Coping Strategies, Neural Structure, and Depression and Anxiety During the COVID-19 Pandemic: A Longitudinal Study in a Naturalistic Sample Spanning Clinical Diagnoses and Subclinical Symptoms

Abstract

Background Although the COVID-19 pandemic has been shown to worsen anxiety and depression symptoms, we do not understand which behavioral and neural factors may mitigate this impact. To address this gap, we assessed whether adaptive and maladaptive coping strategies affect symptom trajectory during the pandemic. We also examined whether pre-pandemic integrity of brain regions implicated in depression and anxiety affect pandemic symptoms. Methods In a naturalistic sample of 169 adults (66.9% female; age 19–74 years) spanning psychiatric diagnoses and subclinical symptoms, we assessed anhedonia, tension, and anxious arousal symptoms using validated components (21-item Depression, Anxiety, and Stress Scale), coping strategies (Brief–Coping Orientation to Problems Experienced), and gray matter volume (amygdala) and cortical thickness (hippocampus, insula, anterior cingulate cortex) from magnetic resonance imaging T1-weighted scans. We conducted general linear mixed-effects models to test preregistered hypotheses that 1) maladaptive coping pre-pandemic and 2) lower structural integrity pre-pandemic would predict more severe pandemic symptoms; and 3) coping would interact with neural structure to predict pandemic symptoms. Results Greater use of maladaptive coping strategies was associated with more severe anxious arousal symptoms during the pandemic ( p = .011, false discovery rate–corrected p [ p FDR ] = .035), specifically less self-distraction ( p = .014, p FDR = .042) and greater self-blame ( p = .002, p FDR = .012). Reduced insula thickness pre-pandemic predicted more severe anxious arousal symptoms ( p = .001, p FDR = .027). Self-distraction interacted with amygdala volume to predict anhedonia symptoms ( p = .005, p FDR = .020). Conclusions Maladaptive coping strategies and structural variation in brain regions may influence clinical symptoms during a prolonged stressful event (e.g., COVID-19 pandemic). Future studies that identify behavioral and neural factors implicated in responses to global health crises are warranted for fostering resilience.

Coping Strategies and Stress Related Disorders in Patients with COVID-19

“…During the COVID-19 pandemic, the use of dysfunctional coping strategies was associated with higher levels of anxiety in the general population (self-blame, venting, behavioural disengagement, and self-distraction) [39] and was also described in patients with psychiatric disorders [40,41]. Bailey Holt-Gosselin and collaborators, using the brief COPE, found that women with more severe anxiety symptoms tended to use more maladaptive coping strategies such as self-distraction, denial, venting, substance use, behavioural disengagement, and self-blame during the COVID-19 pandemic [42]. Poor mental health in general during the pandemic was associated with the use of maladaptive coping strategies such as denial, emotional discharge, or substance use [43].…”

Learning in Adverse Circumstances: Impaired by Learning With Anxiety, Maladaptive Cognitions, and Emotions, but Supported by Self-Concept and Motivation

“…The personal characteristics described here constitute antecedents for learning and form the basis of the model to be investigated (see Figure 1 ). They may function as a buffer or as an amplifier for the evaluation and emotional responses to environmental-related strain as experienced in the COVID-19 pandemics ( Dinu et al, 2021 ; Godoy et al, 2021 ; Holt-Gosselin et al, 2021 ).…”

“…Just as the population in general, university students were affected by affective sequelae of the circumstances during the pandemic, such as excessive feelings of stress or anxiety. Exacerbation of anxiety in the wake of the pandemic was related to usage of maladaptive cognition and coping strategies ( Dinu et al, 2021 ; Godoy et al, 2021 ; Holt-Gosselin et al, 2021 ). These hitherto unknown circumstances of learning posed a threat to wellbeing and mental health which subsequently may have also impacted students’ learning and academic achievement ( Andrews and Wilding, 2004 ; Barch et al, 2019 ; Charbonnier et al, 2022 ).…”

Convergence, preliminary findings and future directions across the four human connectome projects investigating mood and anxiety disorders

“…The ability to cope adaptively with stressful events is related to the capacity to regulate emotions, which in turn influences the development of anxiety and depression symptoms ( Stanisławski, 2019 ). These symptoms have also been linked with the structural integrity of the brain regions involved in emotion regulation (see Introduction in Holt-Gosselin et al, 2021 ). A recent study used longitudinal data from HCP-DES to investigate whether coping strategies and gray matter content of brain regions involved in emotion assessed pre-pandemic could predict the severity of anxiety and depression symptoms during the pandemic.…”

“…A recent study used longitudinal data from HCP-DES to investigate whether coping strategies and gray matter content of brain regions involved in emotion assessed pre-pandemic could predict the severity of anxiety and depression symptoms during the pandemic. The authors found that maladaptive coping strategies and lower insula thickness were associated with an increase in anxiety symptoms in patients after the onset of the COVID-19 pandemic ( Holt-Gosselin et al, 2021 ).…”