The COVID-19 pandemic significantly disrupted daily life, leading to increased mental health issues. While pre-existing mental health conditions are recognized risk factors, this study investigates whether the *absence* of such conditions might also increase vulnerability due to a lack of coping mechanisms. The pandemic exacerbated existing social inequalities, particularly impacting women who experienced disproportionate childcare burdens and increased domestic responsibilities. Previous research highlighted the link between pre-existing mental health issues and poorer pandemic-related outcomes. However, this study proposes that the lack of experience managing mental wellbeing, rather than the presence of pre-existing issues, could be a critical risk factor. The concept of coping mechanisms, both adaptive and maladaptive, is crucial; adaptive coping, often developed through mental health treatment, might offer protection against pandemic-related distress. This study aimed to longitudinally assess the changes in mental wellbeing among women over the first year of the pandemic, comparing those with and without a history of mental health treatment to determine if the absence of treatment was a significant risk factor.

Existing literature demonstrates a surge in mental health problems following the onset of the COVID-19 pandemic, with pre-existing mental health issues identified as a significant risk factor. Studies show increased prevalence of anxiety, depression, and PTSD, particularly among women, due to factors like disproportionate childcare responsibilities and heightened anxieties about family health. The role of coping mechanisms, including adaptive and maladaptive strategies, has been explored, with adaptive coping linked to better outcomes. Research suggests that resilience and psychological flexibility are key factors in navigating stressful events, and prior exposure to stressful events may provide some protection through learned coping skills. However, the protective or vulnerable role of past or current mental health treatment remains unclear, with a hypothesis that prior treatment could offer advantages due to developed coping skills.

This longitudinal study utilized data from a larger study exploring mental wellbeing, eating behaviors, physical activity, and sleep during the pandemic. 167 cisgender women (aged 18-65) completed online surveys at four timepoints across the first year of the pandemic (March/April 2020, June/July 2020, October/November 2020, and February/March 2021). The Hospital Anxiety and Depression Scale (HADS) and a modified Screening Questionnaire for Disaster Mental Health (SQD) focusing on PTSD symptoms were used to assess anxiety, depression, and trauma symptoms. Participants were categorized into 'current/previous treatment-seeking' and 'no treatment-seeking' groups based on self-reported treatment history. Repeated-measures ANOVAs were conducted on both raw scores and change scores (comparing scores at T2, T3, and T4 to baseline at T1) to account for baseline differences between groups. An a priori power analysis ensured sufficient sample size.

The study found a significant main effect of Time on depression scores, with depression initially decreasing and then increasing to highest levels by the final timepoint. Participants with current or previous mental health treatment reported significantly higher levels of anxiety, depression, and trauma symptoms at all timepoints compared to the no-treatment group. However, analysis of change scores revealed no significant group differences in the *magnitude* of change across time for any wellbeing measure. Although those with a history of treatment-seeking had consistently higher levels of symptoms, the trajectory of change was similar between groups. A trend suggests that the no-treatment group experienced a larger increase in depression over time than the treatment group.

The findings suggest that prior mental health treatment did not lead to greater negative impacts on wellbeing during the pandemic. This might indicate the effectiveness of existing mental health management strategies. Conversely, the similar change trajectory in the low-risk group raises concerns. The lack of significant difference in the magnitude of change between groups, despite consistently higher baseline scores in the treatment-seeking group, challenges the widely-held assumption that pre-existing mental health conditions are solely responsible for increased vulnerability during crises. The consistent higher levels of symptoms in treatment-seeking participants combined with similar trajectories in change between the groups may indicate a lack of sufficient coping strategies within the 'no-treatment-seeking' group. This aligns with research suggesting that adaptive coping strategies are protective, emphasizing the importance of preventative mental health education and resources.

This study highlights the unexpected vulnerability of individuals without prior mental health treatment during the COVID-19 pandemic. The similar magnitude of change in wellbeing, despite consistently higher symptom levels in the treatment-seeking group, underscores the importance of accessible preventative mental health initiatives and coping skills education. Future research should investigate how coping strategies develop and explore methods to effectively teach these skills to broader populations. Expanding mental health support beyond those with pre-existing conditions is crucial for enhancing overall wellbeing.

The study's sample lacked ethnic and socioeconomic diversity, limiting the generalizability of findings to all women. The reliance on self-reported treatment history prevents a complete understanding of the types and effectiveness of treatment received. Further investigation into other potentially influential factors like employment status, family dynamics, and health behaviors is warranted. The lack of specific demographic information on education and financial stability also limits a more nuanced understanding of vulnerability.