Associations between coping strategies and psychological distress among people living in Ukraine, Poland, and Taiwan during the initial stage of the 2022 War in Ukraine

ABSTRACT

Background: The 2022 War in Ukraine has significantly affected the psychological well-being and daily lives of people in many countries.

Objective: Two aims of this transnational study were (1) to compare psychological distress and coping strategies among people living in Ukraine, Poland, and Taiwan, (2) to examine whether the associations between various coping strategies (ie. problem-focused coping, emotion-focused coping, and avoidance) and psychological distress (ie. depression, anxiety, stress, posttraumatic stress disorder symptoms, and hopelessness about the ongoing war) differed among people of various countries during the initial stage of the 2022 War in Ukraine.

Method: In total, 1,598 participants (362 from Ukraine, 1,051 from Poland, and 185 from Taiwan) were recruited using an online advertisement to complete online survey questionnaires, including the Brief Coping Orientation to Problems Experienced inventory; the 21-item Depression, Anxiety and Stress Scale; the Impact of Event Scale-Revised; and a questionnaire devised to assess the level of hopelessness about the ongoing war.

Results: Psychological distress and adoption of coping strategies differed across people of various countries. Among Taiwanese and Polish respondents, avoidant coping strategies were most strongly associated with all categories of psychological distress compared with problem- and emotion-focused coping strategies. However, the associations of various coping strategies with psychological distress differed to a less extent among Ukrainian respondents. In addition, problem- and emotion-focused coping strategies had comparable associations with psychological distress among the people of Ukraine, Poland, and Taiwan.

Conclusions: The 2022 War in Ukraine has affected the psychological well-being of people, especially the Ukrainians. Because of the strong association between the adoption of avoidance coping strategies and psychological distress, despite a less extent among Ukrainian respondents, adaptive coping strategies such as (problem- and emotion-focused) are suggested to help people during times of war.

HIGHLIGHTS

• The 2022 War in Ukraine affected the psychological well-being in Ukraine and elsewhere.

• Compared with problem- and emotion-focused coping strategies, avoidant coping strategies had stronger association with psychological distress, but it varied among different cultures.

Antecedentes: La guerra de 2022 en Ucrania ha afectado significativamente el bienestar psicológico y la vida cotidiana de las personas en muchos países.

Objetivo: Dos objetivos de este estudio transnacional fueron (1) comparar el malestar psicológico y las estrategias de afrontamiento en las personas que viven en Ucrania, Polonia y Taiwán, (2) examinar si las asociaciones entre varias estrategias de afrontamiento (es decir, afrontamiento centrado en el problema, afrontamiento y evitación centrados en las emociones) y malestar psicológico (es decir, depresión, ansiedad, estrés, síntomas de trastorno de estrés postraumático y desesperanza por la guerra en curso) diferían entre las personas de varios países durante la etapa inicial de la Guerra de 2022 en Ucrania.

Método: En total, 1.598 participantes (362 de Ucrania, 1.051 de Polonia y 185 de Taiwán) fueron reclutados mediante un anuncio en línea para completar cuestionarios en línea, incluido el Inventario Breve de Orientación de afrontamiento de problemas experimentados (COPE); la Escala de Depresión, Ansiedad y Estrés de 21 ítems (DASS-21); la Escala de Impacto de Eventos-Revisada (IES-R); y un cuestionario diseñado para evaluar el nivel de desesperanza sobre la guerra en curso. Se realizó un análisis de varianza (ANOVA) para comparar las estrategias de afrontamiento y el malestar psicológico entre las personas que viven en Ucrania, Polonia y Taiwán. Se realizó un análisis de regresión lineal general para examinar las asociaciones entre las estrategias de afrontamiento y el malestar psicológico y se utilizó un análisis de regresión aparentemente no relacionado para comparar si había diferentes asociaciones entre las estrategias de afrontamiento evaluadas y el malestar psicológico. La regresión lineal general y los análisis de regresión aparentemente no relacionados se realizaron estratificados por encuestados polacos, ucranianos y taiwaneses.

Resultados: El malestar psicológico y la adopción de estrategias de afrontamiento difirieron entre las personas de varios países. Entre los encuestados taiwaneses y polacos, las estrategias de afrontamiento de evitación se asociaron más fuertemente con todas las categorías de malestar psicológico en comparación con las estrategias de afrontamiento centradas en el problema y la emoción. Sin embargo, las asociaciones de diversas estrategias de afrontamiento con el malestar psicológico diferían en menor medida entre los encuestados ucranianos. Además, las estrategias de afrontamiento centradas en el problema y la emoción tenían asociaciones comparables con el malestar psicológico entre las personas de Ucrania, Polonia y Taiwán.

Conclusiones: La Guerra de Ucrania de 2022 ha afectado el bienestar psicológico de las personas, especialmente de los ucranianos. Debido a la fuerte asociación entre la adopción de estrategias de afrontamiento de evitación y el malestar psicológico, aunque en menor medida entre los encuestados ucranianos, se sugieren estrategias de afrontamiento adaptativas como las centradas en el problema y la emoción para ayudar a las personas en tiempos de guerra.

背景：2022 年乌克兰战争严重影响了许多国家人民的心理健康和日常生活。

目的：本跨国研究的两个目的是 (1) 比较生活在乌克兰、波兰和台湾的人们的心理困扰和应对策略，(2) 检验 2022 年乌克兰战争初始阶段在各国人民中，各种应对策略（即以问题为中心的应对、以情绪为中心的应对和回避）和心理困扰（即抑郁、焦虑、应激、创伤后应激障碍症状和对正在进行的战争的绝望）的关联是否有所不同。

方法：总共招募了 1,598 名参与者（乌克兰 362 名、波兰 1,051 名和台湾 185 名）使用在线广告完成了在线调查问卷，包括对遇到问题的简要应对方式清单； 21 条目的抑郁、焦虑和应激量表； 事件影响量表修订版； 以及一个旨在评估对正在进行的战争的绝望程度的调查问卷。 使用方差分析 (ANOVA) 比较乌克兰、波兰和台湾居民的应对策略和心理困扰。 进行一般线性回归分析以考查应对策略与心理困扰之间的关联，并使用看似无关的回归分析来比较评估的应对策略与心理困扰之间是否存在不同的关联。 波兰、乌克兰和台湾的受访者分层进行了一般线性回归和看似无关的回归分析。

结果：心理困扰和采用的应对策略因不同国家的人而异。 在台湾和波兰的受访者中，与以问题和情绪为中心的应对策略相比，回避应对策略与所有类型的心理困扰的关联最为密切。 然而，在乌克兰受访者中，各种应对策略与心理困扰的关联差异较小。 此外，在乌克兰、波兰和台湾人民中，以问题和情绪为中心的应对策略与心理困扰具有类似的关联。

结论：2022 年乌克兰战争影响了人们的心理健康，尤其是乌克兰人。 由于采用回避应对策略与心理困扰之间存在密切关联，尽管乌克兰受访者的程度较低，但建议在战争期间采用适应性应对策略（例如以问题和情绪为中心）来帮助人们。

KEYWORDS:

• Coping strategy
• psychological distress
• 2022 War in Ukraine
• psychological well-being
• trauma
• stress response
• depression
• posttraumatic stress disorder

PALABRAS CLAVE:

• Estrategia de afrontamiento
• malestar psicológico
• Guerra de Ucrania de 2022
• bienestar psicológico
• trauma
• respuesta al estrés
• depresión
• trastorno de estrés postraumático

关键词:

• 应对策略
• 心理困扰
• 2022 年乌克兰战争
• 心理健康
• 创伤
• 应激反应
• 抑郁
• 创伤后应激障碍

1. Introduction

On 24 February 2022, Russia invaded Ukraine initiating political, economic, migration-related crises in Ukraine and elsewhere. The Russian invasion is regarded as the largest war in Europe since World War II (Herb et al., 2022; Karmanau et al., 2022; Tsvetkova et al., 2022). During the first 6 weeks following the outbreak of the war in Ukraine, 4.3 million refugees fled the country, and 7.1 million people were left homeless (United Nations High Commissioner for Refugees, 2022). In addition to the Ukrainian population who have been directly affected by the war, people living in other countries have also been affected in various respects. For example, in countries that have close and long-term geographical, historical, economic, and cultural connections to Russia and Ukraine, such as Poland, people naturally developed profound feelings and concerns regarding whether they would become involved in the war. For example, in a study by Pew Research Center the majority of respondents (94%) see Russia as a major threat after the invasion of Russia, up from 65% who said this in 2018 (Center for Public Opinion Research, 2022). In addition, people living in countries that do not have close connections to Russia and Ukraine have also witnessed the significance of this war through media reports. For example, Taiwan–China relations have long been tense. This is because China has asserted its right to use military force in unifying what it considers to be a breakaway territory. Media reports regarding a leaked document from Russian intelligence indicate the possibility of China invading Taiwan in the autumn of 2022 (Shams, 2022). Since the outbreak of the 2022 War in Ukraine, international media has attempted to draw analogies between Russia–Ukraine and China–Taiwan relations (Shams, 2022). This has led to the emergence of the catchphrase ‘today’s Ukraine is tomorrow’s Taiwan’ (Karamushka, 2022). Although the residents of Taiwan have become numb to China’s saber rattling – such as daily incursions into Taiwan’s air defense identification zone, military exercises simulating attacks on the island, and incessant cyberattacks – the dormant fear regarding China’s invasion has intensified among the residents of Taiwan after the outbreak of the 2022 War in Ukraine; the war has thus received much attention from people in Taiwan (Knežević et al., 2016). The residents of Ukraine, Poland, and Taiwan have varying experiences and perspectives owing to their different histories and geopolitical circumstances. It is worthwhile to investigate how residents in these countries differ in their levels of psychological distress experienced and coping strategies adopted in response to the 2022 War in Ukraine.

Some individuals living in countries affected by war may develop negative psychological sequelae because of the stress, family disruption, financial difficulties, and changes in family routines resulting from the war (Hobfoll et al., 1991; Karamushka, 2022). Negative long-term effects of war include the impairment of professional and social functioning, health problems, reduced quality of life, and psychiatric disorders (Knežević et al., 2016). A meta-analysis of the adverse psychological consequences of war highlighted point prevalence values of 26.51% for posttraumatic stress disorder (PTSD) and 23.31% for major depressive disorder (MDD); among those with PTSD, 55.26% presented with comorbid MDD (Hoppen et al., 2021). Therefore, a crucial task of mental health professionals is to help people affected by war develop effective coping strategies to prevent and manage psychological distress (Hobfoll et al., 1991; Mughairbi et al., 2020). Coping is the process of managing specific internal and external sources of psychological stress through cognitive, emotional or behavioural efforts (Wilson et al., 2005). The most widely used coping strategies are problem-focused coping, emotion-focused coping, and avoidance (Baker & Berenbaum, 2007; Carver et al., 1989; Compas et al., 2001; Wilson et al., 2005). Problem-focused coping involves active efforts to manage stressful situations by modifying or eliminating the sources of stress (Baker & Berenbaum, 2007; Carver et al., 1989), typically by generating options to solve the problem, evaluating the pros and cons of those options, and implementing steps to solve the problem (Baker & Berenbaum, 2007). Generally, problem-focused coping is used when people appraise the situation as changeable (Silber et al., 1961). Emotion-focused coping involves regulative efforts to diminish the emotional consequences of stressful events (Baker & Berenbaum, 2007; Carver et al., 1989), especially in an uncontrollable (Endler, 1997) or unchangeable (Folkman & Lazarus, 1985) situation. While problem-focused coping has been widely recognised as an effective strategy, the effects of emotion-focused coping are more ambiguous. Some emotion-oriented coping strategies that encourage approach (Roth & Cohen, 1986), such as positive reinterpretation or seeking social support, are considered adaptive. However, emotion-focused coping that encourages avoidance (Roth & Cohen, 1986), such as denial or self-blame, is viewed as rather maladaptive (Baker & Berenbaum, 2007; Folkman & Lazarus, 1985). Avoidance strategies include behavioural and mental disengagement to avoid directly dealing with stressful situations (Carver et al., 1989). Previous studies have indicated that poor coping strategies may contribute to additional stress, leading to a negative behavioural pattern and the development of psychosomatic symptoms (Yussuf et al., 2013). By contrast, developing effective coping behaviour can reduce stress and help people solve personal problems and maintain psychological balance and health (Silber et al., 1961).

Coping plays an important factor in shaping post-war functioning and a significant determinant for long-term well-being (Amone-P’Olak & Omech, 2020) and helping people adopt effective coping strategies to manage war-related stress can reduce their sense of being adrift and confused during the chaos of war and may improve their psychological well-being (Hobfoll et al., 1991; Mughairbi et al., 2020). Several researchers have examined the relationships between stress coping strategies and psychological distress among adults affected by war. The results have indicated that approach coping strategies (e.g. solving problems or seeking information) are associated with relatively low levels of psychological symptoms (Sharkansky et al., 2000), whereas avoidant coping strategies are associated with alcohol consumption (Bartone et al., 2017) and PTSD symptoms (Benotsch et al., 2000). In general, there is a theoretically- and empirically-based notion that problem-focused coping strategies are associated with a reduction in distress while emotion-focused coping negatively affects psychological functioning (Amone-P’Olak & Omech, 2020; Mikulincer & Solomon, 1989). However, a systematic literature review of 50 studies on the coping strategies used by adults affected by war revealed that the relationship between coping and mental health outcomes is nuanced (Seguin & Roberts, 2017). Hence, variation within and among sample populations, the range of coping typologies investigated, and the various methodological approaches used to explore coping and mental health may account for the discrepancies between the results of previous studies (Seguin & Roberts, 2017).

The present transnational cross-sectional online survey study aimed (1) to explore and compare coping strategies and psychological distress among the residents of Ukraine, Poland, and Taiwan and (2) whether the associations between various coping strategies and psychological distress (i.e. depression, anxiety, stress, PTSD symptoms, and hopelessness) differed among the residents of these three countries during the initial stage of the 2022 War in Ukraine.

2. Methods

2.1. Participants and procedures

This was a cross-sectional, non-probability, online survey conducted between 8 March and 26 April 2022. We recruited the participants through an online advertisement on Facebook and Twitter. We then used Google Forms to host an online survey to collect data from the participants. At the beginning of the online questionnaire, we explained the goal, recruitment criterion, and procedures of this study to the potential participants. Participation in the study was voluntary. The recruitment criterion was being a national of Poland, Ukraine, or Taiwan. The participants were required to click on ‘Agree to participate’ to be redirected to the research questionnaire website or to click on ‘Decline to participate’ to leave the website. They were then asked to answer all of the items on the questionnaire. We emphasised the anonymity and confidentiality of the online questionnaire. This study was approved by the Institutional Review Board of SWPS University of Social Sciences and Humanities in Poland. No incentive to participate was offered.

2.2. Measures

Eligible participants were invited to anonymously provide relevant information using the online tools listed below. All tools were translated into their corresponding Ukrainian, Polish, and Taiwanese versions using the standard forward-, backward-, and pretest-step methods (Beck et al., 2008).

Brief Coping Orientation to Problems Experienced Inventory. The Brief Coping Orientation to Problems Experienced (Brief-COPE) is a 28-item self-administrated inventory (Carver, 1997) derived from the 60-item COPE (Carver et al., 1989). We used the Brief-COPE to measure how our participants behaved in response to the recent events related to the 2022 War in Ukraine. The Brief-COPE is composed of 14 coping reactions to negative life experiences (Carver, 1997). Every item is rated on a 4-point scale from 1 (I haven’t been doing this at all) to 4 (I’ve been doing this a lot). The psychometric properties of the Brief-COPE were supported by a study on the victims of Hurricane Andrew (Carver, 1997). In a subsequent analysis, Poulus and colleagues divided the scale into three subscales: (1) problem-focused coping (e.g. active coping, use of instrumental support, positive reframing, and planning), (2) emotion-focused coping (use of emotional support, venting, humour, acceptance, self-blame, and religion), and (3) avoidant coping (self-distraction, denial, substance use, and behavioural disengagement) (Henningsen & Hamann, 2008). Higher mean item scores of the subscales indicated that the respondents were more likely to cope with the stress associated with the 2022 War in Ukraine by adopting the strategies within that subscale. The scale was administered to Ukrainian, Polish, and Taiwanese respondents in their respective language versions. The Cronbach's alpha values for the problem-focused coping, emotion-focused coping, and avoidant coping subscales were 0.88, 0.80, and 0.78, respectively.

21-Item Depression, Anxiety and Stress Scale. We used the self-administrated 21-item Depression, Anxiety and Stress Scale (DASS-21) (Lovibond & Lovibond, 1995) to measure the three dimensions of emotional state in the preceding week: depression, anxiety, and stress. Each item is rated on a 4-point scale from 1 (Did not apply to me at all) to 4 (Applied to me very much or most of the time). Higher mean item scores of the subscales indicated that the respondents experienced more severe emotional disturbances. The three-factor structure of the DASS-21 is supported by research, along with its acceptable concurrent validity with the Beck Depression Inventory (r = 0.74) and Beck Anxiety Inventory (r = 0.81) (Keyes et al., 2014). Polish, Ukrainian, and Taiwanese respondents answered the scale in their respective languages. Our Cronbach's alpha values for the depression, anxiety, and stress subscales were 0.84, 0.90, and 0.80, respectively.

Impact of Event Scale–Revised. We used the self-administrated 22-item Impact of Event Scale–Revised (IES-R) (Bromet et al., 2005) to measure the three dimensions of the psychological stress reactions (i.e. intrusion, avoidance, and hyperarousal) of the respondents to the 2022 War in Ukraine. The respondents reported their frequency of symptoms over the preceding week on a 5-point scale ranging from 0 (not at all) to 4 (extremely). Higher mean item scores of the subscales indicated that the respondents experienced more severe psychological stress reactions to the 2022 War in Ukraine. The three-factor structure of the IES-R is supported by previous studies, and its internal consistency and concurrent and discriminative validity have been demonstrated in studies on victims of various traumatic events (Beck et al., 2008; Creamer et al., 2003). We presented the scale to Ukrainian, Polish, and Taiwanese respondents in their respective language versions. Our Cronbach's alpha values for the intrusion, avoidance, and hyperarousal subscales were 0.88, 0.81, and 0.85, respectively.

Hopelessness about the ongoing war. We used one item (‘I feel hopeless about the current war in Ukraine’) to assess the current level of hopelessness of the respondents toward the 2022 War in Ukraine. The respondents rated this item on a 4-point scale ranging from 1 (not at all) to 4 (nearly all the time).

Demographics. We collected data on the age, sex, educational level, and nationality of the respondents.

2.3. Statistical analysis

Continuous and categorical variables were presented as means and standard deviations (SDs); categorical variables were presented as frequency and percentage. We compared the coping strategies (problem-focused coping, emotion-focused coping, and avoidant coping) and psychological distress factors (depression, anxiety, stress, PTSD symptoms, and hopelessness about the war) among Polish, Ukrainian, and Taiwanese respondents by using analysis of variance (ANOVA) and performed post hoc comparisons by using the Scheffe test.

General linear model was first used to examine and compare the associations of various coping strategies with psychological distress and seemingly unrelated regression was further used to explore whether there were different associations between the evaluated coping strategies and psychological distress and these analyses were conducted stratified by Polish, Ukrainian, and Taiwanese respondents.

There were two main reasons for using seemingly unrelated regression: (1) it can adjust for the correlation between coping strategies because the decision to the level of adopting one coping strategy affects whether the other coping strategies will be adopted and (2) it allowed us to compare the differences in the regression coefficients of coping strategies for psychological distress. Specifically, we compared a baseline (configurational) model with the regression coefficients of various freely estimated coping strategies for psychological distress and an invariant model with these regression coefficients constrained the same. If the difference in terms of the chi-square change test is statistically significant between models, then these regression coefficients should be separately estimated.

In these analyses, we also controlled for sex, and age groups. Because the numbers of items for the three subscales of the Brief-COPE were not the same, we used the mean scores rather than the sum scores to aggregate the subscales of the Brief-COPE and ensure the comparability of the regression coefficients among the three coping strategies. The mean scores ranged from 1 to 4 across the various subscales of the Brief-COPE. In all of our analyses, we considered a p-value less than 0.05 as statistically significant. The systemfit package (Henningsen & Hamann, 2008) in R 4.2.0 software (R Foundation for Statistical Computing, Vienna, Austria) was used to fit the seemingly unrelated regression.

3. Results

Among a total of 1,626 respondents, we excluded those whose nationality were not Polish, Ukrainian, or Taiwanese, leaving 1,598 respondents (362 from Ukraine, 1,051 from Poland, and 185 from Taiwan) who agreed to participate in the study.

3.1. Psychological distress and coping strategies across countries

Table 1 presents the sociodemographic characteristics of the participants, the scores of the three coping strategies, and the various categories of psychological distress. Problem-focused coping strategies was the most commonly used strategies among the three groups of respondents, followed by emotion-focused and avoidance coping strategies. The Taiwanese respondents reported greater adoption of all coping strategies (problem-focused, emotion-focused, and avoidance strategies) compared with the Polish and Ukrainian respondents. The Polish respondents reported adopting more emotion-focused coping strategies and fewer problem-focused coping strategies compared with the Ukrainian respondents, and no difference in the use of avoidant coping strategies was evident between the Polish and Ukrainian respondents.

Table 1. Sociodemographics, coping orientation, and psychological distress of the Polish, Ukrainian, and Taiwanese respondents.

	Total	Ukrainian	Polish	Taiwanese	Statistics	Post-hoc
Variable	N = 1598	N = 362	N = 1051	N = 185
Sex	n (%)	n (%)	n (%)	n (%)
Male	401 (25.1%)	65 (18%)	253 (24.1%)	83 (44.9%)	–	–
Female	1197 (74.9%)	297 (82%)	798 (75.9%)	102 (55.1%)
Age group
12–21	403 (25.2%)	82 (22.7%)	292 (27.8%)	29 (15.7%)	–	–
22–30	573 (35.9%)	78 (21.5%)	452 (43%)	43 (23.2%)
31–40	302 (18.9%)	76 (21.0%)	156 (14.8%)	70 (37.8%)
41–49	173 (10.8%)	61 (16.9%)	112 (10.7%)	0 (0%)
>50	147 (9.2%)	65 (18%)	39 (3.7%)	43 (23.2%)
Education level
Junior school or below	618 (38.7%)	74 (20.4%)	540 (51.4%)	4 (2.2%)	–	–
Bachelor	442 (27.7%)	133 (36.7%)	206 (19.6%)	103 (55.7%)
Graduate school	538 (33.7%)	155 (42.8%)	305 (29%)	78 (42.2%)
Coping Orientation to Problems Experienced Inventory
Problem-focused	1.7 (0.8)	1.8 (0.6)	1.5 (0.6)	2.8 (0.8)	326.44	T > U > P
Emotion-focused	1.5 (0.6)	1.4 (0.4)	1.3 (0.5)	2.4 (0.6)	391.46	T > P > U
Avoidance	1.0 (0.6)	0.9 (0.5)	0.9 (0.5)	1.6 (0.5)	155.92	T > P = U
Depression Anxiety Stress Scales	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
Depression	1.0 (0.7)	1.3 (0.6)	1.0 (0.7)	0.5 (0.5)	83.94	U > P > T
Anxiety	1.2 (0.7)	1.5 (0.7)	1.2 (0.7)	0.7 (0.7)	84.02	U > P > T
Stress	0.9 (0.7)	1.2 (0.7)	0.9 (0.7)	0.5 (0.6)	71.55	U > P > T
Impact of Event Scale – Revised
Intrusion	1.7 (0.9)	2.1 (0.9)	1.6 (0.9)	1.9 (0.9)	42.83	U > T > P
Avoidance	1.7 (0.8)	1.6 (0.7)	1.6 (0.8)	1.9 (0.8)	9.49	T > P = U
Hyperarousal	1.6 (0.9)	2.0 (0.9)	1.5 (0.9)	1.7 (0.8)	50.47	U > T > P
Hopelessness about the war	3.2 (0.9)	3.2 (0.9)	3.4 (0.8)	2.1 (0.8)	180.04	P > U > T

Note: SD: standard deviation. In the post hoc comparison, P = Polish respondents, U = Ukrainian respondents, and T = Taiwanese respondents. The post hoc comparison was performed using the Scheffe test.

Regarding the psychological symptoms on the Depression Anxiety Stress Scales, anxiety was the most common symptoms among the three groups of respondents, followed by depression and stress. The Ukrainian respondents reported the most severe levels of depression, anxiety, and stress, followed by the Polish and Taiwanese respondents. Regarding the PTSD symptoms on the IES-R, the symptoms of intrusion, avoidance and hyperarousal were similarly common in the Polish and Taiwanese respondents, whereas the symptom of avoidance was relatively low compared with intrusion and hyperarousal in the Ukrainian respondents. The Ukrainian respondents reported the most severe levels of intrusion and hyperarousal, followed by the Polish and Taiwanese respondents, whereas the Taiwanese respondents reported a more severe level of avoidance than those reported by the Polish and Ukrainian respondents. Finally, the Polish respondents reported the most severe levels of hopelessness about the war, followed by the Ukrainian and Taiwanese respondents.

3.2. Associations between coping strategies and psychological distress across countries

The associations of coping strategies with psychological distress in respondents from different countries during the 2022 War in Ukraine are shown in Table 2. The associations between problem-focused coping strategies and psychological distress varied among people from different countries. Nonsignificant associations were observed between depression, anxiety, and perceived stress on the DASS-21, the subscales of the IES-R, and hopelessness about the war in the Taiwanese respondents, but positive associations of them were observed in the Polish respondents. Finally, mixed associations between problem-focused coping strategies and psychological distress in the Ukrainian respondents. The adoption of problem-focused coping strategies positively associated with the subscale of avoidance of the IES-R, and negatively associated with hopelessness about the war, and did not associate the other psychological distress. On the other hand, the association between the adoption of emotion-focused and avoidant coping strategies and psychological distress had more consistent patterns across people living in different countries. Generally, the adoption of emotion-focused and avoidant coping strategies was significantly associated with the severity of depression, anxiety, perceived stress, and hyperarousal.

Table 2. Associations between various coping strategies and mental health during the 2022 War in Ukraine, stratified by country.

	Taiwanese			Polish			Ukrainian
	Problem-focused	Emotion-focused	Avoidance	Problem-focused	Emotion-focused	Avoidance	Problem-focused	Emotion-focused	Avoidance
Variable	B (se)	B (se)	B (se)	B (se)	B (se)	B (se)	B (se)	B (se)	B (se)
Depression Anxiety Stress Scales
Depression	0.498 (0.360)	2.311 (0.447)***	4.647 (0.499)***	1.360 (0.223)***	3.061 (0.301)***	5.098 (0.227)***	−0.306 (0.362)	1.880 (0.476)***	2.851 (0.416)***
Anxiety	0.929 (0.571)	3.441 (0.717)***	6.806 (0.822)***	1.624 (0.304)***	4.038 (0.410)***	7.072 (0.304)***	−0.156 (0.535)	2.918 (0.702)***	4.326 (0.612)***
Stress	0.156 (0.284)	1.258 (0.364)***	3.605 (0.394)***	0.619 (0.177)***	2.303 (0.237)***	4.034 (0.176)***	−0.272 (0.291)	1.306 (0.385)***	2.204 (0.336)***
Impact of Event Scale – Revised
Intrusion	0.574 (0.652)	3.653 (0.822)***	8.012 (0.921)***	3.487 (0.307)***	4.271 (0.433)***	6.102 (0.348)***	0.598 (0.622)	3.958 (0.811)***	3.808 (0.734)***
Avoidance	0.343 (0.621)	2.966 (0.794)***	8.634 (0.821)***	1.346 (0.285)***	2.711 (0.393)***	4.904 (0.316)***	2.039 (0.504)***	3.554 (0.667)***	5.949 (0.544)***
Hyperarousal	−0.107 (0.466)	2.284 (0.593)***	5.969 (0.643)***	2.162 (0.241)***	3.066 (0.335)***	5.082 (0.261)***	0.146 (0.454)	2.741 (0.592)***	3.064 (0.530)***
Hopelessness	0.109 (0.072)	0.242 (0.094)*	0.317 (0.119)**	0.148 (0.039)***	0.168 (0.055)**	0.429 (0.046)***	−0.230 (0.079)*	0.037 (0.108)	0.344 (0.096)***

Note: The analysis was adjusted for sex, educational level, and age group. B: regression coefficient; SE: standard error. *p < .05, **p < .01, ***p < .001.

3.3. Different effects of adopting coping strategies on psychological distress across countries

We used seemingly unrelated regression to compare the associations of various coping strategies on psychological distress among Polish, Ukrainian, and Taiwanese respondents (Table 3). The results indicated that, in both the Taiwanese and Polish respondents, the adoption of avoidant coping strategies had more strongly positive associations with the subscales of the DASS-21 and IES-R compared with the adoption of problem-focused and emotion-focused coping strategies. However, these different effects of coping strategies on psychological distress were less significant in the Ukrainian respondents. For example, our comparison of the associations of problem-focused coping and avoidant coping strategies with the avoidance subscale of the IES-R revealed differences of −2.77, −0.73, and −0.16 for the Taiwanese, Polish, and Ukrainian respondents, respectively.

Table 3. Different effects of various coping strategies on mental health during the 2022 War in Ukraine with seemingly unrelated regression, stratified by country.

	Taiwanese						Polish						Ukrainian
	Problem-focused		Emotion-focused		Problem-focused		Problem-focused		Emotion-focused		Problem-focused		Problem-focused		Emotion-focused		Problem-focused
	vs.		vs.		vs.		vs.		vs.		vs.		vs.		vs.		vs.
	avoidance		avoidance		emotion-focused		avoidance		avoidance		emotion-focused		avoidance		avoidance		emotion-focused
Variable	Difference	χ^2	Difference	χ^2	Difference	χ^2	Difference	χ^2	Difference	χ^2	Difference	χ^2	Difference	χ^2	Difference	χ^2	Difference	χ^2
Depression Anxiety Stress Scales
Depression	−1.17	16.88***	−1.00	11.68***	−0.17	1.84	−1.34	105.95***	−1.21	80.97***	−0.13	3.30	−0.24	2.34	−0.19	1.49	−0.05	0.15
Anxiety	−1.44	11.54***	−1.23	8.05**	−0.21	1.42	−1.97	123.25***	−1.80	96.22***	−0.17	3.53	−0.39	2.77	−0.31	1.66	−0.08	0.23
Stress	−0.96	20.09***	−0.90	18.12***	−0.06	0.59	−1.09	113.33***	−0.98	85.71***	−0.11	4.05*	−0.18	2.28	−0.15	1.68	−0.03	0.09
Impact of Event Scale – Revised
Intrusion	−1.84	13.92***	−1.63	10.67**	−0.21	0.99	−0.88	24.69***	−0.93	27.60***	0.05	0.20	−1.23	0.58	−1.16	<0.01	−0.07	0.72
Avoidance	−2.77	31.72***	−2.60	28.55***	−0.17	0.84	−0.73	30.55***	−0.68	25.83***	−0.05	0.66	−0.16	18.2***	−0.07	16.2***	−0.09	0.20
Hyperarousal	−1.57	18.66***	−1.44	16.24***	−0.13	0.58	−1.03	56.40***	−1.00	51.64***	−0.03	0.18	−1.82	0.95	−1.26	0.16	−0.56	0.46
Hopelessness	−0.01	0.10	<0.01	0.03	−0.01	0.11	−0.03	5.04*	−0.03	4.91*	<0.01	0.01	−0.39	0.93	−0.31	0.58	−0.08	0.19

Note: The analysis was adjusted for sex, educational level, and age group. *p < .05, **p < .01, ***p < .001.

4. Discussion

4.1. Psychological distress and coping strategies across countries

The Ukrainian, Polish, and Taiwanese respondents reported different levels of psychological distress during the initial stage of the 2022 War in Ukraine. The Ukrainian respondents reported the greatest intensity of depression, anxiety, stress, intrusion, and hyperarousal. In addition to exerting a material toll, the war has also exerted a psychological toll on residents of Ukraine, with many witnessing deaths and the destruction of property (Keyes et al., 2014). However, it should be mentioned that the national one-year prevalence of depression and anxiety was reported higher in Ukraine (8.4% and 3.8%) (Bromet et al., 2005) than it in Poland (3.0% and 3.4%, because any anxiety disorders was not reported, we used the specific phobia as the proxy) (Kiejna et al., 2015) and Taiwan (1.9% and 2.4%) (Chien et al., 2004; Wang et al., 2022) before the war. Even Ukrainians living in regions outside war zones face threats related to national security and economic instability. All these effects of war were responsible for the intense psychological distress faced by the Ukrainian respondents. The levels of depression, anxiety and stress were slightly lower among the Polish respondents than Ukrainian respondents but higher than Taiwanese respondents. Poland accepted over 2 million refugees from Ukraine. Thus, people in Poland are exposed to the horrifying details of the war through the experiences of the Ukrainian refugees. People in Poland also worry about the persistent progression of the war and the possibility of Poland becoming a battleground; moreover, the war in neighbouring countries has directly impacted their standards of living (Essau & Trommsdorff, 1996). All of the aforementioned causes might have increased the levels of psychological distress, particularly hopelessness, in the Polish respondents. The lowest levels of depression, anxiety, and distress were observed in the Taiwanese respondents who are located far away from the war in Ukraine. Although learning about the war could have induced a sense of threat in them regarding Chinese invasion (Knežević et al., 2016), the remote distance between Taiwan and Ukraine and the low level of impact on the daily lives of the residents of Taiwan might have shielded the Taiwanese respondents from severe psychological distress. These respondents reported more severe avoidance symptoms of PTSD than their Ukrainian and Polish counterparts. Specifically, residents of Taiwan may shy away from consuming information related to war considering how the war in Ukraine has increased the likelihood of Chinese military action. Nonetheless, further studies are necessary to explore the sociocultural reasons behind such avoidant behaviour among people of Taiwan.

We found that the problem-focused and avoidance coping strategies were, respectively, the most and least adopted strategies across the countries. Because the residents of war zones face a variety of challenges, the adoption of problem-focused coping strategies helps them identify the sources of stress and develop effective coping mechanisms. However, the Taiwanese respondents reported higher levels of adoption of all coping strategies than did their Ukrainian and Polish counterparts. It has been proposed that coping style is affected by the individual’s cultural values and norms (Chien et al., 2004). It has been reported that individuals from Eastern cultures with collectivistic cultures that emphasise interdependence tend to use more emotion-focused and avoidant coping strategies than those from Western countries with individualistic cultures, which has been supported by other researchers (Bjorck et al., 2001; Essau & Trommsdorff, 1996), but not always (Lee & Mason, 2014). In addition to emotion-focused and avoidant coping strategies, we also observed that Taiwanese participants reported using more problem-focused coping strategies than did their Ukrainian and Polish counterparts. A possible explanation was that because greater impacts of the 2022 War in Ukraine on Ukrainian and Polish respondents than it on Taiwanese respondents, and Taiwanese had more cognitive resources for problem-solving. Another possible explanation is that the tendency of adoption of coping strategies among individuals from different cultures varied with different types of stressful events (Schroevers et al., 2007). Further studies are required to validate our findings and identify the sociocultural causes underlying differences in the selection of coping strategies by the residents of various countries. Moreover, people may adopt coping strategies that differ over time or between various war-related issues. Thus, the selection of appropriate coping strategies warrants further studies.

4.2. Associations between coping strategies and psychological distress across countries

According to the findings of the present study, the associations between the adoption of problem-focused coping strategies and the levels of psychological distress were mixed. No associations were observed in the Taiwanese respondents and negative associations were observed in the Polish respondents, whereas problem-focused coping strategies had a positive association with avoidance, but a negative association effect on hopelessness about war. Our results reflected the inconsistent findings on the existing literature. For example, some researchers reported that individuals who were categorised as high problem-focused coping style group reported higher levels of psychiatric symptomatology than low problem-focused coping style group after individuals participated in a war (Solomon et al., 1990). Other researchers reported that individuals who used higher percentages of approach-based coping strategies to deal with combat-related stress reported lower levels of psychological symptoms after war (Sharkansky et al., 2000). Some factors have been proposed to moderate the associations between problem-focused coping strategies and mental health (Ben-zur & Zeidner, 1995), and our findings indicated that cultural difference is also another potential moderator, which has been supported in coping with the COVID-19 pandemic (Ben-zur & Zeidner, 1995).

This study indicated that the adoption of avoidant coping strategies was significantly associated with all categories of psychological distress during the 2022 War in Ukraine. Moreover, compared with problem-focused and emotion-focused coping strategies, avoidant coping strategies had the strongest positive associations with all categories of psychological distress. People who experienced drastic changes to their daily lives during the war needed to respond to these changes in a timely and effective manner. However, the association between the adoption of avoidant coping strategies and the levels of psychological distress may be bidirectional. The adoption of avoidant coping strategies, such as behavioural and mental disengagement, may cause an individual to miss crucial information in wartime, which then increases their psychological distress. Alternatively, psychological distress may limit the ability of people to adopt effective coping strategies during a war.

The results obtained in this study indicated that the adoption of emotion-focused coping strategies was significantly associated with several categories of psychological distress. Moreover, compared with the adoption of problem-focused coping strategies, the adoption of emotion-focused coping strategies had stronger associations with depression and anxiety in Taiwanese and Polish but not in Ukrainian respondents. Emotion-focused coping strategies may be less effective than anticipated in managing daily life changes, which in turn make no contribution to psychological well-being. This result is in line with previous studies, in which emotion-focused coping was found to be generally ineffective and associated with adverse consequences (Amone-P’Olak & Omech, 2020), especially when the stressful situation was changeable (Folkman & Lazarus, 1985) or controllable (Endler, 1997; Mikulincer & Solomon, 1989). However, some people may choose to adopt emotion-focused coping strategies to buffer the emotional consequences of stressful events, particularly when they feel that the stressor must be endured rather than altered or solved (Carver et al., 1989).

4.3. Different effects of adopting coping strategies on psychological distress across countries

In the present study, the different associations of various coping strategies with psychological distress were less significant for the Ukrainian respondents compared with their significance for the Polish and Taiwanese respondents. This might be because the tremendous pressure experienced by the Ukrainian respondents during the war attenuated the effects, both positive and negative, of various coping strategies; thus, the associations between coping strategies and psychological distress became nonsignificant for this group. Future studies are warranted to investigate how people select coping strategies, how the coping strategies help them manage stress during a war, and what factors influence the effects of these coping strategies on psychological distress.

4.4. Implications

The findings of the present study indicate that although Taiwanese residents were not directly involved in the war, they also experienced higher levels of psychological distress. Furthermore, the residents of various regions are located at different distances from the war epicentre and are thus exposed to different levels of war-related stress. We observed the strongest associations between the adoption of avoidance coping strategies and the levels of psychological distress, compared to compared with problem- and emotion-focused coping strategies, suggesting the understanding of responses of psychological distress and the importance of adopting active coping strategies during times of war. Furthermore, cultural differences to psychological distress responses and coping strategies should be considered. The governments should take an initiative to promote the knowledge and awareness of psychological distress and coping strategies via multiple means such as Internet and traditional media or in health care settings in local cultures. Mental health care is necessary for residents in different countries and because face-to-face interventions and training programmes may not be feasible in war zones, online mental health training programmes to help people cope with stress may be a practical alternative with the consideration of indigenous cultural understandings.

4.5. Limitations

This study has some limitations. First, the participants were recruited using an online advertisement–based recruitment strategy. Although this was a practical method for recruiting participants during a war, this method might have limited the number of respondents and introduced potential recruitment bias. A study reported biases in the favour of women, young adults, and people with higher education and incomes when the participants were recruited through an online advertisement on Facebook (Schroevers et al., 2007). Second, we collected the data using an online anonymous questionnaire. Therefore, we were unable to verify the accuracy of the responses. Third, the cross-sectional design of this study precluded causal inference. Fourth, the data were self-reported. The use of only one data source might have introduced common-method variance; thus, the association between coping strategies and psychological distress might have been inflated (Solomon et al., 1990). Fifth, this study lacked a reference group comprising the residents of a country that was not directly involved in an ongoing or anticipated war, such as the United States or Switzerland. Sixth, the numbers of respondents from Ukraine, Poland, and Taiwan were not equal, which might have limited the statistical power of our findings. Finally, some constructs of the measures used in this study might be overlapped. For example, the IES-R measures avoidance symptoms that the individuals with PTSD may use to cope with distressing memories, thoughts, or feelings associated with the trauma-related event; the concept may be overlapped with the avoidance coping strategies measured by the Brief-COPE.

5. Conclusions

The findings of the present study indicate that the 2022 War in Ukraine has drastically affected the psychological well-being and daily lives of the residents of countries that are involved in war. Compared with the adoption of problem- and emotion-focused coping strategies, the adoption of avoidant coping strategies during the initial stage of war exhibited the strongest association with the levels of psychological distress. For both the Taiwanese and Polish respondents, similar strong associations were noted between avoidant coping strategies and psychological distress compared with that noted between problem- and emotion-focused coping strategies and psychological distress. However, the significance of the different associations of various coping strategies with psychological distress were found to be low for the Ukrainian respondents. Thus, interventions aimed at alleviating psychological distress and enhancing effective coping strategies are necessary to help the residents of countries involved in a war.

Ethics approval

This study was approved by the Institutional Review Board of SWPS University of Social Sciences and Humanities (WKEB76/03/2022).

Consent to participate

Online informed consent was received for all participants in study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.