Background
Coping strategies are essential for managing stress and emotional well-being, particularly in high-demand settings like healthcare. In high-demand contexts such as the COVID-19 pandemic, coping strategies may play a critical role in shaping mental health outcomes. Understanding how specific strategies relate to psychiatric symptoms is critical for effective interventions.

Methods
This cross-sectional study analyzed baseline data from 3,075 essential workers enrolled in the TelePSI project, a nationwide randomized controlled trial of brief telepsychotherapy. Participants reported coping strategies from a list of 22 options (in a yes/no format). Psychiatric symptoms—depression, anxiety, and irritability—were measured using PROMIS scales. Exploratory factor analysis (EFA) was used to identify coping dimensions, followed by correlation analyses.

Results
The most frequent strategies were watching YouTube (58.3%) and eating sweets (41.6%). EFA revealed two distinct factors: maladaptive (e.g., substance use, overeating) and adaptive strategies (e.g., physical activity, healthy eating). Maladaptive strategies showed weak positive correlations with psychiatric symptoms, while adaptive strategies showed weak negative correlations. Participants with higher symptom severity were more likely to report maladaptive behaviors.

Discussion
The findings reveal associations between coping patterns and mental health outcomes. Adaptive strategies were associated with lower psychological distress, while maladaptive behaviors showed the opposite pattern, indicating the multifactorial nature of mental health in crisis situations.