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Running head: COVID-ChAMPS
Parenting and child and adolescent mental health during the COVID-19 pandemic
Sarah Whittle, PhD1, Katherine Bray, BSc(Hons)1, 2, Sylvia Chu Lin, BA(Hons)1, Orli Schwartz,
PhD3
1 Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne &
Melbourne Health, Melbourne, Australia
2 Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne,
Australia
3 Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne,
Melbourne, Australia
Correspondence concerning this article should be addressed to Sarah Whittle, Melbourne
Neuropsychiatry Centre, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry
St, Carlton, Victoria, Australia, 3053. E-mail: swhittle@unimelb.edu.au
This work was funded by the National Health and Medical Research Council (Career
Development Fellowship to SW, ID 1125504). The funding source had no role in study design; in
the collection, analysis and interpretation of data; in the writing of the report; or in the decision to
submit the article for publication.
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Abstract
Background: Early work indicates the significant impact of the COVID-19 pandemic on the
mental health of children and adolescents. Understanding which children may be more at risk for
mental health problems, and which risk factors are amenable to change is crucial. The importance
of studying children’s mental health within the context of the family system is recognized.
Methods: The current study investigated associations between parent factors, and children’s
mental health during the early phase of the COVID-19 pandemic across a number of Western
countries (primarily Australia and the United Kingdom). Parents (N = 385) reported on their
pandemic-related stress, mental health, and parenting behaviors, in addition to mental health
changes in their 5-17 year old children (N = 481) during April/May 2020. Results: Analyses
revealed significant associations between parent COVID-19 pandemic stress, parent depression,
anxiety and stress symptoms, and increases in child internalizing and externalizing problems.
Harsh parenting behavior was associated with trauma symptoms and increases in externalizing
problems. Further, some associations were more pronounced for children with existing mental
health problems, and for disadvantaged and single parent families. Limitations: The data was
cross-sectional, the majority of participant parents were female, and all data were parent-report.
Conclusions: Findings suggest the importance of parents in influencing children’s mental health
during the acute phase of the COVID-19 pandemic. Further work is needed to investigate longer-
term impacts.
Keywords: COVID-19, parenting, stress, child mental health, adolescent mental health
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COVID-ChAMPS
The impact of the 2019 coronavirus disease (COVID-19) pandemic on mental health is likely to
be very significant, and is of particular concern in relation to the mental health of children and
adolescents (Dalton, Rapa, & Stein, 2020; Sprang & Silman, 2013; Wang, Zhang, Zhao, Zhang,
& Jiang, 2020). Indeed, early work has provided evidence for negative mental health impacts on
children and adolescents. In Italy and Spain, for example, 85.7% of parents perceived changes in
their children´s emotional state and behaviors during COVID-19 quarantine (Orgilés et al., 2020),
with child problems spanning both internalizing and externalizing domains.
Understanding which children may be more at risk for mental health problems, and which risk
factors are amenable to change is crucial to ensuring good outcomes for youth mental health
during the COVID-19 pandemic and future crises (Cobham, McDermott, Haslam, & Sanders,
2016). The importance of studying children’s mental health within the context of their social
ecological system (with a primary emphasis on the family system) is recognized (Cobham et al.,
2016), and this applies both to children and adolescents, given the continued importance of
parents in children’s mental health beyond childhood and throughout adolescence (Yap et al.,
2007). The role of parents is likely to be particularly important for child and adolescent mental
health in the context of the acute phase of the COVID-19 pandemic, whereby many parents and
children are spending large amounts of time together under stay-at-home orders, against the
backdrop of increased pressures experienced by parents, such as the need to juggle home-
schooling with other responsibilities (Griffith, 2020).
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It is well-established that parental stress plays an important role in child mental health via its
effects on the emotional and behavioral functioning of parents (Conger et al., 2010). Much work
supports a link between perceived stressors, including those associated with the impact of the
COVID-19 pandemic such as economic hardship and social isolation, and increased mental
health problems in parents (Conger et al., 2010). Further, research has shown that parental mental
health problems are associated with increased vulnerability to distress and poor mental health in
children and adolescents (Conger et al., 2010). A link between parents’ and children’s mental
health problems in the period following unpredictable, traumatic or stressful experiences (e.g.,
disasters) has also been established (Cobham et al., 2016).
The mechanisms via which parental mental health problems impact children may be via ‘social
referencing’ or parental emotional socialization processes (Silk et al., 2006), or more directly via
changes in parenting behaviors (Conger et al. 2010). Indeed, there is evidence that increased
mental health problems in parents following stress significantly influence parenting behaviors
and parent–child relations (Riley et al., 2008) and increase the risk for mental health problems in
children (Rasic, Hajek, Alda, & Uher, 2014). Stress-related mental health problems in parents
have been shown to specifically relate to both increases in negative caregiving behaviors such as
harsh parenting, and decreases in positive caregiving behaviors such as warm parenting
(Beckerman et al., 2017; Conger et al., 2010). These types of parenting behaviors have in turn
been associated with poor child mental health (Conger et al., 2010), including following stressful
or traumatic experiences (Cobham et al., 2016).
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Not all parents experiencing stress as a result of the economic and social impacts of the COVID-
19 pandemic may be at risk of mental health problems or poor parenting. Some protective parent
factors may mitigate the impact of the COVID-19 pandemic on children’s mental health. In
particular, perceived family connectedness is likely to be important, which has been shown to be
protective of child mental health in research on traumatic events such as disasters (Cobham et al.,
2016). Resilience factors are also likely to be important. Much research has highlighted the
importance of a positive outlook for resilience (Walsh, 2016). In the context of COVID-19,
parents’ positive outlook may encourage family efforts to take initiative, be creative and to
persevere (Walsh, 2020).
Although there are established links between parent stress and mental health problems, parenting
and family factors, and child mental health (Conger et al., 2010), and prior work has investigated
these associations in relation to exposure to major stressors (like disasters), it is important to
investigate these associations during the COVID-19 pandemic due to the unique nature of the
pandemic. Unlike disasters, stress related to COVID-19 is likely to be relatively chronic, and
there is some evidence that family factors are likely to be more relevant for child mental health
during chronic (vs. acute) stressors (Sagy, 2002). Further, the association between parental and
child mental health problems may be different in the case of a pandemic like COVID-19. Parents
experiencing distress might typically seek social support, or use family routines to regulate
family functioning – many of these coping strategies are not readily available during a situation
when separation and isolation is demanded (Sprang & Silman, 2013). As such, the unique issues
and stressors associated with the COVID-19 pandemic warrant investigation of specific
associations between parent distress, parenting/family factors and child mental health.
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The aim of this study was to investigate associations between parental stress related to the
COVID-19 pandemic, their own mental health, parenting and family factors, and changes in their
child and adolescent offspring’s mental health during the acute phase of the pandemic.
Participants were recruited from Western, English-speaking countries where the majority of
families were under stay-at-home (shelter-in-place) orders during April and May of 2020. While
models of family stress and child mental health emphasize a causal chain, whereby stress in
parents leads to child mental health problems via parent mental health problems and poor
parenting behaviors, given the cross-sectional nature of this study, we investigated each of the
parent factors independently. We hypothesized that higher parental COVID-19 pandemic-related
stress, higher parental mental health problems (depression, anxiety and stress symptoms), and
poor parenting behaviors (i.e., more hostile parenting behavior, lower parental warmth) would be
associated with increased mental health problems in children. We also hypothesized that higher
family cohesion, and higher levels of parental positive outlook, would be associated with lower
child problems. We investigated child trauma symptoms, in addition to internalizing and
externalizing problems. However, we did not have predictions about effects on specific child
mental health problems given that prior literature indicates that the parent factors of interest here
are associated with a wide range of mental health problems in children and adolescents following
stressful events (Roelofs, Meesters, Ter Huurne, Bamelis, & Muris, 2006).
Given previous research suggesting age and gender differences in the effects of parent factors on
child mental health (Klimes‐Dougan et al., 2007; van Eijck, Branje, Hale, & Meeus, 2012), their
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moderating role was investigated. Other early work has suggested that negative COVID-19
impacts on mental health may be particularly problematic for those children with pre-existing
problems (Zhang et al., 2020). As such, we investigated whether existing (‘baseline’) mental
health problems in children moderated effects. Finally, in exploratory analyses, we investigated
sociodemographic factors that might moderate associations with poor child mental health. In
particular, families with lower income relative to needs, and single parent families, may be more
prone to the negative impacts of stressors associated with the COVID-19 pandemic due to limited
resources (Reiss, 2013). Children from these families may be more at risk of negative mental
health outcomes due to the cumulative nature of stressors that they face (Sameroff, 2000).
Methods
Parents were recruited via online advertising through local University and other professional and
personal networks, in addition to paid Facebook advertisements (targeting Age:25-55; people
who match: Parents: Parents with primary school-age children (6-8 years), Parents with pre-teens
(aged 9-12), or Parents with teenagers (aged 13-17)). Australia, New Zealand, the United
Kingdom, the United States and Canada were targeted given similar stay-at-home orders were in
place at the time (mid-April to mid-May; stay-at-home except for essentials was required in all
countries except for Canada, where stay-at-home was recommended). Inclusion criteria included
a) being the parent or legal guardian of at least one child aged between 5 and 17 years, b)
child/children living at home with them at least half of the time, c) English speaking, and d)
providing informed consent to participate in the survey. Three hundred and eighty one
participating parents (94% female) met these criteria, responded correctly to at least one of two
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validity questions (to check for careless responding) in the survey (see Supplementary Material
for survey items), and completed at least 70% of the survey questions on their child’s mental
health, and thus comprised the final sample. Parents were invited to complete the survey for up to
six children, and to ensure that there was no bias in selecting a specific child to answer questions
about (who may be having more mental health problems, for example), order of child (oldest to
youngest, youngest to oldest) was counterbalanced in the survey. The research was ethically
approved by The University of Melbourne.
Measures
All measures were administered via a Qualtrics survey (see Supplementary Material for a copy of
the survey). Where possible, established measures were selected where there was existing
evidence for measurement invariance within Western countries/cultures (Essau et al., 2012;
Rohner & Ali, 2020). The following data was collected and used in analyses.
Demographic information pertaining to the age and gender of parent participant and children,
country of residence, ethnicity, parent educational attainment, single parent status, and pre-
COVID-19 household income was collected. A measure of income-to-needs was created by
dividing household income (the midpoint of the income bracket selected) by the square root of
the number of people in the household (OECD, 2012).
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To assess COVID-19 pandemic-related stress, parents responded to a series of questions about
distress and worry related to the COVID-19 pandemic (financial problems, worry about
uncertainty, physical and mental health of self or others) (items taken from the Combined
COVID Health Emotional Lifestyle Changes questionnaire available at https://osf.io/c2z8k/,
items Block 2: 1 to 4, 6, 10a to 11b, and Block 3: 5) (Pfeifer, 2020, May 22) using a 6-point
Likert scale (1=Not at all, 6=Extremely). A cumulative (or total) stress score was created by
summing responses to the seven distress/worry items. Internal consistency for the current
sample was good (Cronbach’s alpha = 0.81). Positive outlook was measured using a single
question (with the same Likert scale) asking about perceived positive impact of the COVID-19
pandemic (Pfeifer, 2020, May 22).
Parental mental health was assessed using the Depression, Anxiety, Stress Scale 21 (DASS-21
(Henry & Crawford, 2005)), a 21-item questionnaire that measures symptoms associated with
depression, anxiety and stress. The DASS-21 has been shown to have good psychometric
properties and is strongly correlated with other depression symptoms scales such as the Beck
Depression Inventory. The internal consistency for these subscales in the current sample was
good (Cronbach’s alpha = 0.91 (Depression), 0.87 (Anxiety) and 0.87 (Stress)). Scores from
these three subscales were used in analyses.
Parenting and family factors were assessed using the Parental Acceptance Rejection/Control
Questionnaire (parent version)-Parent PARQ/Control (Ronald P. Rohner & Khaleque; R. P.
Rohner & Khaleque, 2005). This questionnaire consists of 29 items on a Likert scale (1= almost
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never true to 4= almost always true), which evaluates parental acceptance/rejection and
controlling behaviors with their children. The PARQ/Control has been shown to have good
psychometric properties. The hostility/aggression (6 items) and warmth/affection (8 items) scales
were included in analyses (Cronbach’s alphas for the current sample were 0.74 and 0.74,
respectively) given a priori hypotheses.
The family cohesion scale of the Family Environment Scale (FES (Moos, 1981)) is
conceptualized as “the extent to which family members are encouraged to express their feelings
directly,” and comprises nine true–false items. The FES has acceptable psychometric properties,
although the cohesion subscale had an internal consistency reliability of 0.48 in this sample.
Child mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ
(Goodman, 2001)), a brief behavioral screening questionnaire that asks about 25 attributes over
the past six months. The SDQ has sound psychometric properties and is widely used in
epidemiological, developmental, and clinical research. We utilized the Conduct and Inattention-
Hyperactivity, and Emotional scales given that they assess externalizing and internalizing
problems, respectively. The standard response format was used to assess ‘baseline’ problems.
Cronbach’s alphas for the current sample were 0.73, 0.81 and 0.78, respectively. As per other
work (Bai, Wang, Liang, Qi, & He, 2020), for each item we also asked parents to indicate
whether the behavior was occurring more (+1), the same (0), or less (-1) since COVID-19. We
summed these items for each subscale such that we had measures of change in behaviors since
COVID-19. These change scores were used as the dependent variable in analyses. Cronbach’s
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alphas for the current sample were 0.50 (Conduct), 0.60 (Inattention-Hyperactivity), and 0.77
(Emotional). Peer problems were considered, however, based on poor reliability of the change
score (alpha 0.17) and questionable interpretation given the stay-at-home circumstances, this
scale was not used in analyses.
To assess child trauma symptoms, we used the University of California at Los Angeles (UCLA)
Post-traumatic stress disorder (PTSD) Reaction Index for DSM 5 parent report of impairment in
functioning (Steinberg & Stanick, 2013). With a ‘Yes’/’No’/’Don’t know’ response format,
parents were asked to report on eight items addressing changes in the child’s relationships with
parents/caregivers, and seven items addressing problems in developmental progression. A total
trauma response symptom score was calculated by summing all 15 items, where a ‘Yes’ response
was weighted 1, and ‘No’/’Don’t know’ responses were weighted 0. Cronbach’s alpha for the
sample was 0.81.
The survey included other questions assessing parent-child communication about the COVID-19
pandemic. Although outside the scope of the current paper, associations between parent-child
communication and child mental health are presented in Supplementary Material.
Statistical Analysis
Scale scores were calculated as long as 70% of items loading onto scales had responses.
Percentage of missing (scale scored) data across the whole dataset was 2.2%. The largest
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percentage of missing data was for the PARQ (11%). We used R (Version 4.0.2 (2020)) for all
data scoring, visualization and analysis. Multiple imputation was used to account for missing data
using the R package mice (Buuren & Groothuis-Oudshoorn, 2010) (50 imputed datasets). R
packages lme4 (Bates et al., 2018) and robustlmm (Koller, 2016) were used for linear mixed
models analyses. The full reproducible code is available here:
https://github.com/SANDMNC/COVID-ChAMPS/tree/v.1.0.0 (DOI: 10.5281/zenodo.3961265).
Mixed effects models, with family as a random effect, were used to investigate associations
between parent and family factors, and child mental health outcomes. For each predictor
(COVID-19 pandemic stress; DASS Depression, Anxiety, Stress; PARQ Hostility, Warmth; FES
Cohesion; positive outlook), four outcomes were tested (change in SDQ Conduct Problems,
Inattention-Hyperactivity, Emotional Symptoms; and trauma symptoms). For SDQ change
outcomes, the relevant baseline SDQ score was included as a covariate. Other covariates included
child age and gender, parent age and gender, family income-to-needs, parental education, and
country. Note that ethnicity was not included as a covariate because responses closely aligned
with country.
For each analysis, a main effects model was first tested, and then a step-up procedure was used to
test for interactions between the predictor and child age, gender, and baseline SDQ scores (for
SDQ change outcomes). Two-, three- and four-way interaction models were retained based on
significance of variance added (e.g., a three-way interaction model was retained if both the three-
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way interaction involving the predictor of interest, and the variance explained by the model as
compared to the two-way interaction model, were significant).
A false discovery rate (FDR) procedure (Benjamini & Hochberg, 1995) was used to control for
multiple comparisons (11 predictors [including communication reported in Supplementary
Material] x 4 child outcomes). For each significant model, a follow-up robust linear mixed model
was run to ensure that findings were not affected by any violations to statistical assumptions (e.g.,
normality of model residuals). Only findings that remained significant using the robust mixed
model are presented.
For all significant models, follow-up exploratory analyses investigated possible moderating roles
of income-to-needs and single parent status (i.e., one vs. two parents/caregivers in the home).
Finally, for significant models, sensitivity analyses were conducted including only those
participants under current stay-at-home orders.
Results
Descriptive statistics for the sample of parents and children are presented in Table 1. Participating
parents (N=385) were primarily in Australia and the United Kingdom. Data on 481 children
ranging from 5 to 17 years old (51% females) was obtained. Two hundred and eighty-four
parents completed the survey for one child, 86 completed it for two children, 13 for three
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children, one for four children and one for five children. Ninety one percent of families had been
under ‘stay-at-home’ orders since COVID-19, and 83% were under these orders at the time of the
survey. Percentages of children for whom parents reported SDQ mental health problems as
having increased since COVID-19 are presented in Figure 1 (and Supplementary Table S1).
Frequencies of participants scoring in DASS/SDQ groups based on clinical cut-offs are provided
in Supplementary Tables S3. Of note, participating parents has higher rates of mental health
problems than might be expected based on data from population samples (Salari et al., 2020;
Westrupp et al., 2020). Bivariate correlations (Table S4), and histograms of key variables and
covariates (Figure S1) are presented in Supplementary Material.
COVID-19 pandemic stress
See Table 2 for statistics for significant predictors, and Supplementary Tables S4-S22 for full
model output for all significant models. COVID-19 pandemic stress was associated with
increasing SDQ inattention-hyperactivity and conduct problems, and higher trauma symptoms
since COVID, and increasing SDQ emotional problems only for those children with higher
baseline problems. See Figure 2 for scatterplots of significant associations. In order to tease apart
pandemic-specific stress from general distress, models were rerun controlling for DASS stress.
For conduct problem outcomes, COVID-19 pandemic stress was no longer a significant predictor
(p > 0.05) after including DASS stress in the model. Child age and gender did not moderate any
associations.
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Parental mental health
DASS depressive symptoms were associated with higher child trauma symptoms since COVID.
DASS anxiety symptoms were associated with increasing SDQ emotional problems, and higher
trauma symptoms since COVID-19 in children.
DASS stress symptoms were associated with higher trauma symptoms since COVID-19. They
were also associated with increasing emotional and conduct problems only for those children
with elevated baseline problems, and increasing SDQ hyperactive problems for younger but not
older children. There were no other moderating effects of age or gender. See Figure 3 for
scatterplots of significant associations.
Parenting behaviors
Parental hostility was associated with increased SDQ hyperactive problems and more trauma
symptoms, and increased conduct problems only for those children with high baseline problems.
Parental warmth was associated with fewer trauma symptoms, but no other child outcomes. See
Figure 4 for scatterplots of significant associations. Child age and gender did not moderate any
associations.
Family cohesion and positive outlook
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Higher family cohesion was associated with fewer child trauma symptoms. See Figure 4 for
scatterplots of significant associations. Positive outlook was not associated with any child
outcomes. Child age and gender did not moderate any associations.
Moderating sociodemographic factors
The associations between both parental hostility and warmth, and child trauma symptoms, were
significantly moderated by income-to-needs (p < 0.001 and p = 0.033, respectively), such that
associations were more pronounced for those with lower income-to-needs (Figure 4). Finally, the
association between DASS stress and increased conduct problems was moderated by single
parent status (p = 0.004) such that the association was more pronounced for children with high
baseline problems and families with a single parent status (Figure 3).
All results held when restricting the sample to those under stay-at-home orders at the time of the
survey.
Discussion
In this survey of 381 parents (primarily from Australia and the UK), we found evidence for
significant associations between parent and family factors (perceived COVID-19 pandemic
stress, parent mental health, parenting behaviors, and family cohesion), and changes in child
mental health during the acute phase, or first wave, of the pandemic. These parent and family
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factors were related to increases in a broad array of child mental health problems, both
internalizing (emotional problems, trauma symptoms) and externalizing in nature (inattention-
hyperactivity, conduct problems). Despite the wide age-spread of children (i.e., age five to 17),
there were few moderating effects of age, and no moderating effects of child gender. Finally,
there were some sociodemographic factors that moderated associations.
Parental perceived COVID-19 pandemic stress and current stress symptoms (DASS Stress) were
associated with the most widespread effects (i.e., increases in the widest array of internalizing
and externalizing problems in children). Associations between perceived COVID-19 pandemic
stress and increases in child emotional and inattention-hyperactivity problems, and trauma
symptoms, remained after covarying for DASS stress. This suggests unique effects of COVID-
19-related worries, not explained by parent’s general stress levels. This is consistent with
previous work showing that parental experience of stress that is specific to a traumatic event,
uniquely predicts children’s wellbeing (Juth, Silver, Seyle, Widyatmoko, & Tan, 2015). Although
we cannot infer directionality or causality, we theorize that parental COVID-19 pandemic-
related, and general, worry/stress may influence changes in child mental health via a number of
mechanisms. Parental worry/stress may lead to child distress via ‘social referencing’, whereby
children ‘read’ the fear and concerns of their parents to gauge threat or danger (Masten &
Narayan, 2012). Parents’ stress may affect their ability to provide adequate care (Masten &
Narayan, 2012) during a time when children most need it (Salmon & Bryant, 2002). Further,
Attachment Theory (Bowlby, 1988) suggests that parents’ stress may reduce their children’s
feelings of emotional connectedness and security, resulting in children feeling unsafe, insecure,
and distressed.
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Parental depressive and anxiety symptoms were also associated with increases in children’s
problems, and specifically their internalizing problems. Although links between parental
depression and anxiety, and similar symptoms in children, could arise from inherited factors, or
shared adversity, it is possible that the association may be explained in part by environmental
factors (Lewis, Rice, Harold, Collishaw, & Thapar, 2011). In addition to the above-discussed
social referencing and attachment mechanisms, it is possible that parents’ symptoms may have a
negative impact on interactions within the family and with their children (Foster, Garber, &
Durlak, 2008), resulting in elevations in children’s own internalizing symptoms.
Our findings of links between parenting behaviors and child COVID-19 pandemic-related
increases in mental health problems are consistent with prior work showing that increased
parental hostility and lower parental warmth are associated with increases in children’s mental
health problems following disasters and traumatic events (Cobham et al., 2016; Wilson et al.,
2010). Parenting has long been believed to play a crucial ‘scaffolding’ role in the mental health of
children and adolescents (Cassidy, 1994; Field, 1994; Marie B. H. Yap, Allen, & Sheeber, 2007),
with much research linking positive parenting factors (including increased parental
warmth/acceptance) and reduced risk for mental health problems in children and adolescents
(Schwartz et al., 2014; Yap, Pilkington, Ryan, & Jorm, 2014; Yap, Schwartz, Byrne, Simmons, &
Allen, 2010). Conversely, negative parenting behaviors (including parental rejection/criticism)
have been associated with more child mental health problems (Schwartz et al., 2014; Yap et al.,
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2014). Our findings suggest that parenting behaviors may be an important factor to consider in
relation to child mental health during the COVID-19 pandemic.
The theoretical model motivating this work (Conger et al., 2010) suggests that parental perceived
stress impacts child mental health via changes to parent mental health, and in turn changes to
parenting behaviors. Given the cross-sectional nature of the data, we could not directly test this
model, but it is worth noting that associations between parental mental health and parenting
behaviors were weak (Table S3). As such, it may be that parent mental health and parenting
behaviors are independent predictors of child mental health. It may also be that associations
between parenting behaviors and changes in child mental health are likely to reflect the effects of
pre-existing parental behaviors (rather than changes in parenting behaviors caused by parent
stress of mental health problems triggered by the COVID-19 pandemic).
For the most part, there were significant associations between parent/family factors and COVID-
19-related increases in child mental health problems regardless of baseline problems. However,
for certain associations, child mental health problems were exacerbated for those children with
existing elevated problems. This was particularly true for those children and adolescents with
existing emotional problems. This finding is consistent with recent research showing
exacerbation of symptoms during COVID-19 in adults with internalizing disorders (Van Rheenen
et al., 2020). While age and gender did not appear to be particularly relevant moderating factors,
exploratory analyses suggested that other sociodemographic factors are important to consider. In
particular, higher parental hostility and lower parental warmth were associated with child trauma
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symptoms particularly within lower income families. Links between parental hostility, anxiety
and stress, and child trauma symptoms and conduct problems, were more pronounced for single-
parent households. These findings are consistent with the cumulative risk hypothesis, which
asserts that the accumulation of risk factors impacts developmental outcomes, such that the
greater the number of risk factors, the greater the prevalence of mental health problems in
children (Sameroff, 2000). As such, stressors associated with low income relative to family
needs, and single-parent households, when combined with poor parenting practices or parental
mental health problems, may accumulate to increase the likelihood of poor child mental health
outcomes. These findings may be particularly relevant for identifying families, and children and
adolescents in most need of mental health assistance during the COVID-19 pandemic. Also
relevant to informing interventions is that perceived family cohesiveness appeared to have a
buffering effect on child trauma symptoms, such that children of parents reporting high family
cohesion did not experience COVID-19 pandemic-related increase in trauma symptoms. Further
research should investigate resilience factors that may inform intervention efforts.
This study has a number of limitations that should be considered when interpreting results. The
major limitation is that due to the cross-sectional nature of the data, we are unable to infer
directionality of effects or causality. It is possible that child mental health problems may lead to
changes in parenting behavior and parent mental health problems (Stone, Mares, Otten, Engels, &
Janssens, 2016). Longitudinal research, investigating change in both parenting behaviors and
child and parent mental health, is needed to infer directionality and test mechanistic pathways.
Indeed, longitudinal research is needed to capture the enduring and/or emerging nature mental
health effects in children and adolescents. Economic problems, and their knock-on effects on
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parent and child mental health may be recognized mainly after the acute phase of the pandemic.
Long-lasting economic pressure is likely to increase mental health problems of parents, which in
turn will affect longer-lasting changes in parent-child interactions, increasing risk of children’s
mental health problems (Conger et al., 2010; Fegert, Vitiello, Plener, & Clemens, 2020). Second,
some scales were created for the study’s purpose, and as such, validity and reliability are not
established for some measures. Although internal consistency was acceptable for most measures,
it was low for some (particularly family cohesion), so interpretation of results from these
measures should be made with caution. Third, despite efforts to recruit mothers and fathers, our
sample of parents were predominantly mothers. Given evidence for differential impact and
importance of maternal and paternal behaviors for male and female children’s mental health
(Roelofs et al., 2006), further research on this topic is needed. Finally, the parents who
participated in this study had particularly high rates of mental health problems, and as such are
unlikely to be representative of the broader population (Salari et al., 2020; Westrupp et al., 2020).
As a result, findings may not be generalizable.
Despite these limitations, study findings suggest the importance of parent and family factors for
children and adolescent’s mental health during the acute phase of the COVID-19 pandemic.
Results suggest that both COVID-19-specific factors (parental perceived pandemic stress), and
parents’ parenting behaviors and mental health, may be important in influencing children’s
mental health during the COVID-19 pandemic. Further, some parental factors appeared to be
more strongly associated with children’s mental health in the context of low socioeconomic status
and single parent households. Findings have implications for the identification of
children/adolescents who may be most at risk of poor mental health outcomes during the
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COVID-19 pandemic, and may inform parent- or family-based interventions both during the
ongoing COVID-19 pandemic as well as any possible future pandemics or disasters.
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Table 1: Descriptive statistics
Demographic measure
Frequency (or
Mean) Percentage (or Stnd. Dev.)
Country
Australia 133 34.55
U.K. 133 34.55
U.S.A 52 13.51
New Zealand 28 7.27
Other 39 10.13
Age
Parent Age 38 7.15
Child Age 10 3.61
Parent Gender
Female 362 94.03
Male 20 5.19
Non-binary/gender-fluid 1 0.26
Other 1 0.26
Child Gender
Female 252 51.12
Male 239 48.48
Non-binary/gender-fluid 1 0.20
Other 1 0.20
Parent Education
Partial primary school 3 0.78
Completed primary school 3 0.78
Partial high school 20 5.19
Completed high school 37 9.61
TAFE 56 14.55
Partial University 80 20.78
Graduated Bachelor’s degree 53 13.77
Honors degree 29 7.53
Partial graduate school 21 5.45
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Completed graduate school 81 21.04
Another parent in the home
No 89 23.11
Yes 295 76.62
Household income
< AU$36,400 per year 22 5.71
Up to AU$52,000 per year 39 10.13
Up to AU$90,000 per year 64 16.62
Up to AU$140,000 per year) 49 12.73
> AU$140,000 per year 75 19.48
Prefer not to say 72 18.70
Measures N Mean SD Minimum Maximum
DASS
Depression 385 6.19 4.64 0.00 21.00
Anxiety 385 4.40 4.23 0.00 21.00
Stress 385 8.44 4.36 0.00 21.00
FES Cohesion 384 5.62 1.75 1.00 8.00
PARQ
Hostile 428 8.15 2.51 6.00 20.00
Warmth 428 9.49 2.17 8.00 23.00
SDQ (baseline)
Emotional problems 480 3.49 2.67 0.00 10.00
Hyperactivity 480 4.91 2.80 0.00 10.00
Conduct 481 2.20 2.04 0.00 10.00
Trauma symptoms 474 3.19 3.10 0.00 14.13
Pandemic stress 493 3.03 1.16 0.00 5.00
Positive outlook 493 2.27 1.18 0.00 5.00
DASS Depression Anxiety Stress Scale, FES Family Environment Scale, PARQ Parental
Acceptance Rejection Questionnaire, SDQ Strengths & Difficulties Questionnaire.
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Table 2. Main effects and interactions for significant models
Independent variable
Main effect Interaction with baseline
problems (aor child age)
Dependent variable Estimate SE P Estimate SE P
COVID-19 pandemic stress
Change in SDQ emotional problems 0.01 0.00 0.002
Change in SDQ inattention-hyperactivity 0.05 0.01 <0.001
Change in SDQ conduct problems 0.03 0.01 0.014
Trauma symptoms since COVID-19 0.13 0.02 <0.001
DASS depressive symptoms
Trauma symptoms since COVID-19 0.17 0.03 <0.001
DASS anxiety symptoms
Change in SDQ emotional problems 0.11 0.03 <0.001
Trauma symptoms since COVID-19 0.18 0.04 <0.001
DASS stress symptoms
Change in SDQ emotional problems 0.02 0.01 0.012
Change in SDQ inattention-hyperactivity a-0.01 0.00 0.006
Change in SDQ conduct problems 0.02 0.01 0.004
Trauma symptoms since COVID-19 0.19 0.03 <0.001
Parental hostility
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Change in SDQ inattention-hyperactivity 0.07 0.03 0.027
Change in SDQ conduct problems 0.04 0.01 0.001
Trauma symptoms since COVID-19 0.39 0.06 <0.001
Parental warmth
Trauma symptoms since COVID-19 0.33 0.06 <0.001
Family cohesion
Trauma symptoms since COVID-19 -0.38 0.09 <0.001
a Stascs are for DASS stress symptoms * age
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Figure Legends
Figure 1. Change in conduct (C), emotional (E), and inattention-hyperactivity (H) problems since
COVID-19. Changes for individual items displayed for illustration purposes only. SDQ Strengths
& Difficulties Questionnaire.
Figure 2. Significant associations between perceived parental COVID pandemic stress and child
(A) inattention-hyperactivity problems, (B) conduct problems, (C) trauma symptoms, and (D)
emotional problems. Change score > 0 indicates increase in problems since COVID-19.
Figure 3. Significant associations between parental (A) DASS depressive symptoms and child
trauma symptoms, (B) DASS anxiety symptoms and child emotional problems, DASS stress
symptoms and (C) trauma symptoms, (D) conduct problems (dependent on baseline problems and
single parent status), (E) emotional problems (dependent on baseline problems), and (F)
inattention-hyperactivity problems (dependent on child age). Change score > 0 indicates increase
in problems since the COVID-19 pandemic.
Figure 4. Significant associations between parental hostility and child (A) inattention-
hyperactivity problems, (B) conduct problems (dependent on baseline problems), and (C) trauma
symptoms (dependent on income-to-needs). Associations between (D) family cohesion and child
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trauma symptoms, and between (E) parental warmth and child trauma symptoms (dependent on
income-to-needs). Change score > 0 indicates increase in problems since the COVID-19
pandemic.
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Figure 1
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AB
C D
Figure 2
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AB
C
E F
D
Figure 3
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A B C
DE
Figure 4
