Cumulative risk and developmental health: an argument for the importance of a family-wide science

Youth mental health in a Canadian community sample during COVID-19: Exploring the role of perceived sense of belonging

Research has linked broad societal changes related to the COVID-19 pandemic and poorer mental health in young people. There remains a pressing need for studies examining the factors that are associated with better mental health and well-being. The current study addresses this gap using a community-based survey called the Waterloo Region Youth Impact Survey. It was designed in partnership with local youth and the Canadian Index of Well-Being in accordance with United Nations International Children's Emergency Fund guidelines. Using a convenience sampling methodology, this survey was developed to explore the domains, rates, and correlates of well-being and mental health among youth during the pandemic (N = 297). Confirmatory factor analysis was used to identify dimensions related to children's social environment (friends, school, family), sense of belonging, mental health, and well-being. Subsequently, a mediation model was tested. The relationship between children's environments and mental health and well-being operated via perceived sense of belonging. Findings shed light on patterns of youth mental health and well-being during the pandemic, illustrating the role of belonging as a promotive factor with public health relevance.

A case study of virtually delivered emotion-focused family therapy

Clinical psychologists and therapists are increasingly taking advantage of internet and mobile-based technologies to deliver mental health services for individuals and groups since the COVID-19 pandemic. However, there is a dearth of research evaluating the appropriateness of virtual platforms for family interventions. Further, no research has examined the effectiveness of weekly emotion-focused family therapy (EFFT). This case study presents a virtually delivered 8-week EFFT intervention, which supported caregivers to manage child symptoms of depression, anxiety, and anger, facilitate emotion processing, and strengthen relationships. Two parents from one family during a marital separation participated and completed brief measures of therapeutic alliance, family functioning, parental self-efficacy, and parental and child psychological distress at 12 time points as well as a posttreatment semistructured interview. A strong therapeutic alliance was formed, and general family functioning, parental self-efficacy, parent psychopathology, and child depression, anger, and anxiety symptoms improved over the course of therapy.

Parenting and pandemic pressures: Examining nuances in parent, child, and family well-being concerns during COVID-19 in a Canadian sample

Introduction

The COVID-19 pandemic has caused vast disruptions in family life for Canadian parents since early 2020. While numerous environmental stressors have been identified, including job loss and the demands of balancing work-life conflicts and at-home schooling, relatively less is known about the areas of family life parents are most concerned about and how these worries relate to well-being across the family system.

Methods

Canadian parents (n = 29,831, 90.29% mothers, 57.40% Ontario residents) of children aged 0-14 were surveyed about their concerns related to child, parent, and family well-being in June 2020. Structural equation modelling was used to model the relationship between concerns about children, parenting, and the whole family, in association with several sociodemographic variables including child disability status, parent sex and education, job loss during COVID-19, and caregiver employment.

Results

Parenting, child, and family concerns were positively correlated. Higher child and family concerns were reported by parents who had not attended university, those who had experienced employment loss or reduced hours, and families with all adults working outside the home. Parents of children with a disability reported higher concerns across all three domains: child, parenting, and family psychosocial well-being.

Discussion

These results showcase distinct associations between social determinants of health and the types of worries caregivers exhibited across multiple areas of family life during the first wave of the COVID-19 pandemic in Canada. Findings are interpreted in relation to clinical intervention and public policy targets for families.

Family Functioning and Health-Related Quality of Life in Parents of Children with Mental Illness

Previous research suggests that family dysfunction may be related to lower health-related quality of life (HRQoL) in parent caregivers, but it is unknown if this association exists in the context of child mental illness. Therefore, the objectives of this study were to compare HRQoL between parent caregivers and Canadian population norms using the Short Form 36 Health Survey (SF-36); examine associations between family functioning and parental HRQoL; and investigate whether child and parental factors moderate associations between family functioning and parental HRQoL. Cross-sectional data were collected from children receiving mental healthcare at a pediatric hospital and their parents (n = 97). Sample mean SF-36 scores were compared to Canadian population norms using t-tests and effect sizes were calculated. Multiple regression was used to evaluate associations between family functioning and parental physical and mental HRQoL, adjusting for sociodemographic and clinical covariates. Proposed moderators, including child age, sex, and externalizing disorder, and parental psychological distress, were tested as product-term interactions. Parents had significantly lower physical and mental HRQoL versus Canadian norms in most domains of the SF-36, and in the physical and mental component summary scores. Family functioning was not associated with parental physical HRQoL. However, lower family functioning predicted lower parental mental HRQoL. Tested variables did not moderate associations between family functioning and parental HRQoL. These findings support the uptake of approaches that strive for collaboration among healthcare providers, children, and their families (i.e., family-centered care) in child psychiatry settings. Future research should explore possible mediators and moderators of these associations.

Relationship Quality and Mental Health Implications for Adolescents during the COVID-19 Pandemic: a Longitudinal Study

Although parent-adolescent and peer-adolescent relationship quality are critical for adolescent wellbeing during typical stressful life events, the unique features of the COVID-19 pandemic put into question whether strong parent-adolescent and peer-adolescent relationship quality functioned as protective factors of adolescent mental health in this context. The current longitudinal study examined a community sample of adolescents across 3 time points, each 6 months apart (Time 1: Fall, 2019; n = 163, 50.9% male; mean age = 15.75 years, SD = 1.02). Results showed that increases in depression symptoms, perceived stress, and emotion dysregulation from Fall 2019 to Fall 2020 were predicted by changes in parent, but not peer relationship quality. The current study demonstrates that adolescent-parent relationship quality may be protective against mental health difficulties during the COVID-19 pandemic, while adolescent-peer relationship quality may not. Identifying protective factors that may play a role in mitigating the impact of the pandemic, and other such widespread health crises, on youth mental health is critical in reducing the long-term psychological harm of the viral outbreak, as well as promoting adolescent wellbeing and resilience.

How are families in Germany doing in 2022? Study protocol of a nationally representative, cross-sectional study of parents with children aged 0-3 years

BACKGROUND

In order for Early Childhood Intervention (ECI) to be effective, data-based information on families' resources, burden and current use of support services for families with young children, as well as on children's health and development is needed. The study Kinder in Deutschland [Children in Germany]-KiD 0-3 2022 aims at providing these data to help us understand families' situation and needs in Germany now, including families' experience of the COVID-19 pandemic.

METHOD

The study will recruit up to 300 pediatricians who will invite parents of children aged up to 48 months to participate in the study during a well-child visit. Parents (goal N = 8,000) will complete an online-questionnaire with their own web-enabled device. Pediatricians will complete a short questionnaire about each participating family. The questionnaires cover family psychosocial burden and resources, child health and development, use of family support services, as well as the families' experiences of the COVID-19 pandemic. Data will be analyzed to assess patterns of families´ psychosocial burdens and resources, use of support services for families with young children, and children´s health and development. Concordance between parent and pediatrician report will be assessed and comparisons with the predecessor study of 2015 will be drawn.

DISSEMINATION

Findings will be disseminated through scientific conferences, open access peer-reviewed journals, and dissemination channels of the National Centre for Early Prevention.

DISCUSSION

The present study will provide parent and pediatrician reports on how families with young children are doing in Germany. These data will be used to inform Germany's early childhood intervention (ECI) program ("Frühe Hilfen") on current needs of families with young children.

Patterns and predictors of adolescent life change during the COVID-19 pandemic: a person-centered approach

The present study investigated patterns of adolescent life changes across multiple life domains and utilized a holistic-interactionistic perspective to examine their individual, familial, and societal correlates with a sample of 2544 Chinese parent-adolescent dyads. Adolescents were aged from 10 to 19 years old (50.16% girls). Latent profile analysis revealed five life change profiles, including three improved profiles at various degrees, one unchanged profile, and one worsened profile. The majority of adolescents had an improved or unchanged life. Multinomial logistic regression analyses found that most of the individual, familial, and societal factors predicted the group memberships. Notably, parent-adolescent conflict was a significant factor that predicted memberships of all patterns. These findings show the resilience of adolescents and indicate the need for policies and interventions that consider the holistic nature of adolescents' person-context system, especially during a global crisis such as the COVID-19 pandemic.

Evaluation of COVID-19-related psychological distress in parents of children referring to a child and adolescent psychiatry outpatient clinic: a university hospital sample

AIMS

We aimed to determine parents' levels of anxiety and fear and suspicion in relation to the COVID-19 period and the possible predictive factors for these variables in families admitted to a child and adolescent psychiatry outpatient clinic of a university hospital in Turkey. In this way, it is hoped to contribute to the identification of priority target groups in psychosocial support services.

METHOD

The research study group consisted of 600 patients aged 0-18 years and their parents who were referred to a child and adolescent psychiatry outpatient clinic of a university hospital. Parents completed the COVID-19-related psychological distress (CORPD) scale and the data recording form developed specifically for this study. All cases included in the study were examined by a child and adolescent psychiatrist for diagnostic evaluation and their current diagnoses were recorded.

RESULTS

Parents of children with any psychiatric diagnosis had higher suspicion scores on the CORPD scale and parents of children with high COVID-19-related anxiety also had higher anxiety and fear scores on the same scale. Logistic regression analysis revealed that negative changes in family relationships increased the risk of higher maternal COVID-19-related suspicion.

CONCLUSIONS

The most important factors associated with parental high CORPD levels were negative changes in family relationships and children with high COVID-19-related anxiety. Children's high COVID-19-related anxiety levels were associated with living with a single parent or separation from parents, negative changes in family relationships, previous COVID-19 infection in the family, and changes in daily routines.

Effects of Socioeconomic Status, Parental Stress, and Family Support on Children's Physical and Emotional Health During the COVID-19 Pandemic

In the current study, we conduct an exploratory study on children's emotional and physical health in response to the COVID-19 pandemic. The direct and interactive effects of parental stress, family socioeconomic status (SES), and family support on child adjustment were investigated. A total of 116 children of varied socioeconomic and their parents were interviewed. Parents with low household income perceived greater distress related to uncertainty and health worries compared to those with higher household income. However, it was among high-SES families that parental distress was associated with child difficulties. At a multivariate level, children's health was associated with SES, family support, and parental COVID-19 stress. Among families with low household income, when parents perceived low/average COVID-19 stress, family support worked as a protective factor for children's adjustment. Understanding how COVID-19 relates with children's emotional and physical health within families with low and high household income may help to inform recommendations for best practices, for example through family support interventions.

Rates, perceptions and predictors of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents

Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14–18 years) took part in the ’in isolation instead of in school’ (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.

Supportive Neighborhoods, Family Resilience and Flourishing in Childhood and Adolescence

Flourishing is linked with health and well-being in childhood and adulthood. This study applied a promotive factors model to examine how neighborhood assets might benefit child and adolescent flourishing by promoting family resilience. Using data from the combined 2018 and 2019 National Survey of Children’s Health, structural equation models tested direct and indirect relationships between neighborhood physical environment, neighborhood social cohesion, family resilience, and flourishing among 18,396 children and 24,817 adolescents. After controlling for multiple covariates that may influence flourishing, the models supported that higher levels of neighborhood social cohesion were directly associated with higher levels of flourishing adolescents, and indirectly by positive associations with family resilience for both children and adolescents. No indirect effects between neighborhood physical environments and flourishing were supported by the data for either children or adolescents. However, neighborhood physical environments were positively associated with adolescent flourishing. Understanding social environmental factors that strengthen and enhance child and adolescent flourishing are critical toward designing prevention, intervention, and policy efforts that can build on the existing strengths of families and their communities.

Juggling School and Work From Home: Results From a Survey on German Families With School-Aged Children During the Early COVID-19 Lockdown

As consequence to the coronavirus outbreak, governments around the world imposed drastic mitigation measures such as nationwide lockdowns. These measures included the closures of schools, hence, putting parents into the position of juggling school and work from home. In the present study, we investigated the well-being of parents with school-aged children and its connection to mitigation measures with particular focus on parental roles “caregiver,” “worker,” and “assistant teacher” as stressors. In addition to direct effects, we expected indirect effects on well-being through changes in household dynamics. Data were collected via an online survey (N = 1313, 85.5% female; 53.2% university degree) conducted during the first wave of school closures in Germany. We observed that during the early COVID-19 pandemic, parental well-being in general was quite positive. Comparing the positive and negative PANAS subscales, parents agreed significantly more with the positive than with the negative items, t(1299) = 28.55, p < 0.001. Parents also reported an increase in positive family activities during the lockdown, t(1272) = 43.96, p < 0.001. Although a significant increase in negative household dynamics, such as disputes, was also observed to a lower extent, t(1295) = 7.78, p < 0.001. Using structural equation modeling, we observed that “homeoffice” was not significantly related to parents’ well-being, but positively affected household dynamics. Taking on the role of “assistant teacher” was negatively related to household dynamics. Additionally, we found a significant direct effect on negative affect for “assistant teacher.” We conclude that parents of school-aged children have mostly been able to establish positive dynamics in their households during the lockdown given the extra time they got to spend with their children by working from home. However, our results identify the role of “assistant teacher” as a potential stressor for parents. Bridging the gap between teachers and parents seems warranted especially if (some) distance-learning continues, in order to avoid long-term consequences for the students.

Screen Time as a Mechanism Through Which Cumulative Risk is Related to Child Socioemotional and Developmental Outcomes in Early Childhood

Socio-demographic risks are associated with higher child screen time and higher screen time is associated with poor socioemotional and developmental health. Existing studies have not examined children's screen time as a mechanism through which distal risks may be associated with child outcomes. In the current study, we examined whether two proximal factors, screen time and parenting quality, mediate the relation between distal cumulative risk and child outcomes. Participants (N = 1992) were drawn from a birth cohort of mothers and their children (81% white; 46% female). Mothers reported on cumulative risk factors (maternal income, education, depression, stress, marital status, housing instability, unemployment, and maternal history of childhood adversity) during the prenatal period. Parenting quality (ineffective/hostile, positive interactions) and children's screen time (hours/week) were assessed when children were three years of age. Child socioemotional (internalizing and externalizing problems) and developmental (achievement of developmental milestones) outcomes were measured at five years of age. Path analysis revealed indirect effects from cumulative risk to internalizing symptoms and achievement of developmental milestones via screen time. Indirect effects were observed from cumulative risk to internalizing and externalizing behavior via hostile parenting behavior. Over and above the effects of parenting, screen time may be a factor that links structural forms of social disadvantage during the prenatal period to child socioemotional and developmental outcomes. Due to modest effect sizes of screen time, it remains the case that child socioemotional and developmental health should be conceptualized within the context of distal cumulative risk factors such as caregiver psychological and material resources.

The impact of school closure and social isolation on children in vulnerable families during COVID-19: a focus on children's reactions

For children the consequences of the COVID-19 public health measures may have long-term effects into adulthood. By exploring children's reactions more broadly, we are better placed to understanding the breadth of implications of home school and social isolation under COVID-19. The present study explored how COVID-19 related variables, namely, home school experience, child perceived family stress and instability, screen time use, missing friends and worry about virus infection are associated with children's emotional, somatic/cognitive and worry reactions, respectively. A total of 442 children (M = 11.43 years, SD = 2.59) from the longitudinal FamilieForSK-study participated and a series of hierarchical linear regression models were applied controlling for background variables including children's psychological vulnerability. Results showed significant associations between all COVID-19 related predictors, except screen time use, and the three outcomes. Family stress and instability had the strongest effects with standardised betas ranging from .356 to .555 and collectively, predictors explained between 20.7 and 44.1% of variance in outcomes. Furthermore, several associations were moderated by age and older children were more negatively impacted (i.e., higher level of reported reactions). The present study provides more conclusive evidence of the effects of home school and social isolation under COVID-19 on children. It also exemplifies the importance of focusing on children's reactions more broadly, as there was evidence that children on average had fewer emotional reactions compared to before the pandemic.

Divided When Crisis Comes: How Perceived Self-Partner Disagreements over COVID-19 Prevention Measures Relate to Employee Work Outcomes at Home

As a response to the COVID-19 pandemic, our societies went into a lockdown model and many organizations required or permitted their employees to work from home. As a result, employees need to deal with the COVID-19 pandemic while they work from home, providing an opportunity to examine how COVID-19 prevention experiences influence those who are working from home. Based on the interpersonal self-regulation perspective, we propose that employees who perceive having more disagreements with their partners over COVID-19 prevention measures are more likely to experience a reduction in their identification with the partner which is subsequently associated with their negative work outcomes through emotional exhaustion. Results from a two-wave survey study with a sample of 282 employees who worked from home during the COVID-19 pandemic supported our predictions: perceived self-partner disagreements over COVID-19 prevention measures related to a reduction in identification with the partner, which was subsequently associated with exhausted regulatory resources and undermined work outcomes. Furthermore, these negative effects were particularly salient for individuals who were not married. Theoretical and practical implications for family-to-work interference and working from home in times of crisis are discussed.

COPEWithME: The Role of Parental Ability to Support and Promote Child Resilient Behaviors During the COVID-19 Emergency

The COVID-19 pandemic has led to lockdown in many countries and Italy was the first one interested in Europe. The lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, but it is very demanding for the population involved and especially for children and their families. The aims of the present study are: (a) to explore the psychometric properties of the COPEWithME questionnaire, a new tool to evaluate parents' ability to support and promote child resilient behaviors, (b) to investigate the relation between parents' resilience and their ability to support and promote child resilient behaviors with child resilience and child stress-related behaviors assessed during the COVID-19 outbreak. Participants (N = 158 mothers, with 6- to 11-years-old children, 53% female), who were volunteers and anonymous, filled out an online questionnaire composed by CD-RISC 25, PMK-CYRM-R, and COPEWithME. With regard to the COPEWithME, validation exploratory factor analyses revealed a one-factor solution of 18 items. The COPEWithME positively correlates both with mothers' resilience and with children's resilience. Mediation analysis showed that the association between mothers' resilience and children's stress-related behaviors was mediated by the mothers' ability to support and promote child resilient behaviors. The COPEWithME, to our knowledge, is the first measure of parents' ability to support and promote resilient behaviors in school-age children, a key parenting skill that may help children in dealing with stressful situations such as the COVID-19 outbreak. These findings represent useful insights to advance mental health interventions in the post-pandemic phases suggesting focusing on a family's resources and resilience processes.

Growing Up Under COVID-19: Young People's Agency in Family Dynamics

The COVID-19 pandemic transformed the nature of family life in countries across the world. School, and workplace closures meant that families spent more time at home and had to confront new economic, social, and psychological challenges as a result of lockdowns and the greater proximity of family members. Policy, research and media coverage of the pandemic's impact on family life has focused primarily on the economic costs borne by households. This article draws on the findings from an empirical research project funded by the UK Nuffield Foundation on "Politics, Participation and Pandemics: Growing up under COVID-19", which worked with young people as co-researchers, to present an innovative perspective on the impact of lockdown on family relationships. The research team adopted a longitudinal ethnographic action research approach to document and make sense of the experiences of young people (aged 14-18) in four countries: Italy, Lebanon Singapore and the United Kingdom. The project used digital ethnography and participatory methods to track the responses of 70 young people to the challenges created by the pandemic. The study used the family as a prism for understanding how the lives of children and young people in different family circumstances and relationships were affected by the crisis. This article analyses, firstly, the complex shifting dynamics within households to identify the transformative effects of the pandemic on family life in various socio-cultural contexts. Secondly, it examines how young people's agency shaped family dynamics. In conclusion, the authors recommend how the findings from the study can be used to inform government interventions designed to minimise the impacts of the pandemic on the social well-being and rights of children and young people, and to recognise them as active participants in family and civic life both during and after the pandemic.

The Impact of COVID-19 on Adolescents' Daily Lives: The Role of Parent-Child Relationship Quality

COVID-19 lockdown measures have profoundly impacted adolescent' daily life, with research suggesting an increase in irritability, stress, loneliness, and family conflict. A potential protective factor is parent-child relationship quality; however, no studies have investigated this. We used data from SIGMA, a longitudinal, experience sampling cohort study, in which N = 173 adolescents aged 11 to 20 were tested before and during COVID-19. Multilevel analyses showed decreased daily-life irritability and increased loneliness from pre- to mid-pandemic. Daily-life stress levels were unchanged. Relationship quality was negatively associated with irritability and loneliness and buffered against the increase in loneliness. Effect sizes were small and do not support a strong effect of the first lockdown on irritability, stress, loneliness, and family conflict in adolescents.

Cumulative Social Risk and Child Screen Use: The Role of Child Temperament

OBJECTIVES

It is critical to understand what children, and in which context, are at risk for high levels of screen use. This study examines whether child temperament interacts with cumulative social risk to predict young children's screen use and if the results are consistent with differential susceptibility or diathesis-stress models.

METHODS

Data from 1,992 families in Calgary, Alberta (81% White; 47% female; 94% >$40,000 income) from the All Our Families cohort were included. Mothers reported on cumulative social risk (e.g., low income and education, maternal depression) at <25 weeks of gestation, child's temperament at 36 months of age (surgency/extraversion, negative affectivity, effortful control), and child's screen use (hours/day) at 60 months of age. Along with socio-demographic factors, baseline levels of screen use were included as covariates.

RESULTS

Children high in surgency (i.e., high-intensity pleasure, impulsivity) had greater screen use than children low in surgency as social risk exposure increased. In line with differential susceptibility, children high in surgency also had less screen use than children low in surgency in contexts of low social risk. Children with heightened negative affectivity (i.e., frequent expressions of fear/frustration) had greater screen use as social risk increased, supporting a diathesis-stress model.

CONCLUSIONS

Young children predisposed to high-intensity pleasure seeking and negative affectivity in environments characterized as high in social risk may be prone to greater durations of screen use. Findings suggest that an understanding of social risks and individual characteristics of the child should be considered when promoting healthy digital health habits.

"Is it us or is it me?": Family experiences of connectedness following a reflecting team intervention

The present study examined family-wide versus individual perceptions of, and changes in, family connectedness in response to a one-time reflecting team (RT) intervention. Seventy-six families (N = 208 individuals), recruited during family therapy, completed family connectedness measures before and after the RT intervention. A subset of adults (n = 26) completed 1-week follow-up measures. Three-level (family, individual, time) multilevel models were used to partition sources of variance in connectedness while permitting different fixed and random effects for adults and minors. Results indicate that family connectedness is a characteristic of whole-families (34% of the variance), individuals (43%), and change over time (23%), including measurement error. Additionally, participants reported higher family connectedness after the RT. This study demonstrates the importance of considering family connectedness as a multilevel relationship construct that potentially changes in response to RT.

Longitudinal Relations Between Parental Strain, Parent-Child Relationship Quality, and Child Well-Being During the Unfolding COVID-19 Pandemic

As COVID-19 sweeps across the globe, scientists have identified children and families as possibly particularily vulnerable populations. The present study employed a developmental framework with two measurement points (the first at the peak of the lockdown restrictions (N = 2,921), the second after restrictions had been majorly loosened (N = 890)) to provide unique insights into the relations between parental strain, child well-being, and child problem behavior. Cross-lagged panel analyses revealed longitudinal effects of child well-being and problem behavior at T1 on parental strain at T2 with parent-child relationship quality as a moderator. True intraindividual change models showed that decreases in parental strain between measurement points predicted increases in child well-being and decreases in child problem behavior. Thus, the present research points to parental stress coping and child emotional adjustment as promising avenues for professionals and policy makers in their efforts to ensure child and family well-being throughout the pandemic.