{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:32:51Z","timestamp":1786383171587,"version":"build-2736575974"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020044","name":"Yale School of Public Health, Yale University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020044","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011493","name":"Whitney and Betty MacMillan Center for International and Area Studies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011493","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["DFD-175791"],"award-info":[{"award-number":["DFD-175791"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK128277"],"award-info":[{"award-number":["R01DK128277"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>\n                    Adolescents in American Samoa face a high mental health burden, with many youth experiencing symptoms of depression, anxiety, substance use, and suicidality. Understanding the strategies that adolescents use to cope with stressors can help strengthen existing mental health promotion and psychoeducational resources. We aimed to identify common coping strategies used by adolescents in American Samoa in response to mental distress. Using a two-stage qualitative approach, semi-structured interviews were conducted with a diverse sample of adult community members (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200928) from American Samoa. Later, five focus groups with adolescent participants (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200935, aged 13\u201318 years) were conducted to validate themes identified among adult key informants. Transcripts were coded in duplicate and analyzed using thematic analysis. Coping strategies were characterized as approach or avoidant according to Billings and Moos\u2019 (1981) existing framework. Key informants and adolescents identified coping strategies that fell into three major domains: (1) Avoidant coping strategies aimed to divert attention away from the stressor or suppress distress and were sometimes associated with high-risk responses, including self-harm, suicide, and substance use; (2) Approach coping strategies were generally supportive and involved engaging with distress, seeking connection, or expressing emotions, including through social engagement and confiding in peers; and (3) Mixed coping strategies that had characteristics of avoidant and approach depending on the context in which they were used (prayer, social media). Utilizing a collaborative and community-partnered approach, these findings provide a foundation to develop mental health promotion and psychoeducational initiatives to help adolescents better understand their own stress and build healthy coping strategies.\n                  <\/jats:p>","DOI":"10.1371\/journal.pmen.0000669","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:27:14Z","timestamp":1786382834000},"page":"e0000669","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cThey just want to stop feeling what they\u2019re feeling\u201d: A qualitative investigation and characterization of coping strategies for mental distress among adolescents in American Samoa"],"prefix":"10.1371","volume":"3","author":[{"given":"Julia","family":"Winschel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J.","family":"Mew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Blas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leiema","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si\u2019itia","family":"Soliai-Lemusu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah R.","family":"Lowe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Naseri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L. M.","family":"Toelupe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2601-3454","authenticated-orcid":true,"given":"Nicola L.","family":"Hawley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jueta","family":"McCutchan-Tofaeono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"pmen.0000669.ref001","first-page":"45","article-title":"Teu le va: We over me. A brief overview of mental health amongst Samoans in American Samoa","author":"JB McCutchan-Tofaeono","year":"2021","journal-title":"Int Cult Psychol Ser"},{"issue":"1","key":"pmen.0000669.ref002","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/inm.13223","article-title":"\u201cThere are still broken or fragmented systems\u201d: Qualitative assessment of needs to strengthen adolescent mental health services in American Samoa","volume":"33","author":"EJ Mew","year":"2024","journal-title":"Int J Ment Health Nurs"},{"key":"pmen.0000669.ref003","doi-asserted-by":"crossref","first-page":"107502","DOI":"10.1016\/j.childyouth.2024.107502","article-title":"O le tagata ma lona aiga, o le tagata ma lona fa\u2019asinomaga (Every person belongs to a family and every family belongs to a person): Development of a parenting framework for adolescent mental wellbeing in American Samoa","volume":"160","author":"EJ Mew","year":"2024","journal-title":"Child Youth Serv Rev"},{"issue":"2","key":"pmen.0000669.ref004","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/BF00844267","article-title":"The role of coping responses and social resources in attenuating the stress of life events","volume":"4","author":"AG Billings","year":"1981","journal-title":"J Behav Med"},{"issue":"6","key":"pmen.0000669.ref005","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/BF01536949","article-title":"Approach and avoidant coping: Implications for adolescent mental health","volume":"24","author":"MA Herman-Stabl","year":"1995","journal-title":"J Youth Adolescence"},{"issue":"7","key":"pmen.0000669.ref006","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1037\/0003-066X.41.7.813","article-title":"Approach, avoidance, and coping with stress","volume":"41","author":"S Roth","year":"1986","journal-title":"Am Psychol"},{"key":"pmen.0000669.ref007","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.jad.2025.03.077","article-title":"Unique relations of avoidant, emotion, and problem focused coping and suicidality in a sample of sexual and gender minorities","volume":"379","author":"BK Clausen","year":"2025","journal-title":"J Affect Disord"},{"issue":"7","key":"pmen.0000669.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159854","article-title":"Exploring the Relationship between Experiential Avoidance, Coping Functions and the Recency and Frequency of Self-Harm","volume":"11","author":"E Nielsen","year":"2016","journal-title":"PLoS One"},{"issue":"6","key":"pmen.0000669.ref009","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/S0306-4603(99)00058-1","article-title":"Stress-coping and temptation-coping as predictors of adolescent substance use","volume":"24","author":"EF Wagner","year":"1999","journal-title":"Addict Behav"},{"issue":"6","key":"pmen.0000669.ref010","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s10964-020-01330-x","article-title":"Longitudinal Associations between Coping Strategies and Psychopathology in Pre-adolescence","volume":"50","author":"CE Richardson","year":"2021","journal-title":"J Youth Adolesc"},{"key":"pmen.0000669.ref011","article-title":"Coping among adolescents: differences and interaction effects of gender, age, and supportive social relationships in Arab culture","author":"MA Albqoor","year":"2021","journal-title":"Curr Psychol"},{"issue":"1","key":"pmen.0000669.ref012","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/08964289.2021.1946468","article-title":"Peer victimization and relationships to approach and avoidance coping to health and health behaviors","volume":"49","author":"K Darabos","year":"2023","journal-title":"Behav Med"},{"key":"pmen.0000669.ref013","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13031-015-0062-5","article-title":"Coping among trauma-affected youth: a qualitative study","volume":"9","author":"M Cherewick","year":"2015","journal-title":"Confl Health"},{"key":"pmen.0000669.ref014","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1037\/0033-295X.98.2.224","article-title":"Culture and the self: implications for cognition, emotion, and motivation","volume":"98","author":"HR Markus","year":"1991","journal-title":"Psychol Rev"},{"issue":"1","key":"pmen.0000669.ref015","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/0265407513484631","article-title":"Individualism and collectivism as moderators of the association between attachment insecurities, coping, and social support","volume":"31","author":"MT Fr\u00edas","year":"2014","journal-title":"J Soc Pers Relat"},{"issue":"1","key":"pmen.0000669.ref016","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/0011000015618762","article-title":"Counseling attitudes and stigma among Polynesian Americans","volume":"44","author":"GEK Allen","year":"2015","journal-title":"Couns Psychol"},{"issue":"1","key":"pmen.0000669.ref017","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1037\/a0023266","article-title":"Religiosity, coping, and psychological well-being among Latter-Day Saint Polynesians in the U.S","volume":"2","author":"GEK Allen","year":"2011","journal-title":"Asian Am J Psychol"},{"issue":"3","key":"pmen.0000669.ref018","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1037\/ser0000039","article-title":"Collectivistic coping strategies for distress among Polynesian Americans","volume":"12","author":"GEK Allen","year":"2015","journal-title":"Psychol Serv"},{"issue":"1","key":"pmen.0000669.ref019","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3390\/ijerph22010062","article-title":"\u201cIt Would Ruin My Life\u201d: Pacific Islander Male Adolescents\u2019 Perceptions of Mental Health Help-Seeking-An Interpretative Phenomenological Analysis Focus Group Study","volume":"22","author":"MF Garrett","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"pmen.0000669.ref020","doi-asserted-by":"crossref","first-page":"100753","DOI":"10.1016\/j.puhip.2026.100753","article-title":"A qualitative study exploring the help seeking attitudes and barriers to support for Pasifika young people","volume":"11","author":"A Toluono","year":"2026","journal-title":"Public Health Pract (Oxf)"},{"issue":"5","key":"pmen.0000669.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmen.0000080","article-title":"Community perspectives on adolescent mental health stigma in American Samoa","volume":"1","author":"V Blas","year":"2024","journal-title":"PLOS Ment Health"},{"issue":"1","key":"pmen.0000669.ref022","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/1558689820985948","article-title":"Fa\u2019afaletui: A Pacific Research Framework","volume":"16","author":"F Goodyear-Smith","year":"2021","journal-title":"J Mix Methods Res"},{"issue":"4","key":"pmen.0000669.ref023","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/j.1440-1614.2005.01572.x","article-title":"Ole Taeao Afua, the new morning: a qualitative investigation into Samoan perspectives on mental health and culturally appropriate services","volume":"39","author":"K Tamasese","year":"2005","journal-title":"Aust N Z J Psychiatry"},{"key":"pmen.0000669.ref024","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"7","key":"pmen.0000669.ref025","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.socscimed.2009.01.002","article-title":"Relationships between health and culture in Polynesia - a review","volume":"68","author":"S Capstick","year":"2009","journal-title":"Soc Sci Med"},{"issue":"4","key":"pmen.0000669.ref026","doi-asserted-by":"crossref","first-page":"100162","DOI":"10.1016\/j.anzjph.2024.100162","article-title":"Understanding anger with New Zealand-born Samoan youth: A Samoan qualitative exploration","volume":"48","author":"L Mulipola","year":"2024","journal-title":"Aust N Z J Public Health"},{"issue":"2","key":"pmen.0000669.ref027","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/inm.13090","article-title":"Using Fa\u2019afaletui to explore Samoan consumers\u2019 experience and interpretation of mental health person-centred care in Aotearoa, New Zealand","volume":"32","author":"TI Mulipola","year":"2023","journal-title":"Int J Ment Health Nurs"},{"issue":"3","key":"pmen.0000669.ref028","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1037\/aap0000140","article-title":"Addressing Mental Health Challenges of Samoan Americans in Southern California: Perspectives of Samoan Community Providers","volume":"10","author":"A-M Yamada","year":"2019","journal-title":"Asian Am J Psychol"},{"issue":"2","key":"pmen.0000669.ref029","doi-asserted-by":"crossref","first-page":"5","DOI":"10.12740\/APP\/26313","article-title":"The mediating role of coping in the relationships between religiousness and mental health","volume":"16","author":"D Krok","year":"2014","journal-title":"Arch Psych Psych"},{"issue":"4","key":"pmen.0000669.ref030","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1080\/13674670902737723","article-title":"The relationship of religious coping and spirituality to adjustment and psychological distress in urban early adolescents","volume":"12","author":"CJ Van Dyke","year":"2009","journal-title":"Mental Health Relig Cult"},{"issue":"6","key":"pmen.0000669.ref031","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s10508-012-0016-6","article-title":"Sample size policy for qualitative studies using in-depth interviews","volume":"41","author":"SL Dworkin","year":"2012","journal-title":"Arch Sex Behav"},{"issue":"1","key":"pmen.0000669.ref032","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? An experiment with data saturation and variability","volume":"18","author":"G Guest","year":"2006","journal-title":"Field Methods"},{"issue":"19","key":"pmen.0000669.ref033","doi-asserted-by":"crossref","first-page":"12564","DOI":"10.3390\/ijerph191912564","article-title":"Ke ala i ka Mauliola: Native Hawaiian Youth Experiences with Historical Trauma","volume":"19","author":"L Riley","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pmen.0000669.ref034","first-page":"6203","article-title":"A scoping review of evaluated Indigenous community-based mental wellness initiatives","volume":"21","author":"J Venugopal","year":"2021","journal-title":"Rural and Remote Health"},{"issue":"1","key":"pmen.0000669.ref035","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1186\/s12889-022-14047-2","article-title":"Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review","volume":"22","author":"U Okpalauwaekwe","year":"2022","journal-title":"BMC Public Health"}],"container-title":["PLOS Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000669","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:27:19Z","timestamp":1786382839000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000669"}},"subtitle":[],"editor":[{"given":"Karli","family":"Montague-Cardoso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmen.0000669","relation":{},"ISSN":["2837-8156"],"issn-type":[{"value":"2837-8156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}