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Child and family factors associated with child mental health and well-being during COVID-19

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Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal depression and anxiety) factors associated with children’s mental health and well-being during the COVID-19 pandemic, after controlling for pre-pandemic mental health. This study included 846 mother–child dyads (child age 9–11) from the All Our Families cohort. Mothers reported on the child’s pre-pandemic mental health at age 8 (2017–2019) and during COVID-19 (May–July 2020), the family’s financial impact due to COVID-19, and maternal depression and anxiety. During COVID-19 (July–August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships, and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety, connectedness to caregivers (B − 0.16; 95% CI − 0.22 to − 0.09), child sleep (B − 0.11; 95% CI − 0.19 to − 0.04), and child screen time (B 0.11; 95% CI 0.04–0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic depression, connectedness to caregivers (B − 0.26; 95% CI − 0.32 to − 0.21) and screen time (B 0.09; 95% CI 0.02–0.16) predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95% CI 0.28–0.39) predicted child COVID-19 happiness. Fostering parent–child connections and promoting healthy device and sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.
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European Child & Adolescent Psychiatry
https://doi.org/10.1007/s00787-021-01849-9
ORIGINAL CONTRIBUTION
Child andfamily factors associated withchild mental health
andwell‑being duringCOVID‑19
BraeAnneMcArthur1 · NicoleRacine1· SheilaMcDonald2· SuzanneTough3· SheriMadigan1
Received: 28 May 2021 / Accepted: 16 July 2021
© Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic
recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep,
physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal
depression and anxiety) factors associated with children’s mental health and well-being during the COVID-19 pandemic,
after controlling for pre-pandemic mental health. This study included 846 mother–child dyads (child age 9–11) from the
All Our Families cohort. Mothers reported on the child’s pre-pandemic mental health at age 8 (2017–2019) and during
COVID-19 (May–July 2020), the family’s financial impact due to COVID-19, and maternal depression and anxiety. During
COVID-19 (July–August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships,
and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety,
connectedness to caregivers (B −0.16; 95% CI −0.22 to −0.09), child sleep (B −0.11; 95% CI −0.19 to −0.04), and child
screen time (B 0.11; 95% CI 0.04–0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic
depression, connectedness to caregivers (B −0.26; 95% CI −0.32 to −0.21) and screen time (B 0.09; 95% CI 0.02–0.16)
predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95%
CI 0.28–0.39) predicted child COVID-19 happiness. Fostering parent–child connections and promoting healthy device and
sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.
Keywords COVID-19· Child· Mental health· Screen time· Sleep· Parent–child connections
Introduction
Children have experienced significant life disruptions
as a result of theCOVID-19pandemic, including school
closures, social distancing, missed milestones, and family
stress (e.g., income loss and parent mental illness) [1, 2].
The potential for the COVID-19 pandemic to have signifi-
cant consequences for child mental health and well-being
has garnered considerable attention from parents, the media,
health practitioners, and policy makers, leading many to ask
“are the kids alright?” While empirical evidence is begin-
ning to suggest a significant increase in children’s mental
health symptoms [35], few studies have clearly identified
the socio-environmental factors associated with children’s
Suzanne Tough and Sheri Madigan sharesenior authorship.
* Sheri Madigan
sheri.madigan@ucalgary.ca
Brae Anne McArthur
braeanne.mcarthur@ucalgary.ca
Nicole Racine
nicole.racine2@ucalgary.ca
Sheila McDonald
sheila.mcdonald@albertahealthservices.ca
Suzanne Tough
stough@ucalgary.ca
1 Department ofPsychology, Faculty ofArts, Alberta
Children’s Hospital Research Institute, University
ofCalgary, 2500 University Dr. NW., Calgary, ABT2N1N4,
Canada
2 Department ofPediatrics, Cumming School ofMedicine,
University ofCalgary, 2500 University Dr. NW., Calgary,
ABT2N1N4, Canada
3 Department ofPediatrics andCommunity Health Sciences,
Cumming School ofMedicine, Alberta Children’s Hospital
Research Institute, University ofCalgary, 2500 University
Dr. NW., Calgary, ABT2N1N4, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... In the general population, with the progression of the pandemic, negative changes of the children's mental health have been documented, especially as regards increased anxiety and depressive symptoms (1)(2)(3)(4)(5). Several factors, such as gender, social isolation, difficult parent-child relationships, socioeconomic disadvantage, and increased media information seeking about COVID have been related to negative emotions (6). ...
... On the other side, as expected, half of children had elevated mental health symptoms during the lockdown, with significant scores of behavioral problems and hyperactivity/inattention. In fact, prior mental health is one of the most prominent predictors of child mental health difficulties (7). A recent study from Canada suggested that children who struggled with mental health symptoms prior to COVID-19 were also struggling during the pandemic (6). Furthermore, a meta-analysis showed high levels of anxiety and depression in children during the COVID-19 pandemic, exacerbated by older age of the child and the duration of the pandemic (3). ...
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The coronavirus disease 2019 (COVID-19) pandemic has caused a real disruption of children's lives. Children with neurodevelopmental disorders and their parents seem to be particularly vulnerable to adverse mental health effects due to lockdown policies. This study explores the psychological state of children with Attention Deficit Hyperactivity Disorder (ADHD) and their parents during the first lockdown in France. A national prospective cross-sectional parent-reported study was conducted using an online survey disseminated through different social networks of French ADHD associations during the first lockdown. The survey consisted of open-ended, multiple-choice questions and standardized questionnaires such as the Strengths and Difficulties Questionnaire (SDQ), the coping self-report questionnaire (Brief COPE) and the Patient Health Questionnaire-2 (PHQ-2). A total of 538 parents completed the online survey between the 6th and the 15th of April 2020. These results suggest that most children (65.29%) did not experience a worsening of their behavior but still had pathological levels of hyperactivity (56.47%) and behavioral (57.60%) symptoms at the time of the first lockdown. In addition, some parents (26.27%) showed responses indicating possible major depressive disorder. Positive parental coping strategies were associated with both improved child behavior and fewer parental depressive symptoms. Strengthening parents' coping strategies may be an effective intervention to protect both parents and children with ADHD from the negative psychological effects of lockdown. In times of pandemic, psychological care modalities must evolve to provide quality online interventions for families of children with ADHD.
... These multiple, unexpected challenges may have eroded parents' emotional well-being and mental health, compromising their childrearing skills (Brown et al., 2020;Russell et al., 2020). Yet, these same conditions also may have afforded parents novel opportunities to foster positive family connections that could bolster their own and their children's well-being (Chu et al., 2021;McArthur et al., 2021). Families evincing good parent and child mental health, positive parent-child relationship quality, and parent efficacy in the context of the pandemic could be seen as thriving despite the challenges. ...
... conditions on children's mental health (Bignardi et al., 2021;Creswell et al., 2021), there is growing need to examine the factors that may buttress children's well-being and healthy adjustment . Effective family functioning during the first few weeks of shelter-in-place has been associated with children's concurrent positive adjustment (Chu et al., 2021;McArthur et al., 2021), with benefits for children's adjustment potentially persisting for several months (Hastings et al., 2021). How families initially responded to and coped with COVID-19 may have had persisting influences on children's emotional and behavioral trajectories as the pandemic continued. ...
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Although the COVID-19 pandemic has raised deserved concern regarding adverse impacts on parents’ and children’s mental health, regulations like “sheltering-in-place” may have afforded parents novel opportunities to foster positive family connections, thereby bolstering well-being. Using latent profile analysis (LPA), we (a) distinguished family thriving during shelter-in-place (May-June 2020) from other patterns of family functioning, (b) tested potential predictors of family functioning profiles, and (c) examined if family thriving predicted subsequent child adjustment (September–October 2020). 449 parents in two-parent U.S. families with children aged 2–18 years completed online surveys assessing (a) parent–child relationship quality, parents’ positive psychological adjustment, children’s emotional well-being, and parenting efficacy and satisfaction as family functioning indicators, (b) financial, marital, parental psychosocial assets, and child (age, gender, and temperament) predictors of family functioning, and (c) child adjustment. LPA identified four family functioning profiles: Thriving, Managing, Struggling, and Distressed. Thriving families evinced higher scores on all functioning indicators. Logistic regressions revealed that parents in Thriving families reported significantly lower financial anxiety, less dissatisfaction with partner’s help, less child emotionality, and greater use of cognitive reappraisal, as well as more positive child adjustment in Fall 2020. These findings underscore the multidimensional nature of coping and well-being during COVID-19. Utilizing these levers to promote mental health in families languishing during comparable future crises could promote resilience, thereby protecting children’s well-being.
... During the pandemic, adolescents ages 13 to 18 years-old who reported spending more time with family also reported less loneliness and depression (34). Similarly, among younger adolescents ages 9 to 11 years-old, connectedness to adults at home was associated with lower depression and anxiety during the pandemic as well as greater happiness (35). Interestingly, in this same study, connectedness to peers was not associated with mental health and well-being outcomes, which was explained as potentially resulting from the limited opportunities students had to interact with peers during the study period. ...
... Furthermore, related to relationships with adults at home, 29% of our sample reported that spending time with family inperson and virtually had helped them deal/cope with worries and stress related to the COVID-19 pandemic. This aligns with other COVID-19 pandemic research that has identified maintaining a predictable and supportive structure at home to be an important factor in maintaining children's and adolescents' mental health in times of stress (35,(57)(58)(59). Specifically, eating meals together, creating family routines, maintaining good communication, engaging in shared activities, and creating a sense of belonging within families have been identified as resilience-building supports for children and adolescents during the pandemic (57)(58)(59). ...
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... Mental health challenges are a major global concern at present (World Health Organization) and may be particularly salient for emerging adults (ages 18-25 years) due to developmental characteristics of this time period that increase risk (Arnett, 2015;Arnett et al., 2014). Recent research points to the possibility that COVID-19 could exacerbate these already disturbing trends (McArthur et al., 2021;Rogers et al., 2021;Thakur & Jain, 2020). Thus, it becomes important to understand what might help individuals and families to be resilient, or to cope, in the midst of crisis. ...
... Recent literature is beginning to capture how the pandemic is negatively impacting the mental health of individuals globally (Kwong et al., 2020;McArthur et al., 2021;Rossi et al., 2020;Sabato et al., 2021;Thakur & Jain, 2020), including emerging adults (Evans et al., 2021;Halliburton et al., 2021;Parola et al., 2020;Solomou & Constantinidou, 2020). For instance, research has found a significant increase in depressive symptoms among students from the United Kingdom (Evans et al., 2021) and increases in anxiety, depression, withdrawal, internalizing, and externalizing problems among Italian emerging adults (Parola et al., 2020). ...
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Evidence suggests an impact of the COVID-19 pandemic on mental health, particularly among emerging adults. However, theories on altruism born of suffering or adversarial growth suggest that we might also see prosocial behavior as a function of the pandemic, which may protect against mental health challenges. Because cultural values are central in determining prosocial behavior, the current study explored how cultural values were differentially associated with adaptive prosocial behaviors that might protect against mental health challenges. Participants for the current study included 5,682 young people aged 18–25 years from 14 different countries around the world (68% female, 62% college students). Path analyses suggested that there were few differences in patterns as a function of culture, but revealed that horizontal individualism and horizontal and vertical collectivism were indirectly associated with lower levels of depression via prosocial behavior toward family members. Discussion focuses on the importance of coping by strengthening family relationships via prosocial behavior during the pandemic.
... There have been multiple case studies reported in the US and all parts of the world demonstrating the worsening of mental health conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) [2][3]. For children, in particular, social isolation, excessive screen time, and a lack of socialization were associated with profound effects, resulting in mental health conditions such as major depressive disorder, generalized anxiety disorder, PTSD, and OCD [4]. This is highlighted in a recent study by McArthur et al., where 846 mothers and children participated in a COVID-19 mental health questionnaire in Calgary, Canada [4]. ...
... For children, in particular, social isolation, excessive screen time, and a lack of socialization were associated with profound effects, resulting in mental health conditions such as major depressive disorder, generalized anxiety disorder, PTSD, and OCD [4]. This is highlighted in a recent study by McArthur et al., where 846 mothers and children participated in a COVID-19 mental health questionnaire in Calgary, Canada [4]. The study identified an increase in the reported number of anxiety and depression symptoms such as connectedness to caregivers, child sleep, and screen time duration. ...
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... The importance of parental stress for child wellbeing has been demonstrated, where a reduction in parental stress during the pandemic yield increased wellbeing among the children [25]. Further, connectedness to caregivers before the pandemic has predicted wellbeing among children during the outbreak [26]. Other family factors such as single-parent households and difficult work situation have been associated with worse mental and social health among children during this period [10]. ...
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In this study, we aimed to examine health-related quality of life during the COVID-19 pandemic among a general sample of young people in Norway aged 11–19 years. More specifically, we examine: (1) Change over 2 time-points in five health-related quality of life dimensions, (2) Whether sociodemographic- and COVID-19-related factors contributed to change in these five dimensions, (3) Whether parental stress and socioeconomic status at T1 interacted with change in health-related quality of life across T1 and T2. Data collection lasted from April 27th to May 11th, 2020 (T1), and from December 16th, 2020, to January 10th, 2021 (T2). Youth aged 11–19 years ( N = 2997) completed the KIDSCREEN-27, COVID-19 related and sociodemographic items. Parents ( N = 744) of youth aged 15 years and younger completed the parental stress scale and sociodemographic items. Physical and psychological wellbeing declined significantly from March to December 2020. Subscale scores for social support and peers increased. Controlling for a broad number of sociodemographic and COVID-19-related factors did not make an overall impact on the estimates. Those worried about infection, older aged, girls, and youth born outside Norway had a steeper decline in health-related quality of life subdimensions from T1 to T2. In the wake of the COVID-19 pandemic, we warrant special attention to the recovery of youth's physical and psychological wellbeing.
... Other research has similarly identified the maintenance of family routines, adaptability, and family cohesion as factors of family resilience during the pandemic [30]. Children's perceived connectedness to caregivers has also been found to predict better mental health outcomes for children during the pandemic [38]. ...
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... Dissatisfaction with sharing of childcare duties may lead to increased parenting distress, which was shown to be associated to child abuse potential during the pandemic (Brown et al., 2020;Chung et al., 2020). In a recent study of over 800 mother-child dyads, connectedness to caregivers was an important predictor for child mental health (McArthur et al., 2021). ...
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Importance United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption. Objective To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open. Design, Setting, and Participants This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated. Main Outcomes and Measures Years of life lost. Results A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.31 (95% credible interval [CI], 0.10-0.65) years of final educational attainment for boys and 0.21 (95% CI, 0.06-0.46) years for girls. Summed across the population, an estimated 5.53 million (95% CI, 1.88-10.80) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, 1.47 million (95% credible interval, 0.45-2.59) additional YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both “schools open” and “schools closed” conditions, the analysis observed a 98.1% probability that school opening would have been associated with a lower total YLL than school closure. Conclusions and Relevance In this decision analytical model of years of life potentially lost under differing conditions of school closure, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children’s health.
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Background Parents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes in the prevalence of maternal depression and anxiety symptoms as a result of the COVID-19 pandemic over time and at the individual level. Methods In this longitudinal observational study, women who took part in the All Our Families pregnancy cohort in Canada were invited to complete a COVID-19 impact survey between May 20 and July 15, 2020. Women who had not agreed to additional research, had discontinued, were lost to follow-up, or who were not contactable via email were excluded. Maternal depression and anxiety symptoms during the COVID-19 pandemic were compared with three previous estimates collected at 3, 5, and 8-year timepoints (between April, 2012, and October, 2019). Depression symptoms were assessed using the 10-item Center for Epidemiological Studies Depression scale and anxiety symptoms were assessed using the short form of the Spielberger State-Trait Anxiety Inventory. Repeated cross-sectional analyses were done to assess temporal trends and fixed-effects regression models were fitted to assess within-person change over time. Findings Of the 3387 women included in the All Our Families study, 2445 women were eligible and were invited to participate in the COVID-19 impact study, of whom 1333 consented to participate, and 1301 were included in the longitudinal analysis. At the COVID-19 impact survey timepoint, a higher proportion of mothers had clinically significant depression (35·21%, 95% CI 32·48–38·04) and anxiety symptoms (31·39%, 28·76–34·15) than at all previous data collection timepoints. The mean depression score (8·31, 95% CI 7·97–8·65) and anxiety score (11·90, 11·66–12·13) at the COVID-19 pandemic timepoint were higher than previous data collection waves at the 3-year timepoint (mean depression score 5·05, 4·85–5·25; mean anxiety score 9·51, 9·35–9·66), 5-year timepoint (mean depression score 5·43, 5·20–5·66; mean anxiety score 9·49, 9·33–9·65), and 8-year timepoint (mean depression score 5·79, 5·55–6·02; mean anxiety score 10·26, 10·10–10·42). For the within-person comparisons, depression scores were a mean of 2·30 points (95% CI 1·95–2·65) higher and anxiety scores were a mean of 1·04 points (0·65–1·43) higher at the COVID-19 pandemic timepoint, after controlling for time trends. Larger increases in depression and anxiety symptoms were observed for women who had income disruptions, difficulty balancing home schooling with work responsibilities, and those with difficulty obtaining childcare. White mothers had greater increases in anxiety scores than non-white mothers and health-care workers had smaller increases in depressive symptoms than non-health-care workers. Interpretation Compared with previous estimates, the prevalence of maternal depression and anxiety among mothers in a Canadian cohort increased during the COVID-19 pandemic. Financial support, childcare provision, and avoiding the closure of schools, might be key priorities for preventing future increases in maternal psychological distress. Funding Alberta Innovates Health Solutions Interdisciplinary Team, Canadian Institutes of Health Research, Alberta Innovates, and Alberta Children's Hospital Foundation.
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