COVID19 is an ongoing pandemic that has affected millions of people worldwide. Since the beginning of this pandemic, frontline medical staff in India have been subjected to increased workload and excess working hours.¹ This situation has resulted in various psychological impacts like increased stress, anxiety, insomnia and depressive symptoms.² Studies from the SARS and MERS outbreak show that health care workers not only face short term effects but also long-term psychological consequences due to these stressful situations.³

Lazarus et al,⁴ define coping as the process of “constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands”. In simple terms, it is the process by which a person attempts to manage stressful demands. The different forms of coping strategies include problem focused, emotion focused and dysfunctional coping strategies. Problem focused coping is focusing on the specific problem or situation that has arisen and trying to find some way of changing it or avoiding it in the future, whereas, emotion focused coping is focusing on alleviating the emotions associated with the stressful situation, even if the situation itself cannot be changed. Avoidant or dysfunctional strategies or maladaptive strategies include substance use, denial, self-blame etc.5

People who tend to use problem-focused coping in stressful situations show lower levels of depression both during and after the stressful situation.⁴ Meyer et al, found that maladaptive strategies have a greater relationship with mental health problems such as depression.⁶ On the other hand, adaptive strategies have a stronger relationship with psychological well-being. Matud, studied gender differences in stress and coping and found that women have more emotion focused coping than men.⁷

Coping strategies among medical fraternity have not been studied adequately unlike burnout and stress. There is a need for these studies in India because mental health of medical staff can also impact the quality of service rendered especially during a pandemic. This study aims to identify the most common coping strategies used by frontline medical staff and to find any correlation between socio demographic characteristics and the coping strategies.

Our study indicates that there is a variable distribution of problem focused, emotion focused and dysfunctional strategies among our medical professionals. Previous studies in China have demonstrated that medical staff had more adaptive strategies^9,10 (problem and emotion focused) than maladaptive strategies but this finding could not be supported by our study, probably because individual’s response to items on dysfunctional coping items may be variable.

This study shows that with increasing age, medical professionals tend to use more emotion focused and problem focused strategies, with problem focused strategies having a strong positive correlation as age increases. On the contrary, studies comparing age and coping mechanisms report that older adults were less likely to use problem focused coping due to physiological vulnerability and health related stressors.¹¹ This difference could be attributed to the fact that the study population here is a group of medical professionals with adequate knowledge about the stressor (in this case, COVID 19) unlike general population in previous studies.

With higher designation, medical professionals used more problem based coping mechanisms which are mostly adaptive strategies. Studies have shown that resident doctors have higher stress compared to other medical professionals.¹⁰ Higher designation like teaching faculty thus could have less stress comparatively and tend to use adaptive coping mechanisms. Also, teaching faculty are in general older in age compared to residents and interns and this contributes to them using problem focused mechanisms. This goes along with our finding regarding age and coping strategies.

Being married positively correlated with emotion focused coping and problem focused coping in our study similar to previous studies which also indicate the same.¹² They have more emotional and instrumental support, are well planned and have more acceptance compared to unmarried individuals.¹³

Our study was inconsistent with previous studies regarding the association between gender and coping mechanisms. We had no statistically significant (p<0.05) association between the two variables i.e., no gender difference existed in terms of coping mechanisms. This inconsistency may be due to the fact again that it is a group of medical professionals and this could be an indicator of equal distribution of stress among both genders in the medical field. Dysfunctional coping strategies had no statistically significant correlation with any variable in our study but usually dysfunctional coping is an indicator of higher levels of stress.¹⁴ This could either mean that the levels of stress due to COVID 19 was less among medical professionals or the participants had a biased answering in questions related to substance use, self-blame or denial.

The study population was small and an extensive questionnaire of 28 items in online survey could have been a confounding factor. A comparison of the coping mechanisms of medical professionals with general population could have contributed more to understanding the coping strategies. Measurement of stress along with coping would have rendered us to do a comparison of both.

Our study shows that the factors affecting the coping mechanisms in medical professionals differs from those of the general population seen in previous studies. Within the group of medical professionals, those with higher age, higher designation and being married were more likely to use problem focused and emotion focused coping mechanisms which are in general adaptive strategies. Interventions targeting maladaptive components of emotion focused strategies and dysfunctional strategies could help medical professionals cope better with the COVID scenario and they need to be aimed at younger age group, unmarried people, interns and resident doctors.