Authors: Bruna Martins-Klein (1Department of Psychology, University Southern California, Los Angeles, California, USA; 2Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA), Eric E Griffith (3Duke Aging Center, Duke University, Durham, North Carolina, USA), Kristin Heideman (2Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA; 4Yale Child Study Center, Yale University, New Haven, Connecticut, USA), Irina Orlovsky (2Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA), Ziyuan Chen (1Department of Psychology, University Southern California, Los Angeles, California, USA), Elizabeth Alwan (2Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA)
Categories: Article, distress, resilience, coping
Source: Clinical gerontologist
Authors: Bruna Martins-Klein, Eric E Griffith, Kristin Heideman, Irina Orlovsky, Ziyuan Chen, Elizabeth Alwan
COVID-19 escalated stress within family/neighborhood (local) and national/cultural (global) levels. However, the impact of socioecological levels of stress on pandemic emotion regulation remains largely unexplored.
Thirty older adults from the Northeast US (63–92 years) reported on pandemic stress and emotion regulation in semi-structured interviews. Responses were coded into socioecological sources of local and global stress, and associated use of cognitive emotion regulation strategies from the Cognitive Emotion Regulation Questionnaire was explored.
Older adults experienced significant distress at global levels, and perception of lacking top-down safety governance may have exacerbated local distress of engaging in daily activities during the COVID-19 pandemic. Participants endorsed coping with local stressors via perspective-taking, acceptance, and other adaptive strategies, while global sources of stress were associated with greater use of maladaptive strategies, including other-blame and rumination.
Quantitative assessments may underestimate significant older adult distress and maladaptive coping towards global stressors. Findings should be replicated with more diverse populations beyond the COVID-19 context.
The COVID-19 pandemic has provided a unique window to explore shifts in affective experience and emotion regulation of naturalistic stress among older individuals. Older adults reported heightened pandemic stress due to public health limitations/restrictions, worry about others, loneliness, social isolation (Minahan et al, 2021; Whitehead & Torossian, 2021), and exacerbated mortality salience (Menzies & Menzies, 2020). Despite heightened pandemic stress, older adults demonstrated greater emotional resilience than younger adults, replicating pre-pandemic findings of age-related strengths in emotional processing and regulation across the lifespan (Sardella et al., 2023; Scheibe & Carstensen, 2010). Older adults reported lower pandemic neuropsychiatric symptoms (e.g., Bruine de Bruin, 2021), greater emotional well-being, and lower stress compared to younger adults (Birditt et al., 2021), despite age-matched frequency of daily COVID-19 stressors (Knepple Carney et al., 2021). Older adults also more readily engaged in adaptive emotion regulation strategies, positively reframing the meaning of distressing pandemic situations via cognitive reappraisal (Wolfe & Isaacowitz, 2022; Xu et al., 2020), and focusing on positive aspects of the pandemic (Dworakowski et al., 2022; Zsido et al., 2022). Taken together, these COVID-19 reports suggest a uniform association between older age and greater adaptive emotion regulation strategies to regulate pandemic mood.
These studies, however, fail to consider how emotion regulation strategies may vary depending on the context of experienced stress. Applying Bronfrenbrenner’s ecological model of lifespan development (Bronfenbrenner, 1993) to emotion regulation, it has been argued that regulating efforts must be situated in terms of contextualized stress. Specifically, relationships towards one’s local world (i.e., microsystem), community resources (mesosystem) and broad global culture (macrosystem) can serve to buffer and/or exacerbate an individual’s emotion regulation (Bergeman et al, 2021; Infurna & Luthar, 2018). Although emotion regulation strategy efficacy depends on the context of experienced stress (e.g., Troy et al., 2013), studies of late-life pandemic emotion regulation failed to explore how emotion regulation varies across different contextualized sources of pandemic stress.
While psychosocial health following disasters and traumatic events are predicted by individual emotion regulatory strategy use (Sumer et al., 2005; Zheng et al., 2012; Wingo et al., 2010; Strutt et al., 2022), the interaction between an individual’s personal resources and socioecological context both are key in understanding responses to threshold events like natural disasters (Hobfoll et al., 2008; Shing et al., 2016). Local factors, such as perceived social support within families, predict wellbeing following disasters (Neria et al., 2011), and the pandemic has been the backdrop for escalated rates of interpersonal conflict and domestic violence (Thiel et al., 2022). At global levels, adaptation to disasters relies on trust in an adaptive community response (Benight & Bandura, 2004), as perceived support from one’s community and government predict lower levels of distress among individuals following war (Kimhi & Shamai, 2004) and terror attacks (Kimhi et al., 2017). At global levels, pandemic dissatisfaction with governmental management of pandemic safety practices has fueled political discontent and populism (Jørgensen et al., 2022). No emotion regulation reports, however, explore how older individuals regulated emotional responses to varying sources of experienced stress, despite being one of the most vulnerable, high-risk populations during the pandemic. Older adults have reported regulating local pandemic distress, such as disruptions to routine social activities, by engaging in adaptive regulation strategies, such as perspective-taking (Verhage et al., 2021), similar to patterns seen in response to Hurricane Katrina (Henderson et al., 2010). To our knowledge, only one study explored how differing levels of perceptions of safety impacted downstream pandemic Aruta (2022) found among Filipino adults, safety at home, trust in public institutions, and financial difficulties were independently predictive of psychological distress and quality of life during the pandemic. This report, however, failed to consider what emotion regulation strategies were employed at differing levels of pandemic stress.
In summary, extant research on pandemic emotion regulation has underemphasized contextualized disaster stress, and little is known about the strategies older adults used to regulate their emotions across different stress levels during the COVID-19 pandemic. To begin addressing this gap, we designed a pilot study conducting a semi-structured interview to assess local and global sources of pandemic stress, and emotion regulation strategies used to cope with these stressors in a nonclinical US older adult community sample. We extend prior research by utilizing a mixed-method approach that allowed for open-ended responding, as well as directly assessed both socioecological stress and coping within the same study. We aimed to 1. Do older adults report greater stress at local versus global socioecological levels? 2. Do emotion regulation strategies reported by older adults vary in response to different levels of socioecological stress (local versus global stress)?
Thirty older adults from the Northeast US consented and participated in a single-session, semi-structured online video interview and completed questionnaires via Qualtrics as approved by University of Massachusetts Amherst’s (UMass) Institutional Review Board (#2161). One participant did not complete the quantitative survey, and thus quantitative results are based on a sample of n= 29 (M = 75 years old, SD = 7.3, range = 63–92, 72.4% female, 93.1% White/non-Hispanic, 65.5% retired), while qualitative analyses include the full n=30. Participants underwent a phone-based screening to assess eligibility and interest in participating in the study. Inclusion criteria 60 years of age or older, having corrected-to-normal or normal vision/hearing, access to the internet or a phone, and English fluency. Participants were excluded if they did not consent to audio or video recording of the interview, and/or transcription as part of the study’s analytic plan. All participants consented to study participation through an IRB-approved online consent form via Qualtrics.
Older adult participants were recruited through a UMass database of research volunteers, flyers, workshops, online/social media, and word-of-mouth snowball sampling. Sample size was chosen given prior studies showing that a sample size of 24–50 in qualitative health studies allows for meaningful and interpretable results (Hennink et al, 2017; Ritchie et al., 2013). We opted for a convenience sample given the practical limitations of conducting research during a pandemic quarantine and also as a reflection of the exploratory nature of this pilot study. Participants completed an online demographic form that included questions regarding their overall physical health (e.g., “Have you ever been told by a doctor or other health professional that you had a stroke?) and psychological health (see Table 1 for means and SD), but these responses were not part of study recruitment. All participants evidenced comprehension of semi-structured interview questions, and showed no issues with conversational tracking, though cognitive status was not formally assessed in the study.
The Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski et al., 2007) is a trait measure of cognitive emotion regulation strategy use. (See online supplements for full CERQ.) Participants report frequency of employing each strategy on a scale from 1 (“Almost Never”) to 5 (“Almost Always”). Higher subscale scores indicate greater frequency of cognitive strategy use in response stressful events. Adaptive strategy subscales include positive reappraisal (e.g., “I think I can learn something from the situation”), positive refocusing (e.g., “I think of nicer things than what I have experienced”), refocus on planning (e.g., “I think of what I can do best”), putting into perspective (e.g., “I think that it all could have been much worse”), and acceptance (e.g., “I think that I have to accept that this has happened”),. and Maladaptive strategies include catastrophizing (e.g., “I often think that what I have experienced is much worse than what others have experienced”), rumination (e.g., “I often think about how I feel about what I have experienced”), self-blame (e.g., “I feel that I am the one to blame for it”), and other-blame (e.g., “I feel that others are to blame for it”).
Participants completed demographic/self-report questionnaires online via Qualtrics (see Table 1), and interviews lasting approximately 75 minutes (M = 81.2, SD = 18.0), in which they described the impact of COVID-19 on their lives. Participants were asked about sources of stress exacerbated by the pandemic (“What has been most challenging for you during the quarantine?”), and emotion regulation strategies and tactics utilized to cope with them. The interview began with the question “How has your pandemic experience been going?” Appropriate follow-ups were pursued if they voiced stress in the initial question; for example, if someone said “isolating” they would be asked to explain in more detail and offer an example. The base question “what has been most challenging for you during the quarantine/pandemic?” was asked if participants did not discuss stress and/or coping without prompting. (The full interview guide can be found in the online supplements.)
The interview intentionally asked participants to report stress and coping strategies open-endedly without prompting to allow for comparison of extemporaneous mention of coping strategies to those explicitly outlined within the CERQ. Subsequent questions focused on routines that older adults engage in to clarify behavioral activation and how participants took action to feel better; these segments of the interviews are not reported. Interviews took place from September 2020 to February 2021. For context, the study began prior to the election of Joe Biden as president in November 2021, and the first COVID-19 vaccine was approved midway through data collection in December 2020. Interview recordings were automatically transcribed by Rev.com and reviewed for accuracy by research assistants. In accordance with IRB instructions, all possibly identifying information was removed from transcripts.
Interview transcripts were analyzed with NVivo 12 (QSR International, 2018). We utilized a modified grounded theory approach, as outlined by Glaser (1978) and Goldbach & Gibbs (2017), to develop a codebook that best described reported stress and emotion regulation strategies via both inductive and deductive coding. Authors KH, BMK, and IO created an a priori codebook intended to capture themes related to the pandemic routines, stress, and emotional coping. Author EG reviewed the codebook for coding feasibility. Authors EG, KH, and BMK met weekly to review the codebook and clarify discrepancies in codebook definitions. After constructing the codebook, all coders reviewed the same two transcripts and then collectively compared their coding to reach consensus on definitions and procedure. Subcodes within each thematic code were then further clarified through additional meetings between senior authors. Then authors EG, KH, and two research assistants independently coded the remaining interviews, line-by-line. Coding was reviewed by a separate team member so that each transcript was reviewed by two people. The present analysis focuses on analyzing two top-level 1) sources of stress and 2) emotion regulation strategies.
Coding revealed that sources of stress were conveyed both in response to explicit stress-related interview questions and extemporaneously during other parts of the interviews; both of which were coded by the team. KH and EG coded sources of stress into local stress (disruption of personal lives/or stress related to interaction with family/local community) and/or global stress levels (stress related to governance/systemic management of the pandemic, disconnection from more global cultural values). BMK reviewed example quotes to synthesize consensus among coders.
Participants described emotion regulation strategies throughout the interview (both in response to explicit questions and extemporaneously). We binarily coded for qualitative endorsement of the nine CERQ strategies for each participant (i.e., endorsed, failed to endorse): positive reappraisal, positive refocusing, refocus on planning, putting into perspective, and acceptance, catastrophizing, rumination, self-blame, and other-blame. Note that given the qualitative nature of the interviews, the participants were not rating the relevance or effectiveness of these strategies, but rather describing examples of employing the strategies. As such, our binary coding reflects whether a particular strategy was mentioned at all in the interview. Frequency of strategy endorsement during the interview was compared to frequency of strategies reported quantitatively via the CERQ. Once full-transcript coding was completed, the coping strategies nodes were further coded by BMK and EG to confirm the ecological level (i.e., local or global) at which coping was endorsed.
Nearly all participants reported experiencing stress within their local social ecologies (96.7%). Local-level pandemic stress was attributed to an escalating burden of daily life decision-making in light of infection risk associated with interpersonal contact. Many reported avoiding routine events as well as touchstone cultural gatherings (e.g., weekly coffee with friends, Thanksgiving). Participant 201 highlighted longing for such
Participant 211 similarly articulated how political and social activism was core to their lifestyle, but they begrudgingly had to curtail participation in marches following the murder of George Floyd to prioritize COVID-19
Loss of impulsive decision-making and spontaneous leisure outings that existed prior to the pandemic (e.g., impromptu dinner with a friend) also affected many participants. Safety was associated with consolidating time spent outside of the house to minimize associated risks. Participant 211 explains how safety concerns led to more taxing, upfront planning for what were once casual/spontaneous shopping
Similarly, many reported that routine medical visits transformed from low-to-high uncertainty scenarios, where weighing the line between one’s current and future health required recurrently and proactively assessing safety precautions within clinics. The induced uncertainty created additional stress, as described by participant
The pandemic ultimately turned a space–the health clinic–that once preserved health and safety, into a precarious place that could be a vector for infection, fear, and escalated danger. Thus, previously low-stakes independent decision-making was transformed into an interpersonal negotiation each time an individual planned to leave home during the pandemic, requiring effort and forethought to weigh the costs and benefits of activity engagement depending on discrepancies in safety practices.
Twenty-six participants (86.7%) reported experiencing stress at the global level. Themes of unmanaged global stress were reported throughout the interviews. These replies generally related to larger-scale stressors that highlighted global systems and cultural-level instability that an individual has little power to influence. Most respondents (90.0%) reported feeling helpless and enraged by a perceived lack of top-down governance and unmet need for public health policies. Responses voicing this concern sternly described feeling disappointed in the government and society for not using science as a foundation for decision-making, and not requiring individuals to heed these suggestions via top-down policy. Participants often reported global stressors concurrently with descriptions of maladaptive emotion regulation strategies; thus we report sample excerpts demonstrating global distress below while discussing emotion regulation strategies pertinent to global stress.
Quantitative responses revealed significantly greater use of CERQ adaptive strategies (M = 2.04, SD = 0.55; α = .87) than maladaptive approaches (M = 3.11, SD = 0.53; α = .86) via a Wilcoxon Sign-Rank test (Z = 4.56, p < .001). In contrast, when asked about emotion regulation approaches in the interview, participants qualitatively endorsed both maladaptive and adaptive strategies (see Table 2 and Figure 1). Participants reported more frequently blaming others than using any of the adaptive strategies (80.0%), as well as high endorsement of rumination (66.7%), and catastrophizing (40.0%). The highest endorsed adaptive coping strategies were perspective taking (73.0%), acceptance (63.3%), and refocusing on planning (53.3%).
Preferred strategies reported in the interview also differed depending on the socioecological level of stress reported. At the local ecological level participants more readily endorsed adaptive coping in response to the pandemic, whereas global stress was more often associated with maladaptive coping (see Figure 1). More specifically, when discussing local stressors many participants engaged primarily in adaptive strategies like perspective-taking and/or downward social comparison (73.3%), and acceptance (63.3%) of the pandemic, among others, to manage local stressors (see Table 2 for full breakdown). Participants reported a low-level engagement in maladaptive strategies, such as other-blame (53.3%), in response to pandemic-related local stressors. We outline the details of these findings in the following sections, focusing on the two most frequently endorsed strategies at each level.)
Participants engaged in emotion regulation via perspective-taking largely by focusing on how other less-privileged groups were more adversely affected. Older adults reported feeling less pressure to maintain productivity compared to younger adults, as well-resourced older adults are broadly more likely to be retired and have fewer childcare responsibilities. For instance, Participant 201 voiced appreciation for being in a later life
Another privilege referenced was financial stability; participants regulated their emotions by reflecting on how their own access to secure housing, healthcare, and contactless services (e.g., curbside groceries) reduced COVID-19 stress relative to others with fewer resources. Participant 220 highlights their economic privilege and retirement status as promoting flexibility to adapt to quarantine
Participants reported regulating emotions by using acceptance to embrace that pandemic-related restrictions and fallout were beyond their control. They could not directly influence public health policy, such as masking requirements, so it was not beneficial to cognitively worry about it. Participant 226
Another participant (207) acknowledged that while there were many elements during the pandemic that could not be behaviorally controlled, engaging in ‘self-talk’ to assess what could or could not be done to promote safety helped build self-efficacy and
In contrast to local stress, maladaptive coping was most frequently endorsed in response to global stress. Furthermore, reported stress and maladaptive emotion regulation at the global level often co-occurred and were difficult to disentangle. In this section, we describe the common form of global stress and discuss the two most frequently endorsed coping strategies–rumination and blaming others. (See Table 2; Figure 1 for more details).
Rumination (56.7%) on lack of governance and centralized COVID-19 pandemic safety precautions often echoed a mixed sense of disbelief, outrage, and hopelessness. Participant 212 conveyed anger towards the perceived lack of top-down, scalable operations to support safety
Excerpts also indicated rumination on a lack of shared values with other citizens during the pandemic, echoing both local and global stress concurrently. Participants highlighted concerns about lack of concern for others, empathy, and selfishness; Participant 227
Blaming others was frequently endorsed in response to both local stress (53.3%) and more frequently.in response to global stress (76.7%). Participants who openly discussed pandemic global concerns, often also engaged in processing of political discontent by blaming others for perceived failures in public health response. These preoccupations escalated many times from calmly trying to make sense of lack of governmental support, towards future implications of this poor leadership at the national level as well as frustration at others in their local sphere for failing to adhere to appropriate public health best practices (as prioritized by the participant).
Participant 201 explained that the most challenging part of the pandemic was the political response; they actively blame the government for
Similarly, participant 200 highlights how political decisions driven by profit rather than public safety fueled pandemic
Participants often expressed frustration with how others outside their social circle interpreted or ignored public health regulations, or culturally chose to prioritize gaining capital over public safety. Participant 202 described a scenario where other visitors and hotel management were blamed for possibly exacerbating the pandemic, thus demonstrating how a lack of top-down consensus created local
In this study, we explored differences in sources of local versus global socioecological stress experienced by older adults during the pandemic. We also assessed whether emotional regulation strategies reported varied across local versus global sources of pandemic stress among older adults. Overall, qualitative findings revealed that older adults reported managing local stressors via more adaptive regulation approaches, while reporting greater use of maladaptive coping strategies in response to global pandemic concerns.
Participants reported local-level stress similar to past COVID-19 pandemic research, revealing stress due to loss of in-person activities with friends/family (Minahan et al, 2021; Whitehead & Torossian, 2021). Participants also reported a greater burden of weighing and reconciling risks when engaging in local interpersonal activities. Participants endorsed frustration with a perceived loss of spontaneity in executing neighborhood tasks without extensive pre-planning. The pandemic also escalated the interpersonal burden of weighing one’s own safety and risk preferences against that of others when planning activities, whereas in the past these decisions could be made unequivocally without considering others.
Despite experiencing local interpersonal frustrations, our findings highlighted that older adults responded to local stressors via use of adaptive cognitive emotion regulation strategies, such as downward social comparison and/or acceptance. Among our participants, emotion regulation of local stress often involved social comparison to individuals less fortunate during the pandemic, either due to differing social roles related to retirement (e.g., not actively working, raising children) and/or greater access to housing/financial resources. The relevance of this coping choice corresponds with prior qualitative findings in Dutch older adults who reported employing downward social comparison to regulate frustration related to pandemic restrictions (Verhage et al., 2021). Regulating stress using downward social comparisons may serve to enhance in-group belongingness/cohesion by highlighting differences in power and class across groups (Beersma & Van Kleef, 2011; Wu et al., 2016). However, many participants also engaged in other-blame, often escalating concerns experienced at the local level (e.g., feeling unsafe in close interaction with other guests at hotel) to anger at lack of top-down governance at the global level (e.g., no governmental policy enforcing distancing practices in businesses).
Our results revealed that older adults engaged in adaptive regulation strategies in response to local levels of stress, thus extending past reports of adaptive late-life emotion regulation during the pandemic era (e.g., Birditt et al., 2021; Zsido et al., 2022). While our data lacks a younger adult group and cannot directly address age-related differences, findings do lend support to the pattern that older adults showcase effective regulation of emotions in low-arousal contexts (Sardella et al., 2023; Scheibe & Carstensen, 2010). In contrast, at global levels of pandemic stress, older adults reported high levels of maladaptive emotion regulation strategy use, manifested as discontent at government figures as well as disconnection from society at large for lack of shared collectivist cultural values. This disruption of effective pandemic emotion regulation at high levels of global distress is supported by the Strength and Vulnerability Integration (SAVI) model of affective wellbeing across the lifespan, which suggests that emotion regulation advantages with older age are attenuated or eliminated in high arousal contexts (Charles, 2010). High intensity negative emotion and dysregulation of physiological arousal are suggested to operate in a feedforward loop that reduces psychological flexibility to deescalate high negative arousal states, which may place greater physical burden on the body with age. Our qualitative findings support this model, highlighting a largely overlooked source of unregulated or dysregulated pandemic global stress, in stark contrast to most extant pandemic quantitative research (e.g., Dworakowski et al, 2022; Knepple Carney et al., 2021; Wolfe & Isaacowitz, 2022).
It is important to note that individuals voiced blaming others at both local and global levels concurrently. A major strength of our qualitative approach was allowing open-ended responses that allowed participants to discuss pandemic emotion regulatory difficulties, unlike the quantitative reports we collected, in which respondents reported a greater frequency of adaptive than maladaptive strategies. This may imply that quantitative self-report of emotion regulation, which focuses on general tendencies, does not fully capture the nuances of coping strategies older adults utilized in response to pandemic-related stress.
Past reports emphasize the importance of personal emotion regulation skills on emotional health and pandemic adaptation (Strutt et al., 2022), while overlooking the crucial role of community and sociocultural infrastructure in older adults’ psychological resilience. Our findings could suggest that resilience may be an accumulation of environmental resources at differing levels of abstraction (Ungar, 2019) and may not solely depend on one’s own emotion regulation skills in isolation. A timely, effective, and collaborative public health response may have the potential to reduce psychological distress in future global crises. Beyond COVID-19, system-wide protections and policies can significantly impact trust and comfort for older adults both in healthcare and research settings. For instance, global, system-level ageism in healthcare services and research negatively impact older adult health (Chang et al., 2020), and system providers serve as key agents in scaffolding and protecting older adults experiencing systemic abuse within hospitals (Mysyuk et al., 2015). Understanding how community support can interactively buffer personal negative effects of global stress is of utmost importance.
While preliminary, our findings may suggest that the cognitive burden of COVID-19 could have been two-fold. First, a lack of sociocultural consensus regarding safety during interpersonal interactions could generate stress at the local level (e.g., if all individuals agreed, then less interpersonal stress would arise).
Second, reported disconnection from community members was, as expected, one of the most common sources of stress outlined, which may reflect an escalation of ongoing US trend toward social alienation (Silva, 2018). Research from past disasters highlights that the sense of individuals ‘coming together’ as a community over major events predicts lower suicidality (Joiner et al., 2006), while perception of one’s own social world ‘coming apart’ following national tragedies is predictive of higher rates of suicide and mental illness (Chan et al., 2006; Yip et al., 2010). A lack of top-down, consistent system-wide recommendations may have amplified existing global stressors. As uncertainty around safety shifted during the COVID-19 era, a possible unmet expectation was a lack of top-down governmental or public health structures to provide scaffolding to resolve disagreements about personal definitions of safety, as captured by engagement in other-blame coping at both local and global levels. This may be especially true for well-resourced older adults who may have rarely encountered such profound disappointment towards top-down governance. This systemic distrust was echoed worldwide, leading to protests of government-mandated lockdowns and policies that did not seem aligned with personal safety beliefs (Schraff, 2021). Our findings extend prior findings that low trust in government impacts not only psychological wellbeing (Aruta, 2022), but also the use of maladaptive emotion regulation strategy use following disasters.
Our findings have important clinical implications that extend beyond the pandemic context. Global discontent and isolation can be easily missed through quantitative self-report screening measures. Indeed, our quantitative self-report data yielded differing results from spontaneous, qualitative reporting of emotion regulation. It is crucial to not only screen individuals for stress, but also ask open-ended questions, as much of what we learned pertaining to global distress was not disclosed in response to targeted questions, but through the course of discussion and rapport building. Accordingly, qualitative evidence suggests that older adults feel safer and more open to disclosing struggles when clinics utilize person-centered approaches that build communication and trust, rather than indirect screening (Colligan et al., 2020). Conversational approaches with trusted providers may help address common concerns older adults have in seeking psychological support, starting with resistance to being labeled as someone with mental health issues, to ‘muddling through’ systemic challenges accessing mental health care (Reynolds et al., 2020). The role of the provider also extends to aiding patients navigating frustrating barriers to care at community/neighborhood levels. For older adults from demographics similar to our sample, it may be particularly important to highlight and address the frustration and emotional fallout after the pandemic challenged faith in institutions and revealed incongruity with local networks.
While our findings are novel and hold key implications, the current study is susceptible to limitations. Our sample was a small sample of exclusively older adults, which did not include comparison groups of participants from other age groups. As such, this small convenience sample limited our ability to conduct rigorous statistical tests. Future studies should prioritize extending findings outside of the pandemic context to a larger lifespan sample which would be powered to statistically test relationships between stressors and emotion regulation strategies used across age groups.
Another key limitation is that while the study was collected during the pandemic, the CERQ measure instructions asked about general emotion regulation preferences and were not COVID-19 specific. It is possible, given the recency of the pandemic onset, that the CERQ findings did not capture the dramatically changed ecosystem and emotion regulation strategy shifts, and participants may have reflected on pre-pandemic baseline regulatory practices. In contrast, our qualitative questions prompted participants to reflect specifically on emotion regulation strategies employed in response to the pandemic. In addition, given that the local/global socioecological framing emerged during qualitative thematic analysis, the quantitative and qualitative interview had no specific questions that asked participants to separately report on local and global stressors. Thus, differences in quantitative and qualitative strategy use across local and global contexts cannot be assessed based on the data collected in this pilot.
Another limitation is the binary coding of strategy endorsement in the qualitative interviews, which cannot track the relative pertinence of the strategy to each participant. For example, while one participant may have provided a long, eloquent answer outlining the use of positive reappraisal, another participant may have endorsed use of reappraisal in a single sentence, and both responses were coded as the same. Future research should directly assess the degree of strategy endorsement and not only track binary strategy use, to see if stress impacts the degree of strategy engagement as well as its use more generally.
In addition, our sample was largely demographically homogeneous–predominantly White, highly-educated, US-based, and wealthy. Disparities exist both in health behaviors and beliefs across socioeconomic status (Courtenay et al., 2002; Sachs-Ericsson et al., 2007) and ethnicity (Sue, 1999), and it remains unclear whether these findings would generalize to more diverse samples. It is possible that participants underrepresented in our sample (e.g. men, ethnically and racially diverse, high school educated individuals) coped with the COVID-19 pandemic challenges differently than what was reported by our largely White, highly-educated, economically well-resourced, and female participants. Moreover, our convenience sample included limited representation of individuals with elevated health vulnerabilities, or those susceptible to socioeconomic inequities, which may bias our results towards the perspectives of more advantaged older adults (Kobayashi et al., 2021). It is possible that higher levels of education in our sample led to different emotion regulation outcomes, and evidence supports that greater educational attainment and cognitive control skills are associated with enhanced emotion regulation and coping (Opitz, Lee, Gross, and Urry, 2014); as such cognitive control should be carefully controlled for in future work. Further, while national identity has been found to predict coping outcomes regardless of political beliefs (Bonetto et al., 2022), we did not track political affiliation, which is a key limitation given the political nature of global discontent reported within our data. Overall, this pilot study may prompt future investigation of other naturalistic local and global stressors in relation to late-life emotion regulation outside of the pandemic context, within larger, more diverse samples that can allow for broader exploration of interindividual effects.
In contrast to quantitative reports, our pilot findings showed that older adults adaptively regulated local stress, while maladaptively regulating responses to systemic distress during the pandemic. Our results highlight the importance of considering socioecological stress context when assessing regulation of real-life disasters in older adult populations, and how close-ended quantitative self-report measures of emotion regulation may underestimate significant sources of distress and mental health needs for older adults. Future studies may expand on this pilot study to include populations disproportionately affected by threshold events like the COVID-19 pandemic. Outcomes may inform equitable public health resources, avenues to foster social, medical, and psychological support, and reveal age-aligned coping strategies that adaptatively mitigate stress.