Changes in UK parental mental health symptoms over 10 months of the COVID-19 pandemic

Parent Mental Health Before and During the COVID-19 Pandemic

Although extant cross-sectional data suggest that parents have experienced numerous challenges (e.g., homeschooling, caregiver burden) and mental health consequences during the COVID-19 pandemic, longitudinal data are needed to confirm mental health changes relative to pre-pandemic levels and identify which specific pandemic-related changes most highly predict mental health during the pandemic. In two longitudinal subsamples (N = 299 and N = 175), we assessed change in anxiety, depression, and stress before and during the pandemic and whether the accumulation of pandemic-related changes predicted observed mental health changes. On average, parents reported increased depression and anxiety, but no significant changes in reported stress. Moreover, increased interpersonal conflict, difficulty managing work and caregiving responsibilities, and increased economic challenges were the types of pandemic-related changes that most strongly predicted worse mental health, highlighting that juggling caregiving responsibilities and economic concerns, along with the pandemic's impact on interpersonal family relationships are key predictors of worsening parental mental illness symptoms.

Parental mental health trajectories over the COVID-19 pandemic and links with childhood adversity and pandemic stress

BACKGROUND

The COVID-19 pandemic has created significant disruptions, with parents of school-age children being identified as a vulnerable population. Limited research has longitudinally tracked the mental health trajectories of parents over the active pandemic period. In addition, parents' history of adverse (ACEs) and benevolent (BCEs) childhood experiences may compound or attenuate the effect of COVID-19 stressors on parental psychopathology.

OBJECTIVE

To identify distinct longitudinal trajectories of parental mental health over the COVID-19 pandemic and how these trajectories are associated with parental ACEs, BCEs, and COVID-19 stress.

PARTICIPANTS AND SETTING

547 parents of 5-18-year-old children from the U.K., U.S., Canada, and Australia.

METHODS

Growth mixture modelling was used to identify trajectories of parental mental health (distress, anxiety, post-traumatic stress, and substance use) from May 2020 to October 2021. COVID-19 stress, ACEs, and BCEs were assessed as predictors of mental health trajectories via multinomial logistic regression.

RESULTS

Two-class trajectories of "Low Stable" and "Moderate Stable" symptoms were identified for psychological distress and anxiety. Three-class trajectories of "Low Stable", "High Stable", and "High Decreasing" symptoms were observed for post-traumatic stress. Reliable trajectories for substance use could not be identified. Multinomial logistic regression showed that COVID-19 stress and ACEs independently predicted membership in trajectories of greater mental health impairment, while BCEs independently predicted membership in trajectories of lower psychological distress.

CONCLUSIONS

Parents experienced mostly stable mental health symptomatology, with trajectories varying by overall symptom severity. COVID-19 stress, ACEs, and BCEs each appear to play a role in parents' mental health during this unique historical period.

The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort

BACKGROUND

Children's conduct and emotional problems increased during the COVID-19 pandemic.

OBJECTIVE

We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep).

METHODS

Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families' mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models.

RESULTS

A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=-0.01) or T3 (secondary outcome; standardized effect=-0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=-0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded.

CONCLUSIONS

Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.