0.001; bSS
¼ 0.21; t ¼ 6.61; p < 0.001), anxiety (GAD-7) (bPT ¼
0.37; t ¼ 10.88; p < 0.001; bASC ¼ 0.19; t ¼ 6.69;
p < 0.001; bSS ¼ 0.14; t ¼ 4.13; p < 0.001), and insomnia
(ISI) (bPT ¼ 0.24; t ¼ 6.20; p < 0.001; bASC ¼ 0.11;
t ¼ 3.34; p ¼ 0.001; bSS ¼ 0.12; t ¼ 3.13; p ¼ 0.002).
That indicates that employment of the coping mechanisms
such as positive thinking, social support, and active stress
coping contributes to lower depression, anxiety,
and insomnia.
Alcohol and cigarette consumption was a small but a sig-
nificant predictor for all measured scales. It was a negative
predictor for psychological life quality (b WHOQOL BREF ¼
0.09; t ¼ 3.71; p < 0.001) and well-being (bWHO-5 ¼
0.06; t ¼ 2.44; p ¼ 0.015), which indicates lower psycho-
logical life quality and wellbeing for those who employ this
coping strategy. Alcohol and cigarette consumption was also
a positive predictor for perceived stress (bPSS-10 ¼ 0.06;
t ¼ 2.48; p ¼ 0.013), depression (bPHQ-9 ¼ 0.15; t ¼ 5.66;
p < 0.001), anxiety (bGAD-7 ¼ 0.12; t ¼ 4.45; p < 0.001), and
insomnia (bISI ¼ 0.07; t ¼ 2.48; p ¼ 0.013). This indicates
that people employing this coping strategy are more likely
to have higher scores on perceived stress, depression, anx-
iety, and insomnia scales.
Support in faith was a small positive, but significant pre-
dictor only for the scales: perceived stress (bPSS-10 ¼ 0.08;
t ¼ 3.11; p ¼ 0.002), depression (bPHQ-9 ¼ 0.05; t ¼ 2.03;
p ¼ 0.043), anxiety (bGAD-7 ¼ 0.10; t ¼ 3.87; p < 0.001), and
insomnia (bISI ¼ 0.09; t ¼ 2.88; p ¼ 0.004). These predictors
indicate that employing the coping strategy support in faith
is predictive for higher scores on a stress, depression, anx-
iety, and insomnia scales.
Discussion
This study examined predictive value of coping strategies
for mental health indicators on a representative Austrian
sample during the 4 weeks of COVID-19 lockdown. The
major finding of this study is that scores for coping strat-
egies were found to be predictors for scores on all or the
majority of mental health indicators.
More specifically, a group of coping strategies; positive
thinking, active stress coping and social support contribute
to higher psychological life quality, well-being, perceived
stress, depression, anxiety, and insomnia. These results indi-
cate that an individual who has higher scores on these cop-
ing strategies in their coping with COVID-19 pandemic,
had better mental health during the lockdown. Among these
JOURNAL OF MENTAL HEALTH 5
three coping strategies, the strongest predictor was positive
thinking for all mental health scales followed with social
support, indicating that these coping strategies were found
to be the most beneficial for mental health. Rodr
ıguez-Rey
et al. (2019) demonstrated relevance of positive thinking as
a coping strategy for mental health, more specifically they
found an association of positive thinking with lower score
on PTSD screening instrument. The use of positive coping
strategies was found to be associated with lower depressive
symptoms and with less distress during the COVID-19 pan-
demic as well (Babore et al., 2020; Skapinakis et al., 2020).
Although, the coping strategy active coping was also
found to be a significant predictor for all measured scales
during COVID-19 pandemic, the effect is much smaller
compared to positive thinking as a coping strategy. Active
coping is the second highest predictor for perceived stress
and anxiety, while social support is the second highest pre-
dictor for psychological quality of life, depression, well-
being, depression, and insomnia. Protective role of active
coping on mental health has been shown in previous
research (Luo et al., 2015; Main et al., 2011; Smith et al.,
2008), and approach coping during COVID-19 pandemic
was found to be associated to a higher wellbeing and lower
depression (Dawson & Golijani-Moghaddam, 2020). The
smaller effect of active coping strategy compared to positive
thinking during the lockdown situation can be explained by
limited options for active coping in the situation where the
removal of the stress source is not under the control of the
individual. Active coping would allow smaller modulations
of behavior which could include practicing measures of pre-
caution in the case of exposure to the risk of contamination.
Social support as a coping strategy was also found to be
predictive of mental health during the lockdown. Importance
of social support in reducing distress and mental health diffi-
culties in stressful circumstances is known from previous
research (Fasihi Harandi et al., 2017; Naushad et al., 2019;
Ozbay et al., 2007). Although, one of the main goals of the
lockdown was to reduce number of infections through reduc-
tion of social contacts, a social support played a significant
protective role for mental health. Social support might have
been received through online media, which could have been
used for establishing and/or maintaining support system with
friends, families, and community members. For example, rea-
sonable amount of social media usage for providing informa-
tional, emotional and peer support during the COVID-19
outbreak in Wuhan was found to be beneficial for mental
health (Zhong et al., 2021).
Additionally, we found a coping strategy of alcohol and
cigarette consumption to be a small, but significant pre-
dictor of lower psychological life quality, wellbeing, and
higher perceived stress, depression, anxiety, and insomnia.
Other studies also found a negative impact of substance use
on a psychological response, either in a form of association
of alcohol intake with higher risk on reporting the burnout
(Colville et al., 2017), or substance use with lower resilience
that is highly correlated with anxiety, depression and per-
ceived stress (Smith et al., 2008), and with increased anxiety
(McPherson, 2003). Several studies showed negative effect of
6 S. BUDIMIR ET AL.
maladaptive coping styles on mental health during COVID-
19 pandemic, associating it with higher anxiety and depres-
sion, higher level of psychological distress and lower well-
being (Dawson & Golijani-Moghaddam, 2020; Rahman
et al., 2020; Rettie & Daniels, 2020; Wang et al., 2020b; Yan
et al., 2020).
The coping strategy support in faith had the lowest, but
significant predictive value, compared to other coping strat-
egies. Support in faith was a predictor for higher depression
and anxiety, and it also had a significant predictive value for
higher perceived stress and insomnia. However, psycho-
logical life quality and well-being were not predicted by this
coping strategy in this study. Although other studies report
conflicting results on associations between anxiety, depres-
sion, wellbeing and religiosity, a negative association
between religiosity and anxiety outnumber the studies that
found a positive association or no association (Abdel-Khalek
et al., 2019; Hodapp & Zwingmann, 2019; Koenig, 2001). A
negative effect of religious coping strategy on mental health
was also found during COVID-19 pandemic (Agha, 2021).
A possible explanation for the results in our study could be
that individuals with the coping strategy support in faith
were not able to practice this coping strategy in the usual
way during the COVID-19 lockdown. Since churches were
closed, they could only practice praying alone, and not
together with others in ceremonies which could contribute
to psychological distress in these individuals.
Several limitations should be considered when interpret-
ing these results. First, although linear regression allows cal-
culation of predictors’ contribution in explaining part of the
dependent variable variance, it does not allow conclusions
about causal relationship. Second, although the results of
this study were compared to studies of associations of cop-
ing strategies with mental health, some even during
COVID-19 pandemic, direct comparison of predictive values
of each of the measured coping strategies for each of the
measured mental health scales during the pandemic was not
possible at the moment of writing this paper. As some of
the coping strategies could be culturally specific (e.g. sup-
port in faith coping), it would be interesting to have com-
parison of coping strategies during COVID-19 pandemic
between different cultures.
In conclusion, the results of this study revealed a strong
protective role of positive thinking, social support and active
coping for mental health during the COVID-19 lockdown.
Importance of maintaining good mental health help in
stressful situations is recognized due to a significant psycho-
logical impact of coronavirus outbreak on individuals and
society. These results could be used to encourage education
not only through psychotherapy, but also to a wider popula-
tion through media, internet and social networks (e.g.
B€auerle et al., 2020), about beneficiary and protective effects
that these coping strategies had on mental health during
COVID-19 lockdown.
Disclosure statement
No potential conflict of interest was reported by the author(s).
ORCID
Sanja Budimir http://orcid.org/0000-0002-4110-9112
Thomas Probst http://orcid.org/0000-0002-6113-2133
Christoph Pieh http://orcid.org/0000-0003-2708-303X
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