Resilience level and its association with maladaptive coping behaviours in the COVID-19 pandemic: a global survey of the general populations
Authors: Wong Martin C. S. , Huang Junjie , Wang Harry H. X. , Yuan Jinqiu , Xu Wanghong , Zheng Zhi-Jie , Xue Hao , Zhang Lin , Jiang Johnny Y. , Huang Jason L. W. , Chen Ping , Jia Zhihui , Palaganas Erlinda , Viwattanakulvanid Pramon , Somrongthong Ratana , Caicedo Andrés , Medina-Arellano María de Jesús , Murphy Jill , Paredes Maria B. A. , Withers Mellissa ,   On behalf of the Association of Pacific Rim Universities
Published: January 2023

Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic has induced a significant global concern on mental health. However few studies have measured the ability of individuals to “withstand setbacks, adapt positively, and bounce back from adversity” on a global scale. We aimed to examine the level of resilience, its determinants, and its association with maladaptive coping behaviours during the pandemic.

Methods
The Association of Pacific Rim Universities (APRU) conducted a global survey involving 26 countries by online, self-administered questionnaire (October 2020-December 2021). It was piloted-tested and validated by an expert panel of epidemiologists and primary care professionals. We collected data on socio-demographics, socioeconomic status, clinical information, lifestyle habits, and resilience levels measured by the Brief Resilience Scale (BRS) among adults aged ≥ 18 years. We examined factors associated with low resilience level, and evaluated whether low resilience was correlated with engagement of maladaptive coping behaviours.

Results
From 1,762 surveys, the prevalence of low resilience level (BRS score 1.00–2.99) was 36.4% (America/Europe) and 24.1% (Asia Pacific). Young age (18–29 years; adjusted odds ratio [aOR] = 0.31–0.58 in older age groups), female gender (aOR = 1.72, 95% C.I. = 1.34–2.20), poorer financial situation in the past 6 months (aOR = 2.32, 95% C.I. = 1.62–3.34), the presence of one (aOR = 1.56, 95% C.I. = 1.19–2.04) and more than two (aOR = 2.32, 95% C.I. = 1.59–3.39) medical conditions were associated with low resilience level. Individuals with low resilience were significantly more likely to consume substantially more alcohol than usual (aOR = 3.84, 95% C.I. = 1.62–9.08), take considerably more drugs (aOR = 12.1, 95% C.I. = 2.72–54.3), buy supplements believed to be good for treating COVID-19 (aOR = 3.34, 95% C.I. = 1.56–7.16), exercise less than before the pandemic (aOR = 1.76, 95% C.I. = 1.09–2.85), consume more unhealthy food than before the pandemic (aOR = 2.84, 95% C.I. = 1.72–4.67), self-isolate to stay away from others to avoid infection (aOR = 1.83, 95% C.I. = 1.09–3.08), have an excessive urge to disinfect hands for avoidance of disease (aOR = 3.08, 95% C.I. = 1.90–4.99) and transmission (aOR = 2.54, 95% C.I. = 1.57–4.10).

Conclusions
We found an association between low resilience and maladaptive coping behaviours in the COVID-19 pandemic. The risk factors identified for low resilience in this study were also conditions known to be related to globalization-related economic and social inequalities. Our findings could inform design of population-based, resilience-enhancing intervention programmes.