Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs.
Mixed methods were applied to data collected between April 14th - 28th, 2020 from the “Parenting During the Pandemic” survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5–8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions.
Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time.
Lower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent- child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response.
Citation: Roos LE, Salisbury M, Penner-Goeke L, Cameron EE, Protudjer JLP, Giuliano R, et al. (2021) Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic. PLoS ONE 16(5): e0251720. https://doi.org/10.1371/journal.pone.0251720
Editor: Kyoung-Sae Na, Gachon University Gil Medical Center, REPUBLIC OF KOREA
Received: September 21, 2020; Accepted: May 1, 2021; Published: May 24, 2021
Copyright: © 2021 Roos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: De-identified data relevant to this manuscript is available here:https://osf.io/yw8gr/.
Funding: Initials of funded authors: LR; RG; JP; MS; LPG; KR Grants: 1) Research Manitoba - 2020 Manitoba COVID-19 Rapid Response 2) CHRIM - MG2020-3 - Match for project titled “The PACT Program: Parenting Apart while Coming Together Research Grant Funders Name: 1) The Children’s Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB 2) Research Manitoba, Winnipeg, MB URL of Funders Website: https://researchmanitoba.ca/ https://www.chrim.ca/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
The COVID-19 pandemic has resulted in closures of daycares, schools, and recreational facilities across the world, affecting an estimated 1.38 billion children [1, 2]. Families are coping with numerous challenges including unmet childcare needs, crisis schooling, low resource access, and financial strain [3–5]. In such conditions, supportive parenting relationships are critical for preventing the effects of stress from affecting children’s neurobiological and socioemotional development . Exposure to early life stressors, including poverty, family conflict, and parent mental illness, can impair health across the lifespan . Stress-exposed children are more likely to experience developmental delays, asthma, diabetes, obesity, mental illness, and hospitalization [8, 9]. Stress-linked social determinants of health compound impacts through increased health-risk behaviours . These risks persist throughout life, contributing as much as a 4-fold increase in risk for physical and mental health conditions .
Notably, not all children exposed to early life stress go on to experience significant health risks. Supportive caregiving relationships are consistently identified as powerful protective factors for promoting resiliency to stress [12, 13]. Developmental origins of chronic disease research highlights both the protective neurobiological signaling and relational processes that underlie the significance of supportive parenting to promoting child resilience. At the neurobiological level, responsive caregiving to young children’s distress supports physiological regulation and programs neurocircuitry underlying normative emotional development . From a social-learning perspective, parents model stress-management and encourage different coping strategies over time. These strategies can include directly teaching young children how to handle strong emotions or responding in ways that increase or decrease different child attempts at coping over time, such as withdrawal or aggression.
Although the full scope of adversities experienced by children due to COVID-19 will be difficult to determine for many years, understanding the factors associated with low parenting quality during the current time is critical. Here, we provide observational mixed-methods data on sociodemographic- and pandemic-linked household stressors associated with parenting quality for 1.5- to 8-year-old children. We incorporate qualitative data on first-person parent perspectives to understand the unmet needs of caregivers during these unprecedented global events. The goal of this work is to inform next steps in identifying the specific strengths and needs of families during the pandemic and its aftermath to protect children from negative health consequences of pandemic-linked stress.
Indices of parenting quality
Positive parenting strategies include multiple dimensions of parenting linked to healthy child development including supportive parenting, setting limits, and proactive parenting . Positive parenting involves a variety of behaviours, such as using praise, engaging in joint-play, setting effective routines, and showing warmth, which increase prosocial child behaviours . Positive parenting decreases children’s behavioural problems  and buffers children against the effects of chronic stressors, such as poverty and peer rejection [17, 18]. Negative parenting strategies include over-reactivity, a tendency to respond to children’s difficult behaviour with harshness and anger, and laxness, a tendency to ignore or not follow through with discipline for problematic behaviour . Over-reactivity and laxness have been associated with young children’s emerging mental health problems and are linked to stressors, such as economic strain [20, 21].
Parent stress includes distress related to the caregiving role as well as qualities of the parent-child relationship and perceptions of child difficulties . High parenting stress has wide ranging consequences for child health, including increased risk of child abuse , obesity  and externalizing behavioural problems . Greater parenting stress is also associated with more dysfunctional parent-child interactions including lower parenting sensitivity and higher prevalence of dysfunctional attachment styles [26, 27]. Within the neuroscience literature, research indicates increased stress may be associated with decreases in brain synchrony between mothers and their children .
Pandemic- and sociodemographic-linked parenting risks.
Emerging data indicate multiple concerning pandemic-linked factors expected to limit parent capacities to provide high-quality caregiving, including job loss, food insecurity, domestic conflict, and parent psychological distress. In Canada and the United States, unemployment rates have increased 3- to 6-fold, with the global recession expected to contribute to ongoing financial insecurity. These economic stressors will compound existing inequities, with job losses most pronounced in low salary positions . Such economic adversity has been associated with poor child health outcomes, which are consequently exacerbated by negative parent-child relationships and harsh parenting . Food insecurity is expected to increase significantly due to economic strain, with vulnerable populations most affected . Increased marital conflict and divorce has been reported following shelter-in-place restrictions in China, and increased domestic violence reports in North America [32, 33]. Data from our group and others indicate dramatic increases in parent psychological distress with 30–48% of mothers of young children reporting depression above clinical thresholds . Each of these factors, alone and in combination, has been linked to lower parenting quality (e.g., low responsivity, increased harsh parenting, decreased positive parenting, disengaged parenting) and the emergence of child health and development impairments [35–42].
The present study
The present study provides the first COVID-19 pandemic data on sociodemographic- and pandemic-linked risk factors associated with parenting quality. With an estimated one-third of the world’s population under mandated lockdowns , understanding factors that impact a family’s capacity to provide supportive caregiving is critical. This knowledge will allow for targeted intervention development to prevent long-term child health and developmental consequences in the aftermath of the pandemic. These data are provided to bring attention to this understudied and, as of yet, underfunded area of health investment need and may help identify which families are in most need of support to limit the negative health impacts of COVID-19.
Some of these risks may be most acute when families are isolated, and children do not have access to high quality daycare or school environments. However, other risks are expected to continue for months , due to the unpredictable nature of disease resurgence, childcare closures, and economic recession.
Between April 14, 2020 and April 28, 2020, 656 parents volunteered to complete an online survey on “Parenting During the Pandemic.” Individuals were eligible for the present study if they were above the age of 18 years and a caregiver of at least one child between the ages of 1.5–8 years old. This child age range was selected to be distinguished from the postpartum period, where parent-child interactions may differ from those during early childhood . Early childhood is a sensitive period when children are highly reliant on primary caregivers for emotional and behavioural regulation and are most susceptible to environmental influence including the caregiving environment . Moreover, descriptions of the psychometric properties and intended use of many parenting questionnaires begins at 18 months of age, thus the focus of the current study was on parenting during early childhood.
Participants were recruited online through social media platforms. Data collection occurred through the online health-information secure survey using REDCap (Research Electronic Data Capture) data capture tools hosted at the University of Manitoba . Informed consent was obtained online prior to beginning the survey. Parents of multiple children identified their most-challenging child in the 1.5–8 year age range when completing the Parenting Stress Index and Parenting Questionnaire. Remuneration included a draw for one of five $100/CAD e-gift cards.
Stable household risk factors.
Sociodemographic and historical risk factors were examined as possible covariates. These included marital status (married or co-habitating versus single, widowed, or divorced), annual household income, caregiver education, number of children in the home and caregiver history of diagnosed mental illness (anxiety or depressive disorders).
Current stressors related to COVID-19.
All stressors related to COVID-19 were assessed using a questionnaire created for this study. Employment loss was measured as any loss of hours including working reduced hours or being laid off. Financial strain was assessed as level of difficulty managing unexpected expenses. Food insecurity was assessed as any endorsement of insecurity, based on PROOF guidelines (i.e., at least one affirmative response indicating insecurity) .
Revised Dyadic Adjustment Scale (RDAS).
Marital/relationship quality was assessed using the Revised Dyadic Adjustment Scale (RDAS), a 14-item self-report measure which yields subscales on three relationship domains: 1) Consensus, 2) Satisfaction, and 3) Cohesion . The scale has acceptable internal consistency on subscale and total scale measures (α = .81-.90) and reliably distinguishes between distressed and non-distressed couples in both clinical and research settings .
Parental mental health.
Mental health categorization was determined based on participants’ scores on best-practice measures of anxiety [Generalized Anxiety Disorder 7-Item Scale (GAD-7)  or Perinatal Anxiety Screening Scale (PASS) ] and depression [Center for Epidemiologic Studies Depression (CESD) , CESD-Revised (CESD-R) , or the Edinburgh Postnatal Depression Scale (EPDS)  as well as EPDS-Partner ], based on child age and parent gender . Clinical cut-off scores representing clinically significant anxiety and depression symptoms were used for categorization. Internal consistency of all parent mental health measures is high in previous literature (GAD-7: α = .92; PASS: α = .96; CESD: α = .85; CESD-R: α = .92; EPDS: α = .82) [50–54].
Parenting Young Children (PARYC).
Positive parenting strategies were assessed using the Parenting Young Children (PARYC) scale, a 21-item self-report asking parents to rate how often they engaged in specific parenting behaviours over the past month . The PARYC yields subscales on three distinct areas of parenting: 1) Supporting Positive Behavior, 2) Setting Limits, and 3) Proactive Parenting . Internal reliability for each subscale is acceptable (α = .78 - .85) .
The Parenting Scale (PS).
Negative parenting strategies were assessed using the Parenting Scale (PS), a 30-item self-report measure of ineffective discipline strategies . Parents are asked to rate the likelihood of using particular discipline strategies to yield two discipline subscales: Laxness and Over-reactivity . The PS has good internal consistency (α = .63-.84), test-retest reliability (r = .79-.84), and differentiation between clinical and non-clinical groups .
Parenting Stress Index (PSI).
Parenting stress was measured using the Parenting Stress Index-Short Form (PSI-SF) , a 36-item self-report measure of parents’ stress across three domains: 1) Parental Distress, 2) Parent-Child Dysfunctional Interactions, and 3) Difficult Child . The scale has good internal consistency (α = .78 - .91) and test-retest reliability (r = .61-.75) for subscale and total scale measures . Parental distress was excluded from these analyses because it is largely overlapping with parent depression.
Of the total group of participants, N = 551 and N = 540 participants provided text-based responses to the following two questions: “What are the hardest things about parenting right now?” and “What are some of the things you wish you had that could help you with parenting right now?”, respectively. Open-ended text responses were analyzed following thematic analysis, with the use of NVivo qualitative research software to assist with data organization [57, 58]. Thematic analysis followed the following stages: familiarization with data; line-by-line coding; development of larger meaning units for line-by-line codes; development of initial thematic framework-naming and defining themes and sub- themes; and review of thematic framework. Rigor–the quality, transparency, and thoroughness of qualitative analysis–was assured by documenting a detailed audit trail of the coding process and thematic framework development. NVivo hierarchy charts and maps were used to assess the representativeness of themes and sub-themes in the data. To enhance analytic trustworthiness, a second coder reviewed data and provided consensus in the interpretation of the thematic framework.
Bivariate correlations between sociodemographic and household risk variables of interest were examined with parenting variables for inclusion in subsequent inferential analyses. A series of ordinary least squares (OLS) regressions in Mplus were used to predict each parenting variable from household risk factors and COVID-19 stressors (Table 3). We employed full information maximum likelihood estimation in Mplus to include all available data for participants with at least one dependent variable of interest. Post-hoc t-test analyses were used to examine the effect size of parenting differences between groups.
Participants were predominantly mothers (N = 568, 88.2%, Mage = 35.37, SD = 5.49, age range 21–66 years), married or common law, holding a bachelor’s degree, and residing in Canada (N = 570, 87% of total sample). The sample on average had high socioeconomic status; however, many were affected financially by the pandemic, including experiences of job loss, receipt government financial support, and difficulty managing unexpected expenses.34 Demographic information is displayed in Table 1. This study was approved the University of Manitoba’s Research Ethics Board.
Significant correlations were identified with household income, number of children, marital status, history of mental illness, relationship distress, employment loss, unmet childcare needs, and depression with at least one parenting variable (Table 2). Associated parenting variables included subscales on the PSI (i.e., Parent-Child Dysfunctional Interactions, and Difficult Child), The Parenting Scale (i.e., Laxness and Over-reactivity), and the PARYC (i.e., Supporting Positive Behavior, Setting Limits, and Proactive Parenting). Predictors not associated with any parenting variables were excluded from subsequent analyses. OLS regressions resulted in significant predictors of parenting variable for various household risk factors and COVID-19 stressors (Table 3). Across all parenting variables, caregivers with depression status reported riskier parenting, with effects sizes ranging from medium to large (Fig 1). Across all parenting variables, there were no significant differences in household COVID-19 risk factors between responders and non-responders.
The uncontrollable and severe strains on parent capacities were highlighted across thematic domains (Table 4). Parents spoke about challenges in four domains including: Having too much time together; Self-doubt in parenting and teaching abilities; Role accommodation; and Managing COVID-19 psychological distress. Four main themes were evident for parenting unmet needs including: Childcare and additional supports; Resources and activities; More flexibility in work and school expectations; and Help managing psychological distress.
Here we provide emerging evidence for household factors and recent stressors linked to parenting quality during the COVID-19 pandemic. Parental depression status emerged as a strong and consistent predictor of lower-quality parenting (i.e., more stress, fewer positive behaviors, and more negative behaviors) across every indicator examined. Having multiple children in the home, unmet childcare needs, and relationship distress were additional risk factors for low-quality parenting across multiple indicators. Notably, these links remained after accounting for more stable household risk factors, including sociodemographic variables and history of parent mental illness. First-person qualitative accounts about the challenges of maintaining a positive parent-child relationship under pandemic conditions related to the four main themes of: Too much time together; Self-doubt in parenting and teaching abilities; Role accommodation; and Managing COVID-19 psychological distress; further underscore the impacts of COVID-19 to family functioning.
Common symptoms of depression include feelings of worthlessness and lower self- esteem and self-concept. Many participant responses reflected the theme of self-doubt, in their parenting abilities–in their abilities to connect with their children and to stimulate their growth intellectually, physically, emotionally, and socially. The link between quantitative and qualitative findings support a relationship where number of parenting stressors in addition to unmet needs (most lack of notably childcare, resources and activities, lack of flexibility with employment and home-schooling demands, and lack of psychological support) leave parents feeling overwhelmed and in doubt of their ability to manage their competing and challenging demands, thus further worsening depressive symptoms and increasing the impact on family functioning. These results build on recently published research on the impacts of COVID-19 on family well-being, including one study reporting high endorsement of psychological problems in older children in China  and another smaller sample of Italian families reporting higher than expected rates of parent distress . Understanding specific factors linked to parenting quality in the relatively unprecedented context of a modern global pandemic is critical for guiding efforts to mitigate long-term child health and developmental risks.
Exposure to parent depression in early childhood can have a variety of harmful effects on child health and well-being [19, 61, 62]. Notably, however, depression is typically most impactful when it persists, is severe, and can be directly linked to changes in parenting behaviours [63, 64]. Given the recent onset of the pandemic, it is particularly concerning to observe a similar robust connection between parent depression and lower quality parenting in caregivers of young children. We expect that the pandemic context of household isolation is exacerbating the potential for parent depression to co-occur with parent-child relationship disruptions. At the same time, there are clear opportunities to limit intergenerational health risks given the growing body of research that indicates effectively treating both parental depression and parenting needs predicts improvements in child mental and physical health [10, 65]. Monitoring ongoing parent mental health and parenting needs, and intervening where appropriate, should be of high importance for public health efforts to promote child well-being.
One possible course of intervention is within the marital relationship given the possible indirect effects of poor relationship functioning on child development . Marital or co-parent relationship distress is highlighted as a risk factor for a number of low-quality parenting factors, including dysfunctional parent-child interactions and reduced proactive parenting and limit setting. Inter-parental conflict is an established risk factor for the emergence of parent-child relationship disruptions as children observe and consequently learn to mimic emotionally dysregulated interactions between parents . Spill-over effects can also occur in which parent distress leads to a reduced capacity to engage in more effortful high-quality parenting interactions, resulting in more negative parent-child relationships and associated negative health outcomes in children . Similar to depression, we expect the impacts of relationship distress to have outsized effects on parent-child function during this time, given that young children are likely to be exposed to a higher proportion than usual while receiving less/no out-of-home care.
Unmet childcare needs also emerge as predictive of lower-quality parenting including elevated dysfunctional parent-child interactions, perceptions of difficult child temperament, and reductions in supporting positive behavior and setting limits. Having a higher number of children in the home was also associated with greater over-reactive parenting, which is a particular concern because it is a risk factor for harsh parenting and maltreatment . Due to mandatory reporting requirements, more severe forms of discipline were not explored here but should be examined in subsequent research that is better equipped to respond effectively to address identified child safety risks.
Notably, these associations between psychosocial risks and low-quality parenting are emerging in a relatively high SES sample compared to the general public (e.g., 2018 median annual family income in Canada = $87,930 ), as is common for large-scale online recruitment techniques. The fact that these risks emerge with such strength here is concerning, given that the sample is less likely than the general population to experience co-occurring stressors (e.g. poverty) that further impact parents’ capacity to provide the rich responsive caregiving established to promote healthy development . However, we found that the additional stressors of employment loss or financial strain during the pandemic were not significantly associated with parenting in this sample, despite robust reports of parenting risk associated with economic hardship or recession [70, 71]. It is possible that the economic impacts of these factors in our overall high SES samples has less impact on parenting behaviour than would be the case for families with already low SES. In addition, our questionnaire was collected in the first few months of the pandemic in which it’s possible that the longer-term effects of economic hardships were not reflected in parenting behaviors. However, our online survey also allowed for participant anonymity, as providing contact information was optional. Anonymity on self-report measures of highly stigmatized behaviours, including child maltreatment, has been found to lead to greater likelihood of behaviour disclosures . Given the stigma associated with low-quality parenting, our results could have more ecological validity due to survey anonymity. of household and COVID-19 risk factors on parent functioning. Nevertheless, we provide a timely snapshot of proximal pandemic and stress-related factors linked to greater parenting risk. As data were collected across jurisdictions differentially affected by the pandemic regarding illness, economic burden, and lock-down status, the identified risk factors for lower-quality parenting may vary across jurisdictions with different family and community needs.
Our sample also included a majority of female participants (i.e., mothers), consistent with other research from convenience samples, which limits generalizability of findings to other parenting roles . However, emerging research highlights a gender division of childcare and parenting responsibilities that has disproportionately affected mothers during the pandemic . Given that the majority of child-care tasks are often carried by mothers, it is not unexpected to have mothers responding at a disproportionately higher rate because of their primary role in parenting . This gender gap has implications for how parenting quality of mothers and fathers may be differentially impacted by psychosocial and pandemic-related stressors. A final methodological limitation was the use of self-reports of mental health which capture symptom levels, not clinical diagnoses . However, self-report of mental health is widely used in public-health observational research and have been shown to have high sensitivity and specificity for diagnosis [76–78].
Taken together, numerous pandemic-linked risk factors are identified as significant predictors of parenting stress and behaviours. These are the first data examining individual differences in household factors and pandemic-link stressors to parenting quality during COVID- 19, which is a critical step to targeting health services responses at practice and policy levels.
High quality parenting and positive relationships are understood to be critical for helping young children cope with stressors of varying severity. Over the past decade, numerous calls by pediatric leaders, such as the World Health Organization (WHO), highlight the critical nature of providing mental health and parenting support to primary caregivers of young children [10, 19]. In the absence of targeted action to support caregiver mental health, our data suggest that young children may be exposed to lower-quality parenting and disruptions in family relationships during the COVID-19 pandemic, with potential for significant long-term health and developmental risks.
Next steps for policy makers and health systems aiming to protect child health and development include the dissemination of mental health support for parents. In order to address the widespread unmet parent mental health needs during the pandemic, key considerations will be critical including: implementing evidence-based programs that can treat both depressive symptoms and promote supportive parenting, ensuring supports are low cost, considering a variety of online, telephone, or physically distanced service delivery options to accommodate family schedules and comply with physical distancing public health recommendations.
Novel technologies providing digital delivery of psychological services for families are playing a crucial role during the pandemic [79–81], when in-person care has become less accessible. Particularly for families experiencing a range of household and psychosocial risk factors, providing evidenced-based telehealth services is critical for preventing coercive parent-child interactions and potentially more severe outcomes such as child abuse and maltreatment. Current digital parenting interventions hold promise for improving a range of family outcomes including parenting skills, parent and child mental health, and parenting stress [78–81]. Telehealth programs such as Triple P Online  and ezPARENT  are documented to have similar effect sizes to other evidenced-based parenting programs offered in-person  but may be able to maximize service accessibility and address family health needs now.
Unmet childcare and associated stressors are also a prominent need arising from quantitative and qualitative findings. Qualitative responses indicated that parents are experience distress associated with competing and challenging roles in addition to trying to accommodate role-related responsibilities in the face of scare supports. Further investments in safe and low-costs childcare or access to resources and activities are needed to reduce parent distress and the associated child harms that can arise from harsh or unsupportive parenting. As we globally move towards a second wave of COVID19, young children at home are expected to be highly vulnerable. Emerging research has shown substantial drops in reports of child maltreatment during the pandemic, presumably because professionals (e.g., educators, care providers) are spending significantly less in person time with children due to physical distancing mandates . At the same time, longitudinal studies have indicated increased parent-child conflict, abuse risk, and psychological aggression . Greater consideration of parenting stress and mental health in particular is necessary to limit children’s risk at home and prevent significant harm. Increased vigilance by educator, physician, and other professionals in online and in person settings as well as the provision of timely, evidenced-based supports will be crucial for reducing widespread child developmental risks that is linked to elevated levels of parent stress and mental health problems.
This study provides timely evidence for potential household and pandemic-related risk factors that may contribute to increase parental stress and diminished parenting quality during the COVID-19 pandemic. Given ongoing government-mandated restrictions and associated impacts on families that are likely to persist (e.g., unstable childcare and schooling, decreased provision of family resources, financial strain and job insecurity), our findings highlight the importance of prioritizing the needs of families in order to prevent long-term psychological impacts. Even following the pandemic, potential harms to parent-child relationships and chronic stress exposure incurred during lockdowns may have negative long-term developmental consequences for young children. In response to the pandemic, we recommend careful monitoring of child and parent well-being by health care providers and teachers alongside greater access to evidence-based mental health and parenting supports to promote resiliency.
- 1. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19. Published March 12, 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19—12-march-2020. Accessed March 12, 2020.
- 2. Cluver L, Lachman JM, Sherr L, Wessels I, Krug E, Rakotomalala S, et al. Parenting in a time of COVID-19. Lancet. 2020;395(10231):e64. pmid:32220657
- 3. Garbe A., Ogurlu U., Logan N., & Cook P. (2020). COVID-19 and remote learning: Experiences of parents with children during the pandemic. Journal of Qualitative Research, 4(3), 45–54.
- 4. Patrick S., Henkhaus L. E., Zickafoose J. S., Lovell K., Halvorson A., Loch S., et al. (2020). Well-being of parents and children during the COVID-19 pandemic: A national survey. Pediatrics /, 146(4). pmid:32709738
- 5. Ye J., Pediatric mental and behavioral health in the period of quarantine and social distancing with COVID-19. JMIR pediatrics and parenting. 2020;3(2): e19867. pmid:32634105
- 6. Fisher PA, Beauchamp KG, Roos LE, Noll LK, Flannery J, Delker BC. The neurobiology of intervention and prevention in early adversity. Annu Rev Clin Psychol. 2016;12(1):331–357. pmid:26666968
- 7. Shonkoff JP, Garner AS, Siegel BS, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012; 129(1), e232–e246. pmid:22201156
- 8. Espeleta HC, Brett EI, Ridings LE, et al. Childhood adversity and adult health-risk behaviors: Examining the roles of emotion dysregulation and urgency. Child Abuse Negl. 2018; 82:92–101 pmid:29879586
- 9. Oh DL, Jerman P, Silvério Marques S, et al. Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatr. 2018;18(1):83. pmid:29475430
- 10. Shonkoff JP, Fisher PA. Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Dev Psychopathol. 2013;25(4 Pt 2):1635–1653. pmid:24342860
- 11. Hughes K, Bellis MA, Hardcastle KA, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Heal. 2017;2(8):e356–e366. pmid:29253477
- 12. Flouri E., Midouhas E., Joshi H. et al. Emotional and behavioural resilience to multiple risk exposure in early life: the role of parenting. Eur Child Adolesc Psychiatry, 2015; 24, 745–755. pmid:25300919
- 13. Hostinar CE, Sullivan RM, Gunnar MR. Psychobiological mechanisms underlying the social buffering of the hypothalamic-pituitary-adrenocortical axis: a review of animal models and human studies across development. Psychol Bull. 2014;140(1):256–282. pmid:23607429
- 14. Perry NB, Mackler JS, Calkins SD, Keane SP. A transactional analysis of the relation between maternal sensitivity and child vagal regulation. Dev Psychol. 2014;50(3):784–793. pmid:23895168
- 15. Mceachern AD, Dishion TJ, Weaver CM, Shaw DS. Parenting Young Children (PARYC): Validation of a self-report parenting measure. J Child Fam Stud. 2012;21(3):498–511. pmid:22876108
- 16. Gardner F, Ward S, Burton J, Wilson C. The role of mother-child joint play in the early development of children’s conduct problems: A longitudinal observational study. Soc Dev. 2003;12(3):361–378.
- 17. Luby J, Belden A, Botteron K, et al. The effects of poverty on childhood brain development: The mediating effect of caregiving and stressful life events. JAMA Pediatr. 2013;167(12):1135–1142. pmid:24165922
- 18. Zarra-Nezhad M, Moazami-Goodarzi A, Aunola K, Nurmi JE, Kiuru N, Lerkkanen MK. Supportive parenting buffers the effects of low peer acceptance on children’s internalizing problem behaviors. Child Youth Care Forum. 2019;48(6):865–887.
- 19. Arnold DS, O’Leary SG, Wolff LS, Acker MM. The Parenting Scale: A measure of dysfunctional parenting in discipline situations. Psychol Assess. 1993;5(2):137–144.
- 20. Prinzie P, Onghena P, Hellinckx W. Reexamining the parenting scale: Reliability, factor structure, and concurrent validity of a scale for assessing the discipline practices of mothers and fathers of elementary-school-aged children. Eur J Psychol Assess. 2007;23(1):24–31.
- 21. Hutchings J, Gardner F, Bywater T, et al. Parenting intervention in Sure Start services for children at risk of developing conduct disorder: Pragmatic randomised controlled trial. BMJ Br Med J. 2007;334(7595):678. pmid:17350966
- 22. Abidin RR. Parenting Stress Index, Fourth Edition. 1990.
- 23. Haskett M, Ahern L, Ward CS, Allaire J c. Factor structure and validity of the Parenting Stress Index-Short Form. J Clin Adolesc Psychol. 2006;35(2):302–312. pmid:16597226
- 24. Hughes SO, Power TG, Liu Y, Sharp C, Nicklas TA. Parent emotional distress and feeding styles in low-income families. The role of parent depression and parenting stress. Appetite. 2015; 92:337–342. pmid:26050915
- 25. Baker BL, Blacher J, Olsson MB. Preschool children with and without developmental delay: Behaviour problems, parents’ optimism and well-being. J Intellect Disabil Res. 2005;49(8):575–590. pmid:16011551
- 26. Pereira J, Vickers K, Atkinson L, Gonzalez A, Wekerle C, Levitan R. Parenting stress mediates between maternal maltreatment history and maternal sensitivity in a community sample. Child Abus Negl. 2012;36(5):433–437.
- 27. Jarvis PA, Creasey GL. Parental stress, coping, and attachment in families with an 18-month- old infant. Infant Behav Dev. 1991;14(4):383–395.
- 28. Azhari A, Leck WQ, Gabrieli G, et al. Parenting stress undermines mother-child brain-to- brain synchrony: A hyperscanning study. Sci Rep. 2019;9(1):1–9. pmid:30626917
- 29. Canada Statistics. Measuring the labour market is not business as usual for the week of March 15 to 21. https://www150.statcan.gc.ca/n1/daily-quotidien/200409/dq200409a-eng.htm. Accessed April 9, 2020.
- 30. Hagan MJ, Roubinov DS, Adler NE, Boyce WT, Bush NR. Socioeconomic adversity, negativity in the parent child-relationship, and physiological reactivity: An examination of pathways and interactive processes affecting young children’s physical health. Psychosom Med. 2016; 78(9), 998. pmid:27551989
- 31. United Nations. Ensuring Food Security in the Era of COVID-19. 2020. https://www.un.org/sustainabledevelopment/blog/2020/04/ensuring-food-security-covid-19/. Accessed April 28, 2020.
- 32. Prasso S. Divorce rate after coronavirus quarantine in China is warning. Bloomberg Businessweek. https://www.bloomberg.com/news/articles/2020-03-31/divorces-spike-in-china-after-coronavirus-quarantines. Published March 31, 2020. Accessed April 22, 2020.
- 33. Patel R. Minister says COVID-19 is empowering domestic violence abusers as rates rise in parts of Canada. CBC News. https://www.cbc.ca/news/politics/domestic-violence-rates-rising-due-to-covid19-1.5545851. Published April 27, 2020. Accessed April 28, 2020.
- 34. Cameron EE, Joyce K, Delaquis C, Reynolds K, Protudjer J, Roos LE (2020). Maternal psychological distress & mental health services use during the COVID-19 Pandemic. Journal of Affective Disorders, 276, 765–774. pmid:32736186
- 35. Bronte-Tinkew J, Zaslow M, Capps R, Horowitz A, McNamara M. Food insecurity works through depression, parenting, and infant feeding to influence overweight and health in toddlers. J Nutr. 2007;137(9):2160–2165. pmid:17709458
- 36. Coe JL, Davies PT, Hentges RF, Sturge-Apple ML. Understanding the nature of associations between family instability, unsupportive parenting, and children’s externalizing symptoms. Dev Psychopathol. 2019;32(1):257–269.
- 37. Conger RD, Ge X, Elder GH, Lorenz FO, Simons RL. Economic stress, coercive family process, and developmental problems of adolescents. Child Dev. 1994;65(2):541–561.
- 38. Cowan PA, Cowan CP, Pruett MK, Pruett K. Fathers’ and mothers’ attachment styles, couple conflict, parenting quality, and children’s behavior problems: an intervention test of mediation. Attach Hum Dev. 2019;21(5):532–550. pmid:30821614
- 39. Davis RN, Davis MM, Freed GL, Clark SJ. Fathers’ depression related to positive and negative parenting behaviors with 1-year-old children. Pediatrics. 2011;127(4):612–618. pmid:21402627
- 40. Shelton KH, Harold GT. Interparental conflict, negative parenting, and children’s adjustment: Bridging links between parents’ depression and children’s psychological distress. J Fam Psychol. 2008;22(5):712–724. pmid:18855507
- 41. Spieker SJ, Oxford ML, Fleming CB, Lohr MJ. Parental childhood adversity, depressive symptoms, and parenting quality: Effects on toddler self-regulation in Child Welfare Services involved families. Infant Ment Health J. 2018;39(1):5–16. pmid:29266280
- 42. Steinberg LD, Catalano R, Dooley D. Economic antecedents of child abuse and neglect. Child Dev. 1981;52(3):975. pmid:7285664
- 43. Kaplan J, Frias L, McFall-Johnsen M. Countries that are on lockdown because of coronavirus. Business Insider. 2020. https://www.businessinsider.com/countries-on-lockdown-coronavirus-italy-2020-3?r=DE&IR=T. Accessed April 28, 2020.
- 44. Fernandes, N. Economic effects of coronavirus outbreak (COVID-19) on the world economy (March 22, 2020, Preprint) Available at SSRN: http://dx.doi.org/10.2139/ssrn.3557504
- 45. Gutman L. M & Feinstein L. (2010). Parenting behaviours and children’s development from infancy to early childhood: changes, continuities and contributions. Early Child Development and Care., 180(4), 535–556. https://doi.org/10.1080/03004430802113042
- 46. Karreman A., va Tuijek C., van Aken M. A. G., & Deković M. (2006). Parenting and self-regulation in preschoolers: a meta-analysis. Infant and Child Development., 15(6), 561–579. https://doi.org/10.1002/icd.47
- 47. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. pmid:31078660
- 48. PROOF Food Insecurity Policy Research. Household food insecurity in Canada: A guide to measurement and interpretation. 2018:1–13. Available at: https://proof.utoronto.ca/wp-content/uploads/2018/11/Household-Food-Insecurity-in-Canada-A-Guide-to-Measurement-and-Interpretation.pdf. Accessed May 5, 2020
- 49. Busby DM, Christensen C, Crane DR, Larson JH. A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. J Marital Fam Ther. 1995;21(3):289–308
- 50. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing Generalized Anxiety Disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092–1097. pmid:16717171
- 51. Somerville S, Dedman K, Hagan R, et al. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Womens Ment Health. 2014;17(5):443–454. pmid:24699796
- 52. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1(3), 385–401.
- 53. Eaton WW, Smith C, Ybarra M, Muntaner C,Tien A. Center for Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R). 2004.
- 54. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10- item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150(6), 782–786. pmid:3651732
- 55. Moran TE, O’Hara MW. A partner-rating scale of postpartum depression: the Edinburgh Postnatal Depression Scale—Partner (EPDS-P). Arch Womens Ment Health. 2006;9(4):173–180. pmid:16755331
- 56. Rhoades KA, O’Leary SG. Factor structure and validity of The Parenting Scale. J Clin Child Adolesc Psychol. 2007;36(2):137–146. pmid:17484687
- 57. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–1251. pmid:24979285
- 58. International QSR. NVivo Qualitative Data Analysis Software [Software]. 1999. Available from https://qsrinternational.com/nvivo/nvivo-products/
- 59. Liang L, Ren H, Cao R, et al. The effect of COVID-19 on youth mental health. Psychiatr Q. 2020:1–12. pmid:32319041
- 60. Giorgio E Di, Di Riso D, Mioni G, Cellini N. The interplay between mothers’ and children behavioral and psychological factors during COVID-19: An Italian study. psyRxiv. 2020:1–24.
- 61. Bauer NS, Gilbert AL, Carroll AE, Downs SM. Associations of early exposure to intimate partner violence and parental depression with subsequent mental health outcomes. JAMA Pediatr. 2013;167(4):341–347. pmid:23381234
- 62. Shen H, Magnusson C, Rai D, et al. Associations of parental depression with child school performance at age 16 years in Sweden. JAMA Psychiatry. 2016;73(3):239–246. pmid:26842307
- 63. Brennan PA, Hammen C, Andersen MJ, Bor W, Najman JM, Williams GM. Chronicity, severity, and timing of maternal depressive symptoms: Relationships with child outcomes at age 5. Dev Psychol. 2000;36(6):759–766 pmid:11081699
- 64. Elgar F, Mcgrath PJ, Waschbusch DA. Maternal and paternal depressive symptoms and child maladjustment: The mediating role of parental behavior. J Abnorm Child Psychol. 2007;35(6):943–955. pmid:17577659
- 65. Thanhäuser M, Lemmer G, De Girolamo G, Christiansen H. Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Curr Opin Psychiatry. 2017;30(4):283–299. pmid:28505032
- 66. Rhoades KA. Children’s responses to interparental conflict: A meta-analysis of their associations with child adjustment. Child Dev. 2008;79(6):1942–1956. pmid:19037959
- 67. Erel O, Burman B. Interrelatedness of marital relations and parent-child relations: A meta- analytic review. Psychol Bull. 1995;118(1):108–132. pmid:7644602
- 68. Rodriguez CM. Parent-child aggression: Association with child abuse potential and parenting styles. Violence Vict. 2010;25(6):728–741. pmid:21287963
- 69. Statista. Median Annual Family Income in Canada from 2000–2018. https://www.statista.com/statistics/465739/median-annual-family-income-in-canada-since-1990/. Accessed March 15, 2021.
- 70. Mills-Koonce W. (2013). The family model stress and maternal psychological symptoms: Mediated pathways from economic hardship to parenting. Journal of Family Psychology, 27(1), 96–105. pmid:23421837
- 71. Donnellan M. (2016). Effects of economic hardship: Testing the family stress model over time. Journal of Family Psychology, 30(1), 12–21. pmid:26551658
- 72. Chase SK, Beatty JR, Ondersma SJ. A randomized trial of the effects of anonymity and quasi anonymity on disclosure of child maltreatment-related outcomes among postpartum women. Child Maltreat. 2011;16(1):33–40. pmid:21131632
- 73. Romero E., López-Romero L., Domínguez-Álvarez B., Villar P., & Gómez-Fraguela J. A. (2020). Testing the effects of COVID-19 confinement in Spanish children: The role of parents’ distress, emotional problems and specific parenting. International journal of environmental research and public health, 17(19), 6975. pmid:32987641
- 74. Statistics Canada. Caring for their children: Impacts of COVID-19 on parents https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00091-eng.htm Accessed March 15, 2021.
- 75. Boyd JH, Weissman MM, Thompson WD, Myers JK. Screening for depression in a community sample: Understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psychiatry. 1982;39(10):1195–1200. pmid:7125849
- 76. Cuijpers P, Boluijt P, Van Straten A. Screening of depression in adolescents through the Internet: Sensitivity and specificity of two screening questionnaires. Eur Child Adolesc Psychiatry. 2008;17(1):32–38. pmid:17876508
- 77. de Joode JW, van Dijk SEM, Walburg FS, et al. Diagnostic accuracy of depression questionnaires in adult patients with diabetes: A systematic review and meta-analysis. PLoS One. 2019;14(6):e0218512. pmid:31220131
- 78. Teissèdre F, Chabrol H. Detecting women at risk for postnatal depression using the Edinburgh Postnatal Depression Scale at 2 to 3 days postpartum. Can J Psychiatry. 2004;49(1):51–54. pmid:14763678
- 79. Flannery J. E., Penner-Goeke L., Xie E. B., Prince D., Callaghan D., Tomfohr-Madsen L., et al. [preprint]. Digital parenting training RCT: Meta-analysis and systematic review.
- 80. Riegler L. R., Raj S. P., Moscato E. L., Narad M. E., Kincaid A., & Wade S. (2020). Pilot trial of a telepsychotherapy parenting skills intervention for veteran families: Implications for managing parenting stress during COVID-19. Journal of Psychotherapy Integration., 30(2), 290–303. https://doi.org/10.1037/int000022
- 81. Spencers C. M., Topham G. L., & King E. L. (2020). Do online parenting program create change?: A meta-analysis. Journal of Family Psychology, 34(3), 364–374 pmid:31697102
- 82. Bauemel A. & Faber K. (2018). Evaluating Triple P Online: A Digital Parent Training Program for Child Behavior Problems. Cognitive and Behavioral Practice, 25(4), 538–543. https://doi.org/10.1016/j.cbpra.2017.10.001
- 83. Breitenstein S. M., Fogg L., Ocampo E. V., Acosta D., & Gross D. (2016). Parent Uuse and efficacy of a self-administered, tablet-based Parent training intervention: A randomized controlled trial. JMIR mHealth and uHealth., 4(2). https://doi.org/10.2196/mhealth.5202
- 84. Rapoport E., Reisart H., Schoeman E., & Adesman A. (2020). Reporting of child maltreatment during the SARS-CoV-2 pandemic in New York City from March to May 2020. Child Abuse & Neglect: the International Journal. https://doi.org/10.1016/j.chiabu.2020.104719
- 85. Rodriguez C. M., Lee S. J., Ward K. P., & Pu D. F. (2020). The perfect storm: Hidden risk of child maltreatment during the COVID-19 pandemic. Child maltreatment, 1077559520982066 pmid:33353380