Finding the power within and without: How can we strengthen resilience against symptoms of stress, anxiety, and depression in Australian parents during the COVID-19 pandemic?

Maternal distress during the COVID-19 outbreak: A socio-ecological perspective

INTRODUCTION

Mothers faced an increased risk of adverse mental health outcomes during the COVID-19 pandemic compared to other populations. However, there is little data on the factors that placed mothers at increased risk of distress.

AIMS

The present study explored a range of individual, familial, and environmental factors associated with psychological distress in mothers during the COVID-19 pandemic.

METHOD

This repeated cross-sectional study was composed of a convenience sample of mothers who completed an online survey that included a demographic questionnaire, an emotion regulation questionnaire, and the Depression, Anxiety, and Stress scale. The survey was administered during the second and third lockdowns in Israel in 2020-2021.

RESULTS

The study included 575 mothers (M age = 39). The findings of a hierarchical regression indicated that individual-level factors, composed of age and emotion regulation tendencies predicted psychological distress. The family-level factors of household income and number of children in the family also predicted distress. In terms of environmental-level factors, COVID-19-related media consumption and school status (open or closed) were also significant predictors of psychological distress. Importantly, the results showed that the most important predictors of psychological distress in mothers during the COVID-19 outbreak were school closures, household income, and the use of adaptive and maladaptive emotion regulation strategies.

CONCLUSIONS

The findings highlight the intersection of individual, familial, and environmental factors in mothers' mental health during crises.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

The impact of parents' stress on parents' and young childrens' mental health-Short- and long-term effects of risk and resilience factors in families with children aged 0-3 in a representative sample

Stress in parents has a significant impact on parenting and infant's development. However, few studies have examined cross-sectional and longitudinal links on risk and resilience of burdened families. Thus, this study aimed to investigate subjective risk and resilience factors on family well-being. Data stem from the 2015 nationwide study "Children in Germany" ("Kinder in Deutschland" - KiD 0-3). Parents of children aged zero to 3 years (N = 8.063) were recruited from random probability-sampled paediatric clinics (n = 271) across Germany. Risk and resilience variables such as parents' perceived stress (PSS-4), competence, isolation and attachment (PSI), as well as parental inner anger (items from CAP), relationship quality (DAS-4) and the child's negative emotionality (items from SGKS) were assessed at baseline in addition to demographic variables to predict parents' mental health (PHQ-4) and negative emotionality of the child at baseline (T1) and in the 2-year follow-up (T2) using linear regression models. At baseline, parents' mental health was predicted by inner anger, the child's negative emotionality and being a single parent (R2 = 45.1%) at baseline, but only by parenting competence at the two-year-follow-up (R2 = 25.1%). The child's negative emotionality was predicted (R2 = 27.5%) by the child's age, and parental inner anger and competence, attachment, perceived stress, mental health as well as education background. At two-year-follow-up, the child's age, single parenthood, social welfare benefit, child's negative emotionality at baseline, relationship quality and competence were significant predictor variables (R2 = 22.8%). This study highlights the impact of specific risk and resilience factors not only on parents' mental health but also the child's negative emotionality in the short and long-term in early childhood. Universal, but also selective prevention programs should increase parents' resilience (e.g., focusing on self-efficacy, competence, coping strategies).

The positive and negative emotion functions related to loneliness: a systematic review of behavioural and neuroimaging studies

Loneliness is associated with high prevalences of major psychiatric illnesses such as major depression. However, the underlying emotional mechanisms of loneliness remained unclear. We hypothesized that loneliness originates from both decreases in positive emotional processing and increases in negative emotion processing. To test this, we conducted a systematic review of 29 previous studies (total participants n = 19 560, mean age = 37.16 years, female proportion = 59.7%), including 18 studies that included questionnaire measures of emotions only, and 11 studies that examined the brain correlates of emotions. The main findings were that loneliness was negatively correlated with general positive emotions and positively correlated with general negative emotions. Furthermore, limited evidence indicates loneliness exhibited negative and positive correlations with the brain positive (e.g. the striatum) and negative (e.g. insula) emotion systems, respectively, but the sign of correlation was not entirely consistent. Additionally, loneliness was associated with the structure and function of the brain emotion regulation systems, particularly the prefrontal cortex, but the direction of this relationship remained ambiguous. We concluded that the existing evidence supported a bivalence model of loneliness, but several critical gaps existed that could be addressed by future studies that include adolescent and middle-aged samples, use both questionnaire and task measures of emotions, distinguish between general emotion and social emotion as well as between positive and negative emotion regulation, and adopt a longitudinal design that allows us to ascertain the causal relationships between loneliness and emotion dysfunction. Our findings provide new insights into the underlying emotion mechanisms of loneliness that can inform interventions for lonely individuals.

Family Functioning and the Pandemic: How Do Parental Perceived Social Support and Mental Health Contribute to Family Health?

BACKGROUND

The COVID-19 pandemic and the quarantine measures implemented have profoundly impacted parents and families. The stress and uncertainty generated by the COVID-19 virus, as well as the disruption of routines and social relationships, have weakened both individual and family health and functioning.

OBJECTIVE

The present research is part of a larger study that aims to understand, with a family systems theory, the longitudinal effects of the COVID-19 pandemic on school-aged children, adolescents, and their parents. More specifically, this paper aims to investigate parents' experience of the first months of the pandemic as a predictor of perceived social support, parental ill-being (aggregate score of well-established poor psychological functioning indicators), parental satisfaction, and family functioning.

METHOD

During the first lockdown (April-May 2020), 203 parents of school-aged children living in Quebec completed an online questionnaire.

RESULTS

Path analysis indicates that the impact of COVID-19 and health preoccupation due to COVID-19 are both positively associated with individual parental ill-being, which in turn detracts from family functioning and parental satisfaction. Furthermore, perceptions about positive effects of the pandemic are negatively associated with parental ill-being, and positively with perceived social support, which in turn significantly contributes to family functioning and parental satisfaction.

CONCLUSION

The findings highlight the importance of adopting a systemic perspective to best understand the effects of the pandemic and the social and health measures on individuals, families, and systems, as well as to better support parents and family health through periods of uncertainty.

It's gone, it's back: A prospective study on the COVID-19 pandemic-related shortages and mental health of Australian families

Our aim was to explore the association between COVID-19 pandemic-related product shortages and symptoms of stress, anxiety, and depression in Australian families, concurrently and longitudinally, while controlling for demographic, health, and psychological characteristics. This prospective study used two waves of data (baseline, Time 0 = April 2020; Time 1 = May 2020) from a longitudinal cohort study of Australian parents of a child aged 0-18 years. Parents were surveyed at baseline about whether they had experienced product shortages related to COVID-19. DASS21 was used to measure symptoms of depression, anxiety, and stress at both waves. The sample included 2,110 participants (N = 1,701, 80.6% mothers). About 68.6% of the respondents reported being impacted by one or more shortages. Product shortages correlated significantly with higher combined and individual scores for anxiety, depression, and stress (r = 0.007 to 0.18, all p < 0.001) at baseline. At Time 1, parental emotion regulation explained 4.0% of the variance (p < .001). Our findings suggest a role for improving parental emotion regulation in coping with stressors, such as shortages and lockdowns.

Examining the Relationships Between Fear of Coronavirus, State Anxiety, and Relationship Happiness Among Married Turkish Individuals During COVID-19

The present study aimed to investigate the mediating role of state anxiety in the relationship between the fear of COVID-19 and relationship happiness among married individuals. An additional aim of the study also tested the moderating role of joint family activities between state anxiety and relationship happiness. The study sample consisted of 1713 married individuals (1031 women and 682 men). The study findings showed both the significant direct associations among the studied variables and the mediating role of state anxiety in the relationship between fear of COVID-19 and relationship happiness. It also found that the path of state anxiety to relationship happiness among married individuals having family activities was significantly lower than those who did not. Directions for future research and application were discussed.

Long COVID in the context of social determinants of health

The COVID-19 pandemic has been a challenge for the public health system and has highlighted health disparities. COVID-19 vaccines have effectively protected against infection and severe disease, but some patients continue to suffer from symptoms after their condition is resolved. These post-acute sequelae, or long COVID, continues to disproportionately affect some patients based on their social determinants of health (SDOH). This paper uses the World Health Organization's (WHO) SDOH conceptual framework to explore how SDOH influences long COVID outcomes.

The Resilience of Caregivers and Children in the Context of COVID-19: A Systematic Review

The COVID-19 pandemic has necessitated caregivers and school-aged children to adapt to ongoing changes and uncertainty. Understanding why some caregivers and school-aged children area able to adapt and others are not could be attributed to resilience. The relationships between caregiver or child resilience and socioeconomic status (SES) in the context of COVID-19 remain largely un-explored. Therefore, the purpose of this qualitative systematic review was to explore (1) what is currently known about the relationship between caregiver and child resilience in the context of COVID-19; and (2) the role of SES on caregiver or child resilience throughout the COVID-19 pandemic. Four databases (i.e., MEDLINE, Scopus, PsycINFO, and CINAHL) were systematically searched, title/abstract and full-text screening were conducted, and 17 articles met the inclusion criteria (i.e., discussed resilience of caregivers/children during COVID-19, mean age of children between 7-10, primary research/grey literature, English), including 15 peer-reviewed and two grey literature sources. Thematic analysis revealed five themes: (1) the mitigating effects of child resilience; (2) overcoming the psychological toll of the pandemic; (3) the unknown relationship: caregiver and child resilience; (4) family functioning during COVID-19; and (5) the perfect storm for socioeconomic impacts. Results from this review provide the first synthesis of the impact of the COVID-19 pandemic on the resilience of caregivers and school-aged children. Future research should conduct longitudinal data collection to understand the possible long-term impacts of the pandemic on these populations' resilience. Understanding these impacts will be integral to assisting families in bouncing back from the long-lasting adverse circumstances caused by the COVID-19 pandemic.

Incidence and persistence of psychological distress during the COVID-19 pandemic among individuals with and without disability

OBJECTIVES

We investigated the incidence (becoming distressed at the follow-up) and persistence (distressed at the baseline and the follow-up) of psychological distress among individuals with and without disability in the period from early 2017 (before the COVID-19 pandemic) to late 2020 (the second wave of the pandemic).

METHODS

We analyzed the population-based FinHealth 2017 survey and its follow-up conducted in 2020 (number of individuals who participated in both surveys: n = 4881; age = 18+). Logistic regressions were applied to investigate differences in the incidence and persistence of psychological distress between people with and without disability. We also investigated whether age, quality of life at the baseline, and perceived increase in loneliness during the COVID-19 pandemic moderated the association between disability and the incidence of distress.

RESULTS

The incidence of psychological distress was higher (OR = 3.01, 95% CI:2.09-4.35) for people with disability (18.9%) than among those without (7.4%), being highest (31.5%) among the youngest participants with disability, aged 18 to 39. People with disability who had a poor quality of life at the baseline were particularly prone to become distressed during the follow-up. People who reported perceived increase in loneliness during the pandemic were prone to become distressed at the follow-up regardless of their disability status. The persistence of distress was more common (OR = 6.00, 95% CI:3.53-10.12) among people with disability (65.7%) than among those without (24.9%).

CONCLUSION

The COVID-19 pandemic had more negative mental health effects on people with disability, especially adults with disability who were young and had a low quality of life before the pandemic.

Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors

BACKGROUND

Little is known about the mental health burden or the factors that contribute to mental health variables in parents of children with congenital heart defects (CHD) during the COVID-19 pandemic.

OBJECTIVE

The purpose of this study was to examine risk and protective factors associated with anxiety symptoms, depression symptoms, and perceived stress in parents of young children with CHD during the COVID-19 pandemic.

METHODS

A nonexperimental design was used in this study of 127 parents of children aged newborn to five years with CHD during the COVID-19 pandemic. Regression analyses were conducted to examine associations between COVID-19 stressors, CHD care-related factors, parental resilience, external support, and mental health variables.

RESULTS

Parental resilience, emotional support, and informational support were key protective factors for anxiety, depression, and stress. However, resilience was remarkably low in CHD parents. Increased levels of anxiety symptoms, depression symptoms, and perceived stress were associated with 1) Exposure to a greater number of COVID-19-related stressors, 2) Distress from family visitation restrictions during healthcare encounters, 3) Worry related to the perceived risk of their CHD child's exposure to COVID-19 during healthcare encounters, and 4) Worry about their CHD child's risk of death or serious illness from COVID-19.

CONCLUSIONS

The additive impact of the COVID-19 pandemic plus CHD care-related worries on this parent population's mental health is significant. Interventions that promote resilience, address the effect of healthcare system changes, and support the needs of parents of young children with CHD during this and future pandemics are needed.

Mental Health Status of French School-Aged Children's Parents during the COVID-19 Lockdown and Its Associated Factors

The COVID-19 pandemic has led to widespread social isolation. This study aimed to determine anxiety levels among parents of school-aged children and investigate the associated factors. Data on sociodemographic characteristics, living and working conditions, family relationships, social support (MSPSS) and health status (SF-12) were collected from French parents through an online survey. The Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety. Logistic regression analysis was performed to identify the factors associated with moderate to severe anxiety. Among 698 parents, 19.2% experienced moderate to severe anxiety. A low level of resilience (OR = 4.3, 95% CI: 2.7-6.7) and confirmed COVID-19 cases involving hospitalization (OR = 3.8, 95% CI: 2.0-7.3) among individuals in one's household or in the family circle were found to be the main risk factors for moderate to severe anxiety. Other factors were also identified: a level of education less than high school (OR = 2.1, 95% CI: 1.3-3.2), conflicts at home (OR = 2.3, 95% CI: 1.4-3.7), noises outside the home (OR = 2.0, 95% CI: 1.0-3.9), confirmed cases not involving hospitalization (OR = 1.8, 95% CI: 1.0-3.1) and suspected cases (OR = 1.9, 95% CI: 1.0-3.8). Family support was a protective factor. These findings suggest some need for support programs to help parents cope with public health crises and work-family challenges.

Difference between Minorities and Majorities in the Association between COVID-19-Related Stress and Psychological Distress: A Socio-Ecological Perspective and the Moderating Role of Parenthood

This study introduces a socio-ecological perspective of differences in psychological distress between the Palestinian minority and Jewish majority citizens of Israel during lockdown due to COVID-19. The study examines the association between COVID-19-related stress and psychological distress, and the moderating effect of parenthood. Online questionnaires, completed by 1934 participants (1391 Jews, 552 Palestinians; 1306 parents, 637 without children; 54.86% female, 45.13% male; M age = 40.38, SD = 13.77) assessed COVID-19-related stressors and depression, anxiety, and stress. The Palestinian minority showed a higher level of COVID-19-related stress and psychological distress than the Jewish majority. Parenthood showed a moderating effect on the association between COVID-19-related stress and distress for the Jewish majority but not the Palestinian minority. The results emphasize the significance of considering social status when seeking to understand the differences between minorities and majorities in terms of distress and resilience during pandemic events, and the need for cultural sensitivity and awareness when issuing instructions in such circumstances. Additionally, the results highlight the potential role of parenthood as a resilience factor, depending upon social status.

Factors associated with work-family enrichment among working Israeli parents during COVID-19 lockdowns

This study examined work-family enrichment, protective resources and psychological implications among working Israeli parents during COVID-19. In this cross-sectional study, 409 working parents were recruited during Israel's third lockdown. Levels of FWC/WFC and resilience were moderate, psychological distress and fear of COVID-19 were low, and perceived social support was high. All the study variables showed significant associations with each other. A multivariate regression analysis explained 30% of the WFC and FWC variance. We found differences in FWC/WFC based upon children's age but not on parents' gender. FWC/WFC mediated the effect of perceived social support and resilience on fear of COVID-19 and psychological distress. The findings explain the importance of personal resources during the pandemic in buffering the negative effects of parents' work- and family-related burdens and have important implications for helping families with young children cope during challenging times.

The association of resilience with depression, anxiety, stress and physical activity during the COVID-19 pandemic

Background

COVID-19 has resulted in substantial global upheaval. Resilience is important in protecting wellbeing, however few studies have investigated changes in resilience over time, and associations between resilience with depression, anxiety, stress, and physical activity during the COVID-19 pandemic.

Methods

Online surveys were conducted to collect both longitudinal and cross-sectional data at three time points during 2020. Australian adults aged 18 years and over were invited to complete the online surveys. Measures include the six-item Brief Resilience Scale, the 21-item Depression, Anxiety and Stress Scale, and the Active Australia Survey which have eight items identifying the duration and frequency of walking, and moderate and vigorous physical activities (MVPA), over the past 7 days. General linear mixed models and general linear models were used in the analysis.

Results

In the longitudinal sample, adjusted differences (aDif) in resilience scores did not significantly change over time (time 2 vs. time 1 [aDif = − 0.02, 95% CI = − 0.08, 0.03], and time 3 vs. time 1 [aDif = < 0.01, 95% CI = − 0.07, 0.06]). On average, those engaging in at least 150 min of MVPA per week (aDif = 0.10, 95% CI = 0.04, 0.16), and having depression (aDif = 0.40, 95% CI = 0.33), anxiety (aDif = 0.34, 95% CI = 0.26, 0.41), and stress scores (aDif = 0.30, 95% CI = 0.23, 0.37) within the normal range had significantly higher resilience scores. The association between resilience and physical activity was independent of depression, anxiety, and stress levels. All results were similar for the cross-sectional sample.

Conclusions

Resilience scores did not change significantly during the COVID-19 pandemic. However, there were significant associations between resilience with physical activity and psychological distress. This research helps inform future interventions to enhance or nurture resilience, particularly targeted at people identified as at risk of psychological distress.

COVID-19, Economic Impact, Mental Health, and Coping Behaviors: A Conceptual Framework and Future Research Directions

The COVID-19 pandemic has caused serious economic and social consequences. Recent research shows that the pandemic has not only caused a physical health crisis but also caused many psychological and mental crises. Based on the contemporary cognitive-behavioral models, this article offers a conceptual analysis of how the pandemic affects individual mental health and coping behaviors from the perspective of individual economic status, individual context, and social context. The analysis shows that (1) the pandemic has led to increased economic uncertainty, increased unemployment and underemployment pressure, increased income uncertainty, and different degrees of employment pressure and economic difficulties; (2) these difficulties have stimulated different levels of mental health problems, ranging from perceived insecurity (environmental, food safety, etc.), worry, fear, to stress, anxiety, depression, etc., and the mental health deterioration varies across different groups, with the symptoms of psychological distress are more obvious among disadvantageous groups; and (3) mental health problems have caused behavior changes, and various stress behaviors such as protective behaviors and resistive behaviors. Future research directions are suggested.

Getting to Hope: Perspectives from Patients and Caregivers Living with Chronic Childhood Illness

Promoting hope was identified in our prior work as the top priority research question among patients and caregivers with diverse childhood-onset chronic conditions. Here, we aimed to construct a conceptual model to guide future research studies of interventions to improve hope. We conducted eight monthly virtual focus groups and one virtual workshop with patients, caregivers, and researchers to explore key constructs to inform the model. Discussions were facilitated by Patient Co-Investigators. Participants developed a definition of hope and identified promotors and inhibitors that influence the experience of hope. We utilized qualitative methods to analyze findings and organize the promotors and inhibitors of hope within three strata of the socio-ecologic framework: structural, interpersonal, and intrapersonal. Participants identified three types of interventions to promote hope: resources, navigation, and activities to promote social connection. The hope conceptual model can be used to inform the selection of interventions to assess in future research studies aimed at improving hope and the specification of outcome measures to include in hope research studies. Inclusion of the health care system in the model provides direction for identifying strategies for improving the system and places responsibility on the system to do better to promote hope among young patients with chronic illness and their caregivers.