**1. Introduction**

On 11 March 2020, the World Health Organisation (WHO) declared COVID-19 (acronym for "coronavirus disease 2019") a pandemic due to the high morbidity and mortality registered since this novel coronavirus was first detected in the city of Wuhan (China) in December 2019. The health, economic and social effects of the pandemic are currently extremely severe, and there is still no confirmation of how long they will last. Consequently, the Government of Spain approved a Royal Decree (RD 463/2020, on 14 March) that declared a state of alarm in order to manage the sanitary crisis caused by the pandemic. During the state of alarm, movement had to be individual and limited to first-need activities or commuting to workplace; passenger transport options were radically reduced; cultural, artistic and sporting venues were closed; working from home became a priority and face-to-face education was suspended at all levels, favouring online education.

The lockdown experienced by the Spanish society, as well as almost every country nearby, was an extraordinary situation as it was unfamiliar and has proved to have a strong impact on the psychological well-being of citizens, with various sources of stress.

A first study on the psychological impact of the COVID-19 quarantine in China [1] showed that psychosocial stress and the loss of habits and routines are the two main factors affecting physical and mental well-being during a period of confinement such as the one we have experienced. Studies on situations of risk, conflict and emergencies allow us to synthetise that the main variables implied in psychological impact are the following: fear of contracting diseases, feelings of frustration and boredom, not being able to meet basic needs and the lack of information and clear action guidelines [2], or the presence

**Citation:** López-Ramos, V.-M.; León-del-Barco, B.; Mendo-Lázaro, S.; Polo-del-Río, M.-I. Coping Strategies by University Students in Response to COVID-19: Differences between Community and Clinical Groups. *J. Clin. Med.* **2021**, *10*, 2499. https:// doi.org/10.3390/jcm10112499

Academic Editor: Michele Roccella

Received: 5 March 2021 Accepted: 31 May 2021 Published: 5 June 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

of previous mental health pathologies or economic hardships [3]. Additionally, stigma and social rejection of people infected or exposed to the disease are potential triggers for having difficulties when adapting to the situation [2]. The impact degree depends on several factors. According to Sprang and Silman's research [4], people who have already experienced a quarantine during a pandemic are more likely to develop acute stress, adaptation and pain disorders (30 percent of them presenting criteria of post-traumatic stress disorder).

Nonetheless, there is still scant evidence about the immediate psychological impact of the consequences of the pandemic on the general population, mainly through research studies carried out with Chinese individuals. In a first study with a sample of 1210 people, 53% valued the psychological impact of the situation as moderate to severe, 16% referred moderate to severe depression symptoms, 28% referred moderate to severe anxiety symptoms and 8% declared moderate to severe levels of stress. For 75% of the individuals studied, the main concern was their relatives becoming infected with the disease [1]. Another research carried out with inhabitants of Wuhan and neighbouring towns showed a prevalence of 7% for symptoms of post-traumatic stress [5]. Moreover, the same group considered a wider sample of 2091 people and got a prevalence of 4.6% for symptoms of acute post-traumatic stress one month after the COVID-19 outbreak [6].

The social–cultural and psychosocial reality in Spain may have elements of connection with the results obtained in these and other international research studies, although we could also anticipate important cultural, social and health particularities. During the months of April, May and June 2020, several surveys were carried out, most of them with reduced and not very representative samples, as well as polls that compiled basically descriptive data. Broadly, conclusive results on these kinds of studies are yet to be published, although we do have some works that are starting to offer valuable data, such as the study developed by Ozmiz-Etxeberria et al. [7] with a sample of 976 people, collected in Northern Spain, which indicates that severe and extremely severe levels of stress, anxiety and depression found in this sample were less than those collected in the study carried out in China by Wang et al. [1]. This is probably due to the fact that Spain had broader access to information about the virus since it got here one and a half month later. Otherwise, it is noteworthy that the study by Ozmiz-Etxeberria et al. [7] found higher averages for stress, anxiety and depression in people aged 18–25 years old, followed by those aged 26–60, the average in the three dimensions being lower in those over 60. This may imply that the younger group of the study mainly comprised students and that the stress generated was increased by added stress due to the need to adapt to the new educational context without on-site classes. Another study concluded that 89% of a sample composed by children presented behavioural or emotional alterations as a consequence of lockdown [8]. In this sense, the fact of resuming healthy routines and habits once lockdown was over, together with getting healthy support, must allow the affected individuals to recover to normal functioning [9]. Nevertheless, the need of some type of psychological support after a period of lockdown is to be expected, especially amongst those who presented previous psychological conditions, development disorders or other psychopathologies [10].

It is evident that the impact of lockdown measurements on the general population between the months of March and June, and even the consequences of the restrictive measures prevailing after the state of alarm, have differently affected the various populational sectors that compose Spain's social structure. We consider that, for university students, this impact requires a more detailed study since apart from being young—18 to 25—they were also forced to end the school year 2019–2020 in an online modality and to face final exams also virtually. Determining the extent of consequences for university students would significantly aid the proposals of improvement related to psychological orientation and counselling in this context, and it would also allow the definition of proceedings aimed to manage stress and anxiety in universities, especially in situations of crisis, with a particular approach to individuals with prior mental health issues or disorders.

The unusual, unpredictable nature of the lockdown imposed in Spain to control the spread of COVID-19 gives us an opportunity to reflect on the personalised support models that should be put in place for university students, especially in risk and conflict situations. In this regard, echoing Balluerka et al. [10], individuals who are predisposed to certain problems or who have displayed psychopathological symptoms in the past are likely to be at greater risk of these symptoms reappearing after lockdown. Therefore, in line with Balluerka et al. [10], two types of psychological effects are anticipated to have emerged during and after the lockdown among our sample of university students:


Situations such as the one generated by the COVID-19 pandemic force us more precisely define the conceptualisation of coping strategies as a fundamental element for adaptations made by people in every diverse critical situation they may face [11]. In this way, coping must be approached as a stabilising variable that helps people to keep their psychosocial adaptation in moments of high stress levels [12,13]. A number of studies have concluded that coping strategies focused on the problem itself reduce psychological distress, whereas strategies based on emotions increase it [14]. In this sense, active skills appear to be associated with health, while avoidance ones are linked to the development of a range of diseases [15,16].

The characteristics and nature of the events faced by people influence both the availability and mobilisation of resources, as well as the coping strategies for those [17] (Moos, 1993). From the coping model raised by this author, the characteristics specific to a crisis and the evaluation of the situation carried out by an individual contextualise the response choice specific to coping [11]. It has been observed that stressful situations tend to promote a higher amount of behavioural active coping responses, while those due to interpersonal relationships generate a higher amount of coping focused on emotion [18]. In this sense, it seems to be demonstrated that the more negative life situations and chronic stress sources are present, the less employment of responses focused on approach to the problem there are, and higher the use of responses focused on avoidance is [19]. In relation with evaluation of stressful life situations, it has been checked that, when stressors are evaluated as a challenge, they tend to provoke coping responses focused on approach more than on avoidance. This means that type, severeness and evaluation performed in moments of crisis influence the coping strategies used, which proves the need and pertinence of the interconnection established between the different coping responses and concretion of the situation [19].

Another element of key importance is the degree of controllability of the stressful situation itself. The perceived controllability of the stressful stimulus has an impact on the type of strategy used and on its effectivity for lowering the stress level [20]. In this sense, Moos and Schaefer [13] propose that coping responses focused on approach should be more effective in situations that are regarded as changeable and controllable. In this regard, studies by Mikulic and Crespi [21,22] carried out with people in situations of deprivation of liberty found a prevalence of coping responses focused on avoidance, which are related to the perception of not being able to operate in the imprisonment situation that generates discomfort because of the multiplicity of variables beyond the control of the individuals.

Along these lines, the Coping Responses Inventory—Adult Form (CRI-A) by Moos becomes an important tool for the study of coping responses in an adult population thanks to its psychometric inputs in multiple sociocultural contexts [11].
