COVID-19 and coping: Absence of previous mental health issues as a potential risk factor for poor wellbeing in females

The study investigates how women’s mental wellbeing changed during the first year of the COVID-19 pandemic, focusing on whether having current or prior mental health issues (and associated treatment experience) constitutes a vulnerability or, conversely, offers protection via developed coping skills. The pandemic disrupted core life domains and disproportionately impacted women through increased domestic burdens, employment challenges, and health risks. Prior research identifies female gender and a history of mental health problems as risk factors for poorer outcomes. However, the authors hypothesize that individuals with prior/current treatment may possess adaptive coping strategies and psychological flexibility that buffer against pandemic-related distress. The study aims to compare trajectories of anxiety, depression, and trauma symptoms in females with and without a history of treatment seeking across four timepoints in the UK’s first pandemic year.

The paper situates its question within evidence that COVID-19 increased mental health problems and exacerbated social inequalities, with women often bearing disproportionate burdens (e.g., childcare, domestic labor, occupational strain). Literature indicates women showed greater caution, compliance, worry for family health, and loneliness; female health workers were particularly affected. A pre-existing history of mental health disorders is commonly cited as a risk factor for poorer outcomes. Yet coping theory suggests adaptive vs. maladaptive strategies shape responses to stress. Resilience and psychological flexibility are linked to better wellbeing and fewer maladaptive behaviors. Studies during early pandemic phases show that lower resilience relates to more maladaptive coping and worse outcomes, and that psychological inflexibility predicts avoidance and distress. The authors propose that prior/current treatment could foster adaptive coping (e.g., through CBT), potentially protecting against distress during the pandemic, challenging the assumption that treatment history uniformly increases risk.

Design and setting: Longitudinal online survey of females in the UK across four timepoints over the first pandemic year: T1 (Mar/Apr 2020, first national lockdown), T2 (Jun/Jul 2020, eased restrictions), T3 (Oct/Nov 2020, tiered restrictions/second lockdown), and T4 (Feb/Mar 2021, third lockdown). Ethical approval obtained from university ethics committee (2020-1378-181); informed consent collected. Recruitment via opportunity sampling on social media. Incentives: entry into draws for eight £50 Amazon vouchers at relevant stages. Participants: N=167 cisgender females, aged 18–65 (mean=36.38, SD=14.22). Majority White (92.2%). At T1, 65.9% employed/self-employed; 25.8% in education. Most had unchanged employment status since pre-pandemic. Relationship status varied; ~27.6% had at least one child at home. Grouping by treatment-seeking history: 59 in current/previous treatment group (mean age=34.49) and 108 in no-treatment group (mean age=37.42); age difference not significant (t(165) = -1.27, p=0.205). Measures: (1) Hospital Anxiety and Depression Scale (HADS) with Anxiety and Depression subscales (0–21 each; standard cutoffs); (2) Screening Questionnaire for Disaster Mental Health (SQD) PTSD subscale (9 items; yes/no; 0–9 severity bands), adapted to reference COVID-19; (3) Two yes/no items on treatment-seeking: ever sought treatment, and currently seeking treatment for a mental health problem. Analysis: Participants classified as treatment-seeking if they responded yes to either treatment question; otherwise no-treatment group. Primary analyses: repeated-measures ANOVA with Time (T1–T4) as within-subjects factor and Treatment-Seeking (yes/no) as between-subjects factor for each outcome (anxiety, depression, trauma). To control for baseline group differences, change-from-baseline scores were computed for T2, T3, T4 (Δ=Tn−T1) and analyzed via repeated-measures ANOVA with Time (Δ at T2, T3, T4) as within-subjects factor and Treatment-Seeking as between-subjects factor. A priori power analysis (G*Power) for medium effect size, α=0.05, power=0.80 indicated ≥28 per group required.

- Sample: 167 females; treatment-seeking group n=59, no-treatment group n=108. - Mean levels over time (T1–T4): Main effect of Treatment-Seeking on all outcomes—treatment-seeking participants reported higher anxiety, depression, and trauma across all timepoints than non-seekers (e.g., HADS-Anxiety and HADS-Depression consistently higher in treatment group). Main effect of Time was observed only for depression (HADS-Depression), indicating depression levels changed over the year. - Change-from-baseline analyses (Δ=Tn−T1): No significant between-group differences in the magnitude of change for anxiety, depression, or trauma; both groups exhibited similar change trajectories. Significant main effect of Time for changes in depression only (F=9.314, p<0.001), reflecting initial decreases then increases peaking at T4 after the third lockdown. No other significant main effects or interactions on change scores. - Interpretation: Although those with prior/current treatment had higher absolute symptom levels, both groups experienced comparable magnitudes of change, suggesting that women without prior treatment—traditionally viewed as lower risk—may have experienced relatively greater deterioration without established coping strategies.

Findings indicate that, across the first pandemic year, women with prior/current treatment histories consistently reported higher absolute symptoms, yet the extent of change in anxiety, depression, and trauma matched that of women without treatment histories. Depression showed a time-related pattern across the year in both groups. This parallels the notion that coping resources gained through treatment (e.g., CBT-derived strategies, psychological flexibility) may protect against disproportionate worsening during crises. Conversely, women without prior treatment may lack adaptive coping skills, potentially contributing to relative declines comparable to those with clinical histories. The pattern supports public health strategies that broaden access to coping and mental health literacy training (e.g., MHFA), reinforcing that effective coping can be protective in large-scale stressors like pandemics.

The study contributes longitudinal evidence that prior/current treatment history does not necessarily confer greater vulnerability to pandemic-related declines in wellbeing; rather, women without such histories may be comparatively at risk due to limited coping resources. The authors call for preventative, population-level interventions to build adaptive coping skills and mental health literacy (e.g., Mental Health First Aid), and for the integration of lived-experience insights to tailor supports. Future research should investigate how coping skills develop across diverse populations, mechanisms by which treatment experience confers resilience, and how to effectively teach adaptive strategies to bolster community mental health preparedness for future crises.

- Grouping based on self-reported treatment-seeking; unclear whether no-treatment participants never experienced low wellbeing or lacked insight/access to seek help. Specific treatments received, their timing, intensity, and problem severity were not captured. - Limited demographic diversity (predominantly White, employed, married/cohabiting, fewer with children at home) restricts generalizability across women of different ethnic, socioeconomic, and family contexts. - Female-only sample; findings may not generalize to men or gender-diverse populations. - Nonrandomized design with pre-existing groups; although change-score analyses were used to address baseline differences, residual confounding remains possible. - Limited set of covariates; other influential variables (e.g., employment changes, financial stress, caregiving demands, health behaviors) were not modeled.