| Summary: | Background: People use healthy and unhealthy coping strategies to reduce distress. Understanding the relationship between healthy and unhealthy coping strategies and overwhelming distress is essential to inform formulation and intervention. This study explored the interdependencies between healthy and unhealthy coping strategies using Bayesian network (BN) modelling, a robust risk assessment tool. Methods: 509 college students (Mean age = –22.9 years; 66% Female) completed a web-based survey of psychological distress, mental illness, and coping in 2018–19. BN models were used to explore the interplay of healthy and unhealthy coping strategies driven by psychological distress (at extremely low, moderate, or extremely high levels). Result: At extremely low distress, self-soothing and social support were the most likely coping strategies used. At moderate levels, there was an increased likelihood of using professional support, as well as the increasing use of all unhealthy coping groups of strategies. At extremely high levels of distress, all unhealthy coping strategies were used frequently, including suicidality; however, healthy coping strategies were also used often. Conclusions: These findings support a coping continuum model, from low intensity or low harm to high intensity and high harm, with a high degree of accuracy. Importantly, it shows that overwhelming distress does not necessarily occur in the absence of healthy coping strategies. Furthermore, unhealthy coping strategies are increasingly adopted when healthy strategies are inadequate or unavailable. These findings raise important implications for healthcare targets for people in distress.
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