"They just want to stop feeling what they're feeling": A qualitative investigation and characterization of coping strategies for mental distress among adolescents in American Samoa.

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 = 28) from American Samoa. Later, five focus groups with adolescent participants (N = 35, aged 13-18 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' (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.