Seasonal, Geographical and Sociodemographic Variation in Coping Strategies Among Individuals with Sickle Cell Disease: A Multisite Study in India

The clinical manifestations of sickle cell disease (SCD) vary considerably, and include vaso-occlusive and pain events. By utilizing various coping strategies, people with SCD aim to reduce pain intensity and improve quality of life. The present study, with a longitudinal, repeated-measures design, was conducted among adults with SCD across five districts of India to examine the coping behaviors. A cohort of 124 adult patients from a previous registry was included. Coping strategies, under three domains: (i) Problem-Focused Coping (PFC), (ii) Emotion-Focused Coping (EFC), and (iii) Avoidant-Focused Coping (AFC), were assessed using the Brief COPE questionnaire across four seasons. Sociodemographics were also collected. Separate linear mixed-effects models were fitted for PFC, EFC and AFC to account for repeated measurements across four seasons, with season, study site, age group, gender, annual income, education and occupation included as fixed effects. Linear mixed-effects analyses showed that study site and season were significantly associated with all three coping domains (all p ≤ 0.001). Gender was significantly associated with PFC (p = 0.015) and EFC (p = 0.048). Age group, annual income, education and occupation were not significantly associated. Adjusted mean scores were highest during winter for PFC, EFC and AFC. These findings highlight the importance of contextual and gender-related differences in understanding coping mechanisms. Integrating context-sensitive psychosocial support and coping assessment into comprehensive SCD care may help address patients' differing support needs across settings and seasons. Further research should examine associations between specific coping strategies and clinical outcomes including pain, vaso-occlusive events and quality of life. Coping strategies may be integrated to strengthen patient-centred care.