Adaptive versus maladaptive coping strategies: insight from Lebanese young adults navigating multiple crises

Abstract

Background

Coping strategies are composites of cognitive and behavioral efforts to manage the internal and external demands of stressful situations. They have been documented to relate to general well-being and mental health. However, not all types of coping are created equal, and adaptive versus maladaptive strategies seem to have understudied differential impacts, notably with accumulated adversities.

Methods

We examined coping strategies in a sample of 489 Lebanese university students during accumulating crises, including socio-political unrest and the COVID- 19 pandemic. They were asked to fill out an online survey including standardized questionnaires of well-being (WEMWBS), depression (PHQ- 9), anxiety (HAM-A), intolerance of uncertainty (IUS), and coping (Brief COPE), in addition to demographics and questions about their attitudes and future perspectives.

Results

The results highlight that adaptive coping strategies positively correlate with psychological well-being, whereas maladaptive ones are associated with higher levels of psychopathology. Specifically, it was shown that a positive association exists between anxiety, depression, intolerance of uncertainty, and maladaptive coping strategies while evidencing a negative association between the latter and well-being. Our multinominal regression showed that anxiety, intolerance of uncertainty and well-being were associated with low levels of adaptive coping when taking adaptive coping as a dependent variable.

Conclusion

Our study mainly highlights the relation between coping, uncertainty, and mental health. Although intended to help relieve tension, maladaptive strategies might worsen it instead. We emphasize previous findings to promote healthy adaptive coping strategies in times of unprecedented crises.

Adaptive versus maladaptive coping strategies: does it matter?

In recent year, scholars have developed an increased interest in the individual’s capabilities to use diverse coping mechanisms [16], especially those employed during times of psychological distress caused by natural crises and pandemics, i.e., the COVID- 19 pandemic [43]. Additionally, amidst psychological turmoil, such as that caused by war, individuals tend to utilize a variety of coping strategies [21]. The purposeful and conscious reactions that people exhibit in response to challenging, emotional, and stressful situations can be defined as ‘coping behaviors’ [42]. In other words, coping can be viewed as the set of cognitive and behavioral efforts an individual employs to handle internal and external challenges imposed by a situation that is perceived as distressing (De Boo & Wicherts, 2009). More specifically, when significant individual goals and needs have been compromised by a stressful event, a surge in negative emotions ensues, and the coping process is activated [15]. Hence, coping responses are triggered within a stressful context, with the primary objective of coping mechanisms being to mitigate the overwhelming impact of the resulting stressful negative emotions and to maintain adequate performance [15]. In reference to the Transactional Model of Stress and Coping developed by Lazarus and Folkman [36], when an individual realizes that their personal resources are insufficient to handle the demands of a psychologically distressing situation, they can become overwhelmed, putting their overall well-being at risk [3]. The relationship that exists between individuals and their psychologically challenging environments undergoes two significant stages. Initially, individuals engage in cognitive appraisal, wherein they categorize their experiences based on their perceived impact on their well-being. Therefore, before actively coping with a stressful encounter, individuals must first conduct a cognitive assessment to determine its potential for causing distress. During this phase, individuals perform a ‘primary appraisal’ to evaluate the significance of what is at stake, gauging the level of threat posed by the situation. During the ‘secondary appraisal’, they then assess their ability to handle the situation effectively and mobilize their coping resources accordingly and engage in active coping [3].

Pertinently, as a psychological process, coping is centered on individuals’ subjective interpretations of the situation. Thus, the most effective coping strategy activated by a distressing situation can only be determined relative to one’s self-evaluation and self-assessment of available resources [32]. Examining variations in coping strategies as a response to perceived stress elucidates, on the one hand, the relationship between stress and the emergence of psychopathology (De Boo & Wicherts, 2009) and, on the other, informs governmental instances, policymakers, and healthcare providers on best practices to foster coping skills as they have been systematically evidenced to play a mediating role in the relationship between stress and the development of mental health issues (De Boo & Wicherts, 2009).

Within that theoretical framework, Lazarus and Folkman [36] initially proposed one of the most widely used coping strategies categorizations: problem-focused coping and emotion-focused coping. The former involves one’s reaction to a discomforting situation by addressing the root cause of the problem, while the latter focuses on the regulation of emotional reactions in response to the discomforting situation [42]. These two coping mechanisms should not be regarded as separate coping types but as complementary to one another, especially during extremely stressful situations such as dealing with a chronic illness [32]. However, more recent approaches to coping strategies advocate the alternative use of adaptive or maladaptive categorization [31]. Although temporarily buffering mental distress during dire times, research seems to indicate that the preferential use of maladaptive coping styles and the lack of adaptive ones contributes to the pathogenesis of a variety of psychological illnesses [39]. Adaptive coping strategies are, in fact, shown to maintain and improve psychological well-being [12, 30] while reducing the extent of intrusion a person encounters following a stressful, traumatic event [31].

In order to mitigate the psychological and physiological impacts of stressful events, people resort to a range of coping strategies such as the ones cited above [8]. Recent studies have explored coping strategies in various populations, highlighting the impact of adaptive and maladaptive mechanisms on psychological well-being [11]. It offers valuable insights into adaptive and maladaptive coping mechanisms in response to stressors. Theoretically, and based on the Transactional Model of Stress and Coping by Lazarus and Folkman [36], coping strategies can either safeguard psychological well-being or contribute to its deterioration. In stressful situations, protective coping strategies that correlate with improved levels of psychological well-being include the active involvement of individuals in coping. In other words, those who actively participate in positive thinking, acceptance, positive reframing, planning and similar strategies while in distress tend to report higher levels of well-being compared to those who passively cope with stress. Passive coping that involves avoidance, social withdrawal and self-blame report poorer wellbeing (Budimir et al., 2021). For instance, during the COVID- 19 pandemic outbreak, people have reported experiencing disruptions to their daily lives, increased uncertainty, social stigmatization, fear, and anxieties about job and financial stability, which were linked to poorer psychological well-being [10]. In that regard, people who accepted the reality of the situation used humor to cope, and positively reframed their thoughts (adaptive coping), were seen to have higher psychological well-being, whereas those who utilized behavioral disengagement, avoiding news coverage of the crises, distraction [35], self-blame, and venting as (maladaptive) coping strategies experienced diminished overall mental well-being [20, 40].

Political instability has been documented to be a particularly challenging time, notably for university students who report disruptions to their daily-life routines and an increase in their feelings of loneliness, stress, and anxiety [40], impacting their academic, recreational, familial, and social spheres [51]. In fact, activating ones’ resources to manage distress becomes crucial in populations exposed to similar turmoil. In Lebanon, ongoing socio-economic and political crises have gravely impacted the lives of university students, with consequences ranging from heightened uncertainty and stress to disruptions in their daily lives [13]. However, recent studies indicate that when this same population report engaging in simple behavioral and cognitive strategies—such as practicing gratitude and maintaining adequate sleep hygiene—they score lower on measures of PTSD, depression, and anxiety, along with improved psychological well-being being [13, 14] with underlying adaptive coping capacity [50].

Context and current study

Lebanon is a small Middle Eastern country situated in the Levant region that has been reclassified by the World Bank as a lower-middle-income nation in July 2022 after around 25 years of being a higher-middle-income country [28]. This resulted from a series of events that led to the deterioration of the country’s economy and healthcare systems [Masked for review]. Initially, the influx of Syrian refugees into Lebanon that started in 2011 because of the war in Syria, contributed to the pressure put on the country’s infrastructure, resources, and economy [9]. With the Lebanese financial downfall, unemployment and corruption subsequently surged, leading to nationwide civil demonstrations in October 2019 [44]. The massive devaluation of the local currency resulting from the socio-political unrest coincided with the onset of the global COVID- 19 pandemic, followed only a few months later by the most powerful non-nuclear explosions ever known to man, in the Beirut port, obliterating the capital and resulting in devastating human and economic losses [28]. An additional layer of socio-economic complexity was added as the national banking system collapsed and banks restricted monetary withdrawals, effectively freezing all local bank accounts [27]. These accumulating adversities have drained the economic and mental sanity of many, underlying notable increases in levels of depression, anxiety, and post-traumatic stress disorders altogether [13, 14].

Although young Lebanese university students were at particularly high risks of mental distress in such times of uncertainty, they nonetheless exhibited a remarkable capacity to cope using available resources (El Khoury-Malhame, Sfeir, et al., 2023; [12, 30]). Differential use of underlying coping strategies remained understudied and is, as such, the main objective of the current research. To better understand the differential effect of coping mechanisms on overall mental health, we investigated various factors, including socio-demographic constructs and political opinions, potentially affecting university students’ ability to cope during unstable and unprecedented crises like the COVID- 19 pandemic and the socio-political and economic turmoil in Lebanon. We tracked students’ subjective reports of potential changes in plans and underlying driving reasons. We hypothesized that higher levels of well-being and greater tolerance of uncertainty would be associated with increased use of adaptive coping strategies, whereas lower well-being and greater intolerance of uncertainty would be linked to a higher reliance on maladaptive coping strategies and those who resort to maladaptive strategies would experience greater levels of psychopathology.

Method

Study design and participants

Young Lebanese university students were asked to fill out an online questionnaire aimed at assessing coping and well-being in times of sociopolitical turmoil. After providing informed consent, individuals filled out the questionnaire online and submitted it once completed. We collected demographic data, including gender, education level, major, and financial status (bracket segments), in addition to questions about supporting the uprise or not (yes/no), planning to stay in Lebanon after graduation or not (yes/no), changing plans after the COVID- 19 pandemic and/or the economic crisis (yes/no) and believing the university provided skills to navigate the future or not (on a Likert scale from 1 to 4). The final sample included 489 individuals, of which 224 were males (45.8%). Inclusion criteria included being older than 18 years and currently enrolled in a university in Lebanon (bachelor’s and master’s students).

Procedure

This cross-sectional study was conducted according to the Declaration of Helsinki, after obtaining the ethical approval from the IRB (Institutional Review Board) of the Lebanese American University (LAU.SAS.MM9.22/Apr/2020). An online link was sent to students from different universities by random convenience snowballing and sharing the link on social media accounts (WhatsApp, Facebook, LinkedIn and Instagram). Participants approved the informed consent before filling the survey. Scales were freely available for academic use and have been previously used in Lebanese or Middle Eastern population in their original English versions.

Instruments

The below instruments were all checked for psychometric properties and have been part of a previous publication [Masked for review].

The Brief COPE

[7] is a brief version of the COPE (Coping Orientation to Problems Experienced). It is a self-report questionnaire developed to assess a broad range of coping responses. The instrument typically consists of twenty-eight items on a Likert scale ranging from 0 (= I have not been doing this at all) to 3 (= I have been doing this a lot). The overall Cronbach’s alpha of the Brief Cope that resulted from this study was found to be 0.844 [Masked for review]. For the purpose of this study, the scale was divided into two main factors based on psychometric properties analyses included as supplementary tables as well as in parallel with an advanced recent finding of a validation study in 30 countries, including Lebanon, suggesting improved predictability of this factor analysis (Sanchez et al., submitted). The only subscales loading and retained include:

F1: Adaptive Coping: Active Coping, Positive Reframing, Planning, Acceptance, Emotional Support, Instrumental Support (α = 0.837)

F2: Maladaptive Coping: Negative Attitudes such as Denial, Behavioral Disengagement, Self-Blame, and Substance Use (α = 0.819)

The Warwick-Edinburgh Mental Well-being scale (WEMWBS)

[52] is a scale of fourteen positively worded items for assessing a population’s mental well-being. The WEMWBS is suitable for adults aged 16 and above. The Cronbach’s alpha of the WEMWBS was found to be 0.902 in this study [Masked for review].

The Patient Health Questionnaire- 9 (PHQ- 9)

[33, 34] was used to measure depression. It is a self-rated 9-items measure that assesses the severity of depressive symptoms in individuals aged 18 and older. Each item is rated on a 4-point scale (0 = Not at all; 1 = Several days; 2 = More than half the days; and 3 = Nearly every day). The total score can range from 0 to 27, with higher scores indicating greater severity of depression [2]. Hence, scores of 5–9 are indicative of mild depressive symptoms, 10–14 are moderate, 15–19 are moderately severe, and scores above 20 are severe symptoms. The Cronbach’s alpha of the PHQ- 9 in this study was found to be 0.844 [Masked for review].

The Hamilton Anxiety Rating Scale (HAM-A)

[22] is one of the first rating scales developed to measure the severity of anxiety symptoms. It consists of fourteen items, each probing a given symptom. It measures both mental and physical distress. Each item is scored on a scale from 0 (Not present) to 4 (Severe), with a total score range of 0–56, where scores below 17 indicate mild severity, 18–24 mild to moderate severity and 25–30 moderate to severe symptomatology. In this study, the Cronbach’s alpha of the HAM-A was found to be 0.876 [Masked for review].

The Intolerance of Uncertainty (IUS- 12)

[4] includes twelve items relating to the idea that uncertainty is unacceptable, reflects badly on a person, and leads to frustration, stress, and the inability to take action. Participants rate items on a 5-point Likert scale ranging from 1 (= not at all characteristic of me) to 5 (= entirely characteristic of me). Higher scores represent a higher intolerance of uncertainty. A Cronbach’s alpha of 0.874 for the IUS- 12 was calculated in this study [Masked for review].

Statistical analysis

Data were analyzed using SPSS software version 25. A descriptive analysis was performed using absolute frequencies and percentages for categorical variables and means and standard deviations (SD) for quantitative measures. For bivariate analysis, a Chi-square test was performed to compare the different categories while one-way ANOVA was performed to compare scores means between categories. A p-value of < 0.2 was considered to control for confounders for the multivariable analyses. Two multinomial regressions were performed for multivariable analysis, the first taking adaptive coping as the dependent variable while the second taking maladaptive coping as the dependent variable. The rationale is based on the Transactional Model of Stress and Coping theoretical framework stipulating that adaptive and maladaptive coping strategies are fundamentally distinct constructs that operate through different psychological and behavioral pathways, and they are influenced by unique sets of predictors. Adaptive coping strategies, such as problem-solving and seeking social support, would be typically associated with positive outcomes, including resilience and psychological wellbeing. In contrast, maladaptive coping strategies, such as avoidance or substance use, would be more likely linked to negative outcomes, including increased stress and mental health challenges. A p-value less than 0.05 was considered significant.

Results

Sample characteristics

In this sample of Lebanese university students, the majority were female, in senior classes and supported the October 17 th uprise. Furthermore, the majority were enrolled in business majors (Table 1).

Table 1.

Sample characteristics

	N (%)
Gender
Male	224 (45.4%)
Female	269 (54.6%)
Academic year
Freshman	36 (7.4%)
Sophomore	60 (12.3%)
Junior	127 (26.1%)
Senior	264 (54.2%)
Major
Business	258 (54.4%)
Architecture and design	52 (11%)
Computer science	38 (8%)
Education	33 (7%)
Engineering	36 (7.6%)
Law	3 (0.6%)
Media	27 (5.7%)
Health	3 (0.6%)
Science	24 (5.1%)
Do you support the October 17 th uprise
No	117 (23.9%)
Yes	372 (76.1%)

Means and percentages of continuous variables

Only approximately 9% of the participants scored high on well-being, while a striking 82% of them reported having high levels of uncertainty. Moreover, 27.5% of the participants surpassed the cut-off score for severe anxiety, and 10.4% did so for severe depressive symptoms. For additional details regarding the means and correlations pertaining to the continuous variables, consult our related publication [Masked for review].

Characteristics of students who changed their plans

During the economic and political instabilities, we found that students decided to change their plans as a way to cope with the situation as per the following (Table 2):

Table 2.

Characteristics of students who decided to change their plans

	Economic crisis	COVID- 19	Both	Other	P-value
Plans before the crisis
Continue education	17 (13%)	16 (39%)	51 (18.4%)	9 (25.7%)	0.008*
Work	14 (10.7%)	7 (17.1%)	23 (9.3%)	3 (8.6%)
Education and work	89 (67.9%)	17 (41.5%)	178 (54.3%)	18 (51.4%)
Personal projects	11 (8.4%)	1 (2.4%)	25 (9%)	5 (14.3%)
Gender
Male	68 (53.5%)	23 (57.5%)	105 (38.6%)	19 (55.9%)	0.006*
Female	59 (46.6%)	17 (42.5%)	167 (61.4%)	15 (44.1%)
Major
Business	66 (54.1%)	16 (43.2%)	157 (59.5%)	16 (50%)	0.026*
Architecture and design	13 (10.7%)	4 (10.8%)	26 (9.8%)	6 (18.8%)
Computer science	9 (7.4%)	2 (5.4%)	22 (8.3%)	3 (9.4%)
Education	7 (5.7%)	4 (10.8%)	20 (7.6%)	2 (6.3%)
Engineering	13 (10.7%)	4 (10.8%)	10 (3.8%)	5 (15.6%)
Law	3 (2.6%)	0 (0%)	0 (0%)	0 (0%)
Media	3 (2.5%)	4 (10.8%)	19 (7.2%)	0 (0%)
Health	1 (0.8%)	1 (2.7%)	0 (0%)	0 (0%)
Natural science	7 (5.7%)	2 (5.4%)	10 (3.8%)	0 (0%)

*Significant p-value

- those who had planned to continue their education or were planning to work decided to change due to COVID- 19.

- those who had planned to study and work decided to change due to the economic crisis.

Also, there was a significant gender effect, as male students changed their plans mostly due to the COVID- 19 pandemic, whereas the majority of females decided to change theirs due to the combination of the economic and health crises.

Finally, in terms of the majors assessed, most of those with education, media, health, and science majors reported being affected by the COVID- 19 pandemic, while the majority of those with architecture, computer science, and engineering tracks had other causes to change their plans.

Bivariate analysis of adaptive and maladaptive coping categories

When segmenting this sample of university students living in times of socio-political and economic instabilities, results show that those who reported their higher graduate knowledge scores showed significantly higher levels of adaptive coping than the others [very low: 2.36 (1.17) vs. low: 2.45 (1.03) vs. high:2.91 (0.97)], along with those whose parents were most affected by the economic crisis, those who experienced higher levels of intolerance of uncertainty and higher levels of well-being (Table 3).

Table 3.

Bivariate analysis of the adaptive coping categories

	Very low	Low	High	Very high	P-value
Gender
Male	43 (42.2%)	61 (47.3%)	50 (43.9%)	60 (47.2%)	0.825
Female	59 (57.8%)	68 (52.7%)	64 (56.1%)	67 (52.8%)
Major
Business	50 (54.9%)	61 (48.4%)	67 (59.3%)	72 (59%)	0.291
Architecture and design	16 (17.6%)	12 (9.5%)	10 (8.8%)	11 (9%)
Computer science	3 (3.3%)	11 (8.7%)	12 (10.6%)	11 (9%)
Education	5 (5.5%)	12 (9.5%)	7 (6.3%)	6 (4.9%)
Engineering	4 (4.4%)	12 (9.5%)	5 (4.4%)	13 (10.7%)
Law	2 (2.2%)	0 (0%)	1 (0.9%)	0 (0%)
Media	5 (5.5%)	11 (8.7%)	6 (5.3%)	4 (3.3%)
Health	1 (1.1%)	1 (0.8%)	1 (0.9%)	0 (%)
Natural science	5 (5.5%)	6 (4.8%)	4 (3.5%)	5 (4.1%)
Plans before the crisis
Continue education	21 (20.6%)	28 (20.7%)	22 (19%)	20 (15.7%)	0.642
Work	7 (6.9%)	13 (9.6%)	13 (11.2%)	13 (10.2%)
Continue education and work	64 (62.7%)	78 (57.8%)	75 (64.7%)	85 (66.9%)
Personal projects	10 (9.8%)	16 (11.9%)	6 (5.2%)	9 (7.1%)
Plan studies
Private university in Lebanon	37 (35.9%)	58 (43.6%)	43 (38.4%)	50 (41%)	0.159
Public university in Lebanon	11 (10.7%)	16 (12%)	7 (6.3%)	11 (9%)
Abroad	55 (53.4%)	55 (41.4%)	61 (54.5%)	61 (50%)
Other	0 (0%)	4 (3%)	1 (0.9%)	0 (0%)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	P-value
Graduate knowledge	2.36 (1.17)	2.45 (1.03)	2.91 (0.97)	2.86 (1.17)	< 0.001*
Extent economic crisis affecting parents	2.93 (1.05)	2.81 (0.94)	2.97 (1.02)	3.16 (0.96)	0.044*
Anxiety	17.33 (10.35)	17.56 (8.99)	19.22 (8.81)	19.96 (12.61)	0.145
Depression	11.62 (6.79)	10.87 (5.44)	11.79 (5.26)	12.40 (6.72)	0.227
Intolerance of Uncertainty	31.07 (9.19)	36.52 (7.87)	37.85 (8.31)	39.97 (8.53)	< 0.001*
Well-being	39.91 (12.28)	43.90 (9.04)	47.76 (8.86)	50.56 (9.64)	< 0.001*

*Significant p-value

In this same sample, those with higher levels of anxiety, depression, and intolerance of uncertainty showed higher levels of maladaptive coping than others. Conversely, those with higher level of well-being experienced lower maladaptive coping (Table 4).

Table 4.

Bivariate analysis of the maladaptive coping categories

	Very low	Low	high	Very high	P-value
Gender
Male	47 (42%)	61 (48.4%)	56 (47.1%)	54 (44.3%)	0.756
Female	65 (58%)	65 (51.6%)	63 (52.9%)	68 (58.7%)
Major
Business	84 (57.7%)	63 (54.3%)	60 (50%)	64 (56.6%)	0.178
Architecture and design	12 (10.8%)	13 (11.2%)	14 (11.7%)	12 (10.6%)
Computer science	8 (7.2%)	9 (7.8%)	11 (9.2%)	9 (8%)
Education	3 (2.7%)	9 (7.8%)	12 (10%)	7 (6.2%)
Engineering	4 (3.6%)	12 (10.3%)	11 (9.2%)	8 (7.1%)
Law	0 (0%)	1 (0.9%)	1 (0.8%)	1 (0.9%)
Media	6 (5.4%)	5 (4.3%)	6 (5%)	10 (8.8%)
Health	1 (0.9%)	1 (0.9%)	0 (0%)	1 (0.9%)
Natural science	13 (11.7%)	3 (2.6%)	5 (4.2%)	1 (0.9%)
Plans before the crisis
Continue education	33 (28.7%)	23 (18.3%)	20 (16.1%)	17 (13.6%)	0.171
Work	8 (7%)	11 (8.7%)	13 (10.5%)	15 (12%)
Continue education and work	65 (56.5%)	81 (64.3%)	83 (66.9%)	79 (63.2%)
Personal projects	9 (7.8%)	11 (8.7%)	8 (6.5%)	14 (11.2%)
Plan studies
Private university in Lebanon	49 (43.4%)	47 (37.6%)	50 (40.3%)	48 (40.7%)	0.755
Public university in Lebanon	11 (9.7%)	14 (11.2%)	12 (9.7%)	8 (0.8%)
Abroad	53 (46.9%)	63 (50.4%)	61 (49.2%)	59 (50%)
Other	0 (0%)	1 (0.8%)	1 (0.8%)	3 (2.5%)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	P-value
Graduate knowledge	2.85 (1.34)	2.70 (1.02)	2.55 (1.06)	2.50 (1.18)	0.06
Extent economic crisis affected parents	2.88 (0.98)	3.05 (1.07)	2.96 (0.95)	2.94 (1.01)	0.625
Anxiety	13.05 (9.17)	16.01 (8.10)	19.73 (9.34)	24.41 (10.71)	< 0.001*
Depression	7.99 (5.65)	10.30 (4.73)	12.86 (5.07)	15.08 (6.18)	< 0.001*
Intolerance of Uncertainty	31.95 (8.97)	34.84 (8.64)	38.52 (7.96)	40.72 (7.79)	< 0.001*
Well-being	48.61 (10.68)	47.17 (8.75)	43.31 (11.33)	44.44 (10.94)	< 0.001*

*Significant p-value

Multivariable analysis

Multinomial regression 1, taking adaptive coping as the dependent variable in participants with very low levels of adaptive coping vs. very high levels, showed that higher anxiety (ORa = 0.957), higher well-being (ORa = 0.869), and higher intolerance of uncertainty (ORa = 0.860) were significantly associated with very low levels of adaptive coping. In addition, students whose parents were highly affected by the economic crisis (ORa = 0.697) and those who were planning to continue their studies in a private university (ORa = 0.314) or a public university (ORa = 0.324) versus other plans were also significantly associated with very low adaptive coping.

Model 2 multinomial regression taking adaptive coping as the dependent variable in participants with low levels of adaptive coping vs. very high levels, showed that higher anxiety (ORa = 0.961), higher well-being (ORa = 0.908), and higher intolerance of uncertainty (ORa = 0.937) were significantly associated with lower levels of adaptive coping. In addition, students whose parents were highly affected by the economic crisis (ORa = 0.663) were also significantly associated with lower adaptive coping.

Model 3 multinomial regression taking adaptive coping as the dependent variable in participants with high levels of adaptive coping vs. very high levels showed that lower well-being (ORa = 0.953) and lower intolerance of uncertainty (ORa = 0.953) were significantly associated with high levels of adaptive coping.

Model 4 multinomial regression taking maladaptive coping as the dependent variable in participants with low levels of maladaptive coping vs. very low levels showed that higher intolerance of uncertainty (ORa = 1.042) was significantly associated with low levels of maladaptive coping. In addition, majors (education vs. science) (ORa = 13.792) and majors (engineering vs. science) (ORa = 13.967) were significantly associated with low levels of maladaptive coping.

Model 5 multinomial regression taking maladaptive coping as the dependent variable in participants with high levels of maladaptive coping vs. very low levels showed that higher depression (ORa = 1.163) and higher intolerance of uncertainty (ORa = 1.104) were significantly associated with higher levels of maladaptive coping. In addition, lower graduate knowledge (ORa = 0.688) and majors (education vs. natural science) (ORa = 9.990) were associated with higher level of maladaptive coping.

Model 6 multinomial regression taking maladaptive coping as the dependent variable in participants with very high levels of maladaptive coping vs. very low levels showed that higher depression (ORa = 1.209) and higher intolerance of uncertainty (ORa = 1.116) were associated with very high levels of maladaptive coping. While the plans before the crisis (continue education vs other projects) (ORa = 0.203) was associated with very high levels of maladaptive coping (Table 5).

Table 5.

Multinomial regression of adaptive & maladaptive coping

Model 1 multinomial regression taking adaptive coping as dependent variable in participants with very low level of adaptive coping vs. very high level
Factor	ORa	95% CI	P-value
Anxiety	0.957	0.919; 0.997	0.035*
Well-being	0.869	0.834; 0.906	< 0.001*
Uncertainty	0.860	0.822; 0.901	< 0.001*
Extent economic crisis affected parents	0.697	0.490; 0.992	0.045*
Plan to continue studies in a private university in Lebanon vs other	0.314	0.163; 0.647	0.002*
Plan to continue studies in a public university in Lebanon vs other	0.324	0.105; 0.995	0.049*
Model 2 multinomial regression taking adaptive coping as dependent variable in participants with low level of adaptive coping vs. very high level
Factor	ORa	95% CI	P-value
Anxiety	0.961	0.929; 0.995	0.024*
Well-being	0.908	0.876; 0.942	< 0.001*
Uncertainty	0.937	0.901; 0.974	0.001*
Extent economic crisis affected parents	0.663	0.487; 0.903	0.009*
Model 3 multinomial regression taking adaptive coping as dependent variable in participants with high level of adaptive coping vs. very high level
Factor	ORa	95% CI	P-value
Well-being	0.953	0.921; 0.987	0.008*
Uncertainty	0.953	0.917; 0.990	0.012*
Model 4 multinomial regression taking maladaptive coping as dependent variable in participants with low level of maladaptive coping vs. very low level
Factor	ORa	95% CI	P-value
Uncertainty	1.042	1.003; 1.083	0.033*
Major education vs. natural science	13.792	1.699; 111.954	0.014*
Major engineering vs. natural science	13.967	2.086; 93.535	0.007*
Model 5 multinomial regression taking maladaptive coping as dependent variable in participants with high level of maladaptive coping vs. very low level
Factor	ORa	95% CI	P-value
Depression	1.163	1.063; 1.271	0.001*
Uncertainty	1.104	1.058; 1.153	< 0.001*
Graduate knowledge	0.688	0.478; 0.989	0.043*
Major education vs. natural science	9.990	1.129; 71.576	0.036*
Model 6 multinomial regression taking maladaptive coping as dependent variable in participants with very high level of maladaptive coping vs. very low level
Factor	ORa	95% CI	P-value
Depression	1.209	1.098; 1.332	< 0.001*
Uncertainty	1.116	1.065; 1.170	< 0.001*
Plans before “continue education vs other projects”	0.203	0.046; 0.906	0.037*

*Significant p-value

Discussion

The current study aims at exploring the factors associated with coping with uncertainty and political instability in a large sample of Lebanese university students, focusing on differential use of adaptive and maladaptive strategies in relation to subsequent mental distress and overall well-being in the face of unprecedented accumulating crises.

First and foremost, results show that a majority of students support the massive political uprise (70%), with accompanying high levels of subjective reports documenting the inevitable change to their initial plans amidst the socio-political-economic unrest and the COVID- 19 health crisis. The change is gender-biased, as men most frequently reported their decisions were impacted by the COVID- 19 pandemic alone. In contrast, women had to change their plans when economic and health crises were superimposed. Amidst the COVID- 19 pandemic, empirical investigations have revealed that both men and women experienced modifications to their plans. As an illustration, in light of the pandemic, the approach to planning shifted towards shorter-term perspectives, primarily attributed to individuals’ uncertainty, whereby their perceptions of their future influenced the duration and scope of their planning endeavors [25]. Likewise, university students encountered the need to adjust their plans amid the pandemic, particularly concerning their accommodations and travel plans. The lack of clarity regarding the pandemic and the uncertainty that accompanied it rendered the planning process challenging for students [6]. On the other hand, within the context of the present study, it was found that women, in contrast to men, exhibited a higher likelihood of reporting that the economic crisis impacted their plans. This observation can be elucidated by the prevailing gender wage gap evident in Lebanese society. Research has delineated the “quicksand effect” phenomenon wherein women, despite exerting great efforts, find themselves increasingly at a disadvantage, specifically in the workplace [23]. Additionally, they confront the “glass ceiling effect”, which impedes their ascension to higher levels of leadership and success within the professional and occupational spheres [23]. These factors collectively offer insights into why women are more inclined to report being impacted by the economic crisis in Lebanon, as they perceive themselves to be economically disadvantaged.

The findings revealed that students were more likely to use adaptive coping strategies when they were being affected by the crisis, when they were intolerant of uncertainty yet had gained knowledge and skills at university and reported higher levels of well-being. This echoes previous finding among this population documenting adaptive coping strategies as protective factors of well-being [12, 30]. Another study including a sample of Lebanese participants during the pandemic, had also found that individuals who used approach instead of avoidant coping, had improved general well-being [50]. The results of Almeida and colleagues [1] further reports that individuals using adaptive coping strategies such as “accepting” or “active coping” were more satisfied with life than those using maladaptive strategies such as “self-blame” or “disengagement”. Those adaptive strategies both showcase strategies to deal with problems, either to accept what cannot be changed or to actively work on what can be changed [17, 38], and as such, would contribute to boosting well-being. Moreover, our study results showed that students who experienced higher levels of intolerance of uncertainty and those whose parents were most affected by the economic crisis showed higher levels of adaptive coping. The positive association between adaptive coping and high levels of intolerance of uncertainty may seem counterintuitive. In fact, individuals who cannot tolerate uncertainties may experience difficulties hindering their abilities to cope with stress effectively, subsequently elevating levels of anxiety and mental distress [12, 24, 30],Van den [56]. Yet, in their mediation model, Wang and colleagues (2023) found that psychological resilience was correlated with intolerance of uncertainty and coping strategies. In challenging times, those with high psychological resilience might reduce anxiety associated with the intolerance of uncertainty, hence more positively adapting to the stressor. This can also be explained by the capacity of those exposed to hardships to mobilize their resources when available and engage in post-traumatic growth (PTG), or as the name implies, the capacity of individuals to grow after experiencing trauma. As such, previous reports have systematically illustrated the positive correlation between PTG and actual PTSD only when adequate resources and resilience were put into play (El Khoury-Malhame, Sfeir, et al., 2023; [26]).

On the other hand, our results indicate that individuals with high levels of anxiety and depression symptoms were more likely to resort to maladaptive coping strategies. These results align with existing literature highlighting the association between mental distress such as anxiety and depression on the one hand and maladaptive coping on the other [18, 41]. These maladaptive coping strategies were, in turn, found to be risk factors for depression, anxiety, and stress [19]. More specifically, rumination stands out in its relation to depression, especially in individuals with low levels of adaptive coping [55]. In fact, being excessively worried about ongoing situations such as pandemics and financial meltdown and being unable to tolerate unprecedented levels of uncertainty may deplete one’s cognitive resources and ultimately lead individuals to rely on quick fixes, increasing the use of maladaptive coping styles, which might, in turn, increase the levels of both anxiety and depression symptoms [37, 45]. Examples of those maladaptive coping strategies associated with anxiety and poor mental health, such as mental and behavioral disengagement or self-blame, have been recently recognized under clusters of emotion-oriented or avoidance-oriented strategies [20, 47, 49]. Oppositely, the use of adaptive strategies such as acceptance or humor was associated with improved overall mental health [20].

In addition, the results of this research indicate that individuals with advanced educational levels tend to exhibit higher use of adaptive coping mechanisms. One plausible interpretation of this finding is that continued academic pursuits may influence one’s perceptions of their capabilities, consequently boosting their self-efficacy [53]. As knowledge expands and self-efficacy grows accordingly, there will probably be a corresponding rise in the adoption of adaptive coping strategies [46].

In interpreting the results of the multinomial regression analyses, a number of statistically significant associations ensued. Firstly, this study’s findings underscore that higher levels of intolerance of uncertainty were consistently associated with lower levels of adaptive coping and higher levels of maladaptive coping across several models. This aligns with existing literature highlighting that individuals who struggle with uncertainty may resort to maladaptive coping strategies rather than effectively dealing with their stressors [45]. This phenomenon can be illustrated by the notion that the employment of maladaptive coping strategies provides short-term relief from symptoms of anxiety through the avoidance of feelings of uncertainty about a specific threat [5]. Additionally, across multiple models, it was illustrated that elevated anxiety levels correlated with decreased utilization of adaptive coping strategies, whereas high levels of depression were linked to increased utilization of maladaptive coping strategies. This suggests that individuals experiencing anxiety and/or depression may struggle to employ effective coping strategies to adapt to their stressors [Masked for review]. This intolerance of uncertainty and the use of maladaptive coping strategies would then be associated with elevated levels of anxiety and a decrease in psychological resilience [58]. It could also be that some of the maladaptive coping strategies such as substance use and negative attitudes could be proxies for underlying mental distress and psychopathology like substance abuse or depression and warrants further investigations to better elaborate on this link. As for the results pertaining to the levels of depression, it can be highlighted that people experiencing depressive symptoms may have an impaired ability to regulate their emotions in an adaptive manner effectively [29].

Based on the multinomial regression models, the role of socio-environmental and academic variables also merits attention. The impact of parental economic status on coping strategies was evident, with students whose parents were highly affected by the economic crisis being more likely to exhibit lower levels of adaptive coping. This highlights the ripple effects of economic hardship on individuals'coping resources, decapitating their capacities to cope adaptively. It also emphasizes the need for targeted interventions to support vulnerable populations during times of financial strain [54]. This result aligns with previous studies where higher educations were associated with adaptive coping strategies [48]

It is noteworthy that educational and career-related factors were found to influence coping responses. For instance, students who planned to continue their education before the crisis exhibited high levels of maladaptive coping. It could be that when faced with inescapable force-majeure pressing one to alter major life decisions, it is cognitively and behaviorally easier to fall back on quick fixes such as denial, disengagement and/or substance abuse to be able to deal with the intense stress. Additionally, academic majors differently predicted coping strategies; for instance, students in education or engineering were more likely to demonstrate lower levels of maladaptive coping compared to those in science majors. To the best of our knowledge, this is the first study attempting to investigate such distinctions related to the field of study and, as such, underscore the importance of considering individuals'educational and career trajectories when examining coping behaviors.

Limitations

Due to the ongoing pandemic at the time of data collection, online-based questionnaires were disseminated using a snowball technique. As such, only those internet literates and with proper access to stable connections were able to fill the scales. No other behavioral or physiological data could be monitored. Also, the sample mostly targeted university students in Lebanon and it could as such fail to properly represent the national data. Knowing that the Lebanese universities are a mosaic of various socioeconomic classes and with such a large sample, the study minimizes at best generalizability biases. Nonetheless, its cross-sectional somewhat limits the ability to draw causalities and as such additional interventional or longitudinal studies can help build directionality around its conclusions. Also, the accumulation of challenging events, including the sociopolitical uprise, the economic meltdown and the health crises add layers of complexity to individual responding, based on whether or not participants were directly or indirectly impacted by the traumatic exposures. As such, within these overall contexts, strategies are defined as adaptive or maladaptive. The same strategies, used in different circumstances could be clustered differently for example, positive reframing was labeled as an adaptive coping strategy in this study, however, this could be maladaptive if somebody noted signs of potential significant health problems and decided it was not a problem worthy of help-seeking. Coping as such should be regarded as a flexible construct, depending on the situational factors. Some of the additional confounding biases may also make the interpretation of data more cautiously, especially in relation to other variables affecting the coping strategies used by participants. Some of these variables include resilience [57, 58] or looming cognitive style [5]. Future research touching upon those underlying mental strategies and cognitive-behavioral influences should be conducted on larger samples, and across other age groups to capitalize on the representativeness of our results. Cross-cultural studies can additionally highlight differences in subjective experiences and coping strategies between neighbor countries, while interventional studies can purposefully teach adaptive coping strategies to university students and track how they navigate the climate of protracted crises in the Middle East.

Clinical Implications

This study sheds light on the toll accumulating crises together with severe socio-economic instability have on young students’ psychological health. It primarily investigates the differential efficiency of underlying strategies in properly managing stress. Adaptive coping strategies, but not maladaptive ones, are systematically related to improved well-being, mental health, and tolerance of uncertainty. As such, academic institutions and mental health professionals targeting this critical age group should promote the choice and use of adaptive skills like positive reframing, acceptance, and emotional support to help young adults better navigate challenging times and sustain their overall well-being. This can also be implemented in clinical settings as clinicians may identify coping strategies and better understand case formulation in order to elaborate a treatment plan.

Authors’ contributions

M.EK and S.EK designed the study and supervised data collection. R.C and M.S wrote the main manuscript text and S.AB analyzed the data and prepared the tables. All authors reviewed the manuscript.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Informed consent was approved by the Institutional Review Board at the Lebanese American University (LAU.SAS.MM9.22/Apr/2020) according to the Declaration of Helsinki. All participants approved the informed before filling the survey.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.