Vulnerable parents report less well-being amid pandemic

Moods have deteriorated among US hourly service workers and their children since the COVID-19 pandemic began—especially in those experiencing hardships, according to 30-day survey results published today in Pediatrics.

Researchers at Duke University and Barnard College collected survey data from 645 workers living in a large city with a child 2 to 7 years old from Feb 20, before the US epidemic escalated, to Apr 27, when it was well under way. A subsample of 561 parents completed a one-time survey on the effects of the pandemic on mental health from Mar 23 to Apr 26.

Models showed that parent-reported feelings of well-being decreased significantly since the crisis began. Both parent and child well-being was strongly correlated with the number of pandemic-related hardships (eg, job and income loss, caregiving burden, illness) the family faced.

The authors noted that hourly workers with unstable employment and income; people of color, who are at high risk of infection and severe outcomes; and families with young children, who also shoulder heavy childcare burdens, are at heightened risk for stress, worry, and low well-being.

Job loss, caregiving burden, illness

Before stay-at-home orders were issued, parents reported a negative mood some of the time on 30% of days and all day on 7%. After the orders were issued, those numbers rose to 33% and 9%, along with uncooperative child behavior and mounting worries.

The adjusted percentage of respondents who said they were working each day dropped from 67.9% before stay-at-home orders to 43.8% after, a 35% decrease. And the percentage who reported work disruptions on any given day increased from 9.3% to 19.9%.

Among families, 60% reported job loss, 69% said their income had declined, 45% said their caregiving duties had increased, and 12% had been ill. Only 14% experienced no hardships during the pandemic, but most reported at least two, and 3% had all four hardships.

Each hardship was tied to substantially worse parental mood, and childcare burden and household illness were significantly associated with children's unruly behavior and parental worry. Those with one or no hardships reported little difference in well-being, while those with two or more hardships reported substantially worse mood, sleep quality, and child misbehavior than those with no misfortunes.

Mental health screening, understanding, empathy

Most survey respondents were women, consistent with working in the service industry and having custody of a young child. About half were black, and about one-fifth were Hispanic. Mean age was 31, and mean educational level was 12 years. Children were, on average, 4.9 years old; most were female; about two thirds lived with another adult; and mean family income was $2,239 per month.

"These results should raise concern given the strong links between parental psychological well-being and the well-being of children," the authors wrote.

They called for increasing social, economic, and mental health support, with pediatricians helping parents understand that the stresses of the pandemic may lead children to act out.

"As the crisis continues to unfold, pediatricians should screen for mental health, with particular attention to children whose families are especially vulnerable to economic and disease aspects of the crisis," the researchers wrote. "All adults providing services to young children may be more effective in supporting children’s mental health during this pandemic if they focus on understanding and empathy."

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