Skip to main content
NCBI home page
SAGE - PMC COVID-19 Collection logoLink to SAGE - PMC COVID-19 Collection
. 2023 May 18:08445621231175757. doi: 10.1177/08445621231175757

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

Christine Gervais 1,✉, Isabel Côté 2, Tamarha Pierce 3, Sandrine Vallée-Ouimet 1, Francine de Montigny 1
PMCID: PMC10200807  PMID: 37203175

Abstract

Background

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

Objective

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

Method

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

Results

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

Conclusion

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

Keywords: COVID-19, pandemic, parenting, family functioning, perceived social support, family systems theory

Introduction

Since March 2020, the COVID-19 pandemic has been disrupting the lives of families around the world (Cluver et al., 2020; IFNA 2020). The Public Health Emergency of International Concern, declared by the World Health Organization on January 30, 2020 (World Health Organization, 2020) and restrictive public health measures imposed around the world have affected family functioning (Cluver et al., 2020; Mackolil & Mackolil, 2020) notably by giving parents new realities to reconcile. Although there is considerable heterogeneity in the concrete impacts of the pandemic on families, the literature reports some important issues they faced, including income loss, health preoccupation, and fear of COVID-19, as well as the integration of the health measures in their daily routines in order to protect their family members from the virus (Brown et al., 2020; Fegert et al., 2020). Moreover, families had to cope with homeschooling (Thorell et al., 2021), teleworking (Del Boca et al., 2020), and distancing themselves from family members who could previously have provided them support in raising and caring for their children (Fegert et al., 2020). In accordance with family systems theory, these new realities have forced families to redefine what Wright and Leahey (2013) refer as their instrumental (activities of daily living) and expressive functioning (communication, roles, beliefs, etc.), redrawing the relationships within families themselves as well as those maintained by families with their entourage and with institutions. While certain studies have started to highlight the negative consequences of the pandemic on family health and functioning, including deterioration in parental and child mental health and increased family conflict (Gassman-Pines et al., 2020; Russell et al., 2020), others have instead illustrated that the intimacy associated with the context of confinement also favors sharing positive family moments (Ares et al., 2021; Carroll et al., 2020), including the initiation of new activities, a source of family bonding (Stoecklin et al., 2021). Building on this emerging knowledge about the impacts of the pandemic on families, the present study, part of a larger study using a family systemic lens to examine the longitudinal effects of the COVID-19 pandemic on school-aged children, adolescents, and their parents, explored the relationships between and among parents’ experience of the pandemic (conceptualised as concrete negative impacts of the pandemic, perceptions of its positive effects, and preoccupations regarding health due to COVID-19), perceived social support, ill-being (defined as poor psychological adjustment based on four largely studied indicators such as well-being (reverse-coded), stress, depression, and loneliness), parental satisfaction, and family functioning among a group of parents of school-aged children in Quebec. Our main hypothesis was that perceived social support and parental ill-being would mediate the relationships between parents’ experience of the pandemic and their family functioning. We anticipated that parents who are strongly impacted by the pandemic, have higher preoccupation due to COVID-19, and perceived few positive impacts of the pandemic are more likely to report less perceived social support and higher ill-being. In turn, we expected this pattern of less perceived social support and higher ill-being to be associated with lower parental satisfaction and family functioning. Although the lockdown was maintained for a limited and relatively short period of time, the magnitude of the changes in instrumental and expressive functioning that they required of families, as well as the unprecedented nature of the pandemic, justify studying family functioning and adaptation during this period. Furthermore, the experience of the first lockdown and the distress experienced during it influences the adaptation of individuals and families to the restrictive health measures that were maintained for a period of two years (Tourette-Turgis & Chollier, 2021), underlining the importance of better understanding the factors that can protect the health of families during lockdown.

Background

Since March 2020, families in Québec, as in most Western countries, have been dealing with restrictive public health measures that have many impacts on the interactions between family members and those around them. Of these, the lockdown that lasted six weeks in the spring of 2020 (Institut National de Santé Publique du Québec, 2022) represents the greatest upheaval experienced by families, due to its suddenness as well as the disruption of daily activities, family routines, and relationships that it involved. During this period, daycares, schools, and most commercial establishments were closed. People were told to stay at home, gatherings were prohibited, and visits to hospitals, long-term care facilities, and seniors’ residences were also forbidden.

The lockdown required that families redefine their functioning. The closing of schools and daycare centers, the modification of working conditions, the suspension of extracurricular activities, and the closing of many businesses and gathering places, such as parks and restaurants, represent important changes in the environment of families, generating significant stress and exacerbating the irritability of some (Janssen et al., 2020). In this context, the functions of feeding, protecting, and socializing family members (Shajani & Snell, 2019) have become much more complex.

Emerging literature on the effects of the pandemic have highlighted important transformations in family boundaries resulting from the lockdown and public health measures. Although the negative impacts of the pandemic on the experiences of families are broadly outlined, some research also highlighted some positive impacts it had on families. Indeed, the obligation to stay together disrupted some of the boundaries between family members or subsystems, as each becomes more involved in the daily lives of other family members. For some, these new boundaries offer the opportunity to create new forms of intimacy and stronger family ties (Cluver et al., 2020). At the same time, while the closure of schools and daycare centers and the suspension of social gatherings make families’ boundaries with the outside world impermeable, by contrast, the boundary between work and family became very porous in the context of teleworking with children at home (Del Boca et al., 2020). These new boundaries had particularly important implications for the role that parents occupy under the demands of the lockdown and social distancing, which significantly increases their stress levels (Carroll et al., 2020; Coyne et al., 2021; Spinelli et al., 2020).

Parenting and the pandemic

The lockdown required a redefinition of parental roles to include greater responsibility for the care and education of children. Indeed, parents had to explain to their children a lot of new information related to the pandemic while supervising the adoption of new behaviors (Fegert et al., 2020), such as frequent hand washing and disinfection of the house (Ares et al., 2021). They also had to supervise their children's school organization and learning (Thorell et al., 2021), negotiate with them to redefine family rule and routines surrounding meals, screen time, etc. (Carroll et al., 2020), support the adoption of healthy sleep habits, which have been compromised by fears related to the pandemic (Suffren et al., 2021), and keep their children busy to compensate for the loss of contact and activities with friends. Parents were also challenged to support children in their fears and foster their emotional safety through different modes of communication, while facing uncertainty and fear themselves (Prime et al., 2020). Many parents have reported difficulty in implementing effective strategies to counter their children's moodiness as well as confrontations and conflicts with them (Ares et al., 2021).

These new responsibilities, along with the economic hardships experienced by many families (Cluver et al., 2020), unequivocally represent significant stress for parents (Bradbury-Jones & Isham, 2015; Fegert et al., 2020). A study conducted in 26 countries identified that the presence of children in the household increases the stress associated with the pandemic and that parents with several children report experiencing more stress (Kowal et al., 2020). Moreover, holding a job would itself be a stress factor for parents, especially when teleworking is difficult to reconcile with childcare or supervision of academic learning (Del Boca et al., 2020, Thorell et al., 2021), a reality exacerbated for parents with low levels of education or few resources (Ares et al., 2021). Despite this stress, the lockdown period also represented, for some parents, an opportunity to share quality time with their children (Brown et al., 2020) and to get to know them better (Toran et al., 2021).

Social support, defined as “the psychological and material resources provided through social interaction” (Long et al., 2022), was severely disrupted by the lockdown and social distancing measures. In addition to being deprived of the informal support they once received from their extended family or circle of friends, families had to deal with the significant reduction in the instrumental and emotional support they used to receive from formal services such as daycare, schools, and health services. A U.S. national survey reported that in the early months of the pandemic, nearly a quarter of families lost access to regular childcare for their child (Patrick et al., 2020), thus reducing the number of adults available to meet children's needs.

The inability to see loved ones was also a challenge for families (Brown et al., 2020). Indeed, parents in the Janessen et al. study (2020) reported that the greatest daily difficulty during the pandemic remained the lack of social contact with their friends, while children in a study conducted in Switzerland, Estonia and Canada emphasized that they missed their significant others, including their grandparents, during the lockdown (Stoecklin et al., 2021). Some parents responded to physical distancing measures by frequently exchanging with their loved ones through a variety of health-safe communication channels, such as text messages, video calls, etc., which appeared to help reduce feelings of social isolation (Van Mulukom et al., 2021).

The lockdown and mental health

The complexity of parenting in the context of a pandemic combined with the significant decrease in social support available to individuals and families was a fertile ground for the development or exacerbation of mental health problems (Patrick et al., 2020), thereby undermining the well-being and functioning of families. Indeed, exposure to the virus contributed to the stress felt by mothers as well as their fears of infecting a family member (Brown et al., 2020; Fegert et al., 2020). The fear associated with the virus appeared to be contagious within the family in a lockdown setting, with the parents’ fear being transmitted to their child (Suffren et al., 2021). The new relationship to time experienced during lockdown may have resulted in poor cognitive habits, including rumination and loss of hope (Mackolil & Mackolil, 2020), and parents reported experiencing more negative emotions (Janssen et al., 2020).

The pandemic weakened the mental health of parents (Brown et al., 2020). Lee et al.'s (2021) study of 405 U.S. parents during the spring 2020 lockdown highlighted that approximately 40% of parents had symptoms of major or severe major depression or moderate or severe anxiety. Parents who have lost their jobs (Lawson et al., 2020), those without a supportive partner (Mikocka-Walus et al., 2021), those who consume more media information about COVID-19 (Golding et al., 2021), and those with a pessimistic nature (Mazza et al., 2020) appears to be most affected. With parental anxiety and depressive symptoms limiting the quality of their response to their children's needs (Roos et al., 2021), the pandemic threatens well-being (Suffren et al., 2021) and both individual and family functioning.

The present study

The literature reviewed above indicates that, while some studies have highlighted the impact of the pandemic on family functioning, there is a lack of research exploring family functioning risk and protective factors in the pandemic context, and research is still needed to better understand the interplay between the personal, familial, and social effects of this specific pandemic (Prime et al., 2020). Utilizing the Calgary Family Assessment and Intervention Models (Wright and Leahey, 2013), the present study aimed to address these gaps by investigating parents’ experience of the pandemic as a predictor of perceived social support, parental ill-being, parental satisfaction, and family functioning. We hypothesized the following:

  • Hypothesis 1. Participants’ perceptions of the positive effects of the COVID-19 pandemic, as well as COVID19 related concern will influence their parental satisfaction and family functioning. Specifically, we anticipated that parents who are strongly impacted by the pandemic, have higher health preoccupation due to COVID-19, and perceived few positive impacts of the pandemic will be presenting lower parental satisfaction and family functioning.

  • Hypothesis 2. The above hypothesized relationships will be mediated by the extent to which participants perceive themselves as receiving social support from their surroundings as well as by their overall level of ill-being which was conceptualised in the present study as poor psychological functioning as assessed by four distinct but interrelated indicators (stress, depression, loneliness, and poorer well-being).

Method

The present study is part of a larger longitudinal mixed-method research project assessing the subjective and objective impact of the COVID-19 pandemic on families. In order to take into account the evolution of the pandemic, four measurement periods were planned for this research. The present study reports on the first quantitative measurement point, which was set 6–8 weeks after the implementation of physical distancing measures (end of April–mid-May 2020).

Procedure

This study was initiated during the first weeks of the pandemic, when, internationally, researchers were urgently developing new research projects to collect data promptly to respond to this crisis situation (Schwarz & Stensaker, 2020; Sy et al., 2020). A number of measures were developed specifically for the purpose of the present research due to the unique nature of the COVID-19 pandemic. To ensure the highest level of face validity, these measures were developed through a consultation between several subject-matter experts and through consensus among the authors of the research. Because of the excellent collaboration, the research was evaluated and approved by the Research and Ethics Committee of the University du Québec en Outaouais in a timely manner.

Given the physical distancing measures in place at the time of data collection, all data were collected remotely via an online data collection platform (LimeSurvey). Recruitment was done via social media (Facebook) as well as through newsletters from project partners. The ad included a hyperlink that allowed participants to learn more about the research project. Interested participants then completed the consent form as well as the online questionnaire. Participants who completed the questionnaire were entered into a random draw of four gift cards valued at $50 CND. The parents gave their written consent and to protect their personal data, they were assigned a numerical identifier.

Participants

The sample included 203 parents living in Quebec. To participate in the study, participants had to have a child between 7 and 17 years old, have access to an internet connection, and be able to understand and speak French (the predominant language in this province).

Measures

COVID-19's impact on family

Three items were developed for the purpose of the present study to assess the extent to which the COVID-19 pandemic negatively impacted participants’ families. Items were “Have you or your partner experienced an unexpected loss of income due to the COVID-19 pandemic?” (yes  =  1, no  =  0), “Have the measures put in place to fight the spread of COVID-19 had a positive or a negative impact on your life?” (negative impact  =  1, positive or neutral impact  =  0), and “What are your perceptions of the consequences of COVID-19 on your family?” (negative consequences  =  1, positive or neutral consequences  =  0). A total score was computed from the sum of all 3 items. Higher scores indicate more negative impact of the COVID-19 pandemic on the family.

Health preoccupation due to COVID-19

Four items were developed for the purpose of the present study to assess the extent to which participants were preoccupied by the health consequences of the COVID-19 pandemic. Participants were asked “Are you concerned about the impact the COVID19 pandemic may have on 1) your own health?”, “…2) your partner's health?”, “…3) your child's health?” and “…4) the health of a relative?” Items were answered on a 4-point scale ranging from 0 (Not at all) to 3 (A lot). A total score was computed by summing the 4 items. Higher scores indicate higher levels of preoccupation (Cronbach's alpha  =  .79).

Perceptions about positive effects of the pandemic

Participants’ perceptions of the positive effects of the pandemic on their individual and family life were assessed using a scale inspired by the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996). The measure is composed of 12 items, such as “Since the beginning of the COVID-19 pandemic, have you felt closer with your family?” (Cronbach's alpha  =  .60). Participants indicated with a “yes” or “no” answer whether they had experienced each of the items. All “yes” answers were scored as 1 and all “no” answers as 0. The 12 items were then summed to obtain a total score.

Perceived functional social support

Participants’ perceived functional social support was assessed using the 7 items from the MOS social support survey (Sherbourne & Stewart, 1991). This tool measures social support across four dimensions: 1) emotional/informational, 2) tangible, 3) loving, and 4) positive social interactions. A sample item is “Since the beginning of the COVID-19 lockdown measures, how often have you had someone with whom to share your worries and your most intimate fears?” Items were answered on a 5-point scale ranging from 1 (Never) to 5 (Always). A total score was obtained from the sum of the 7 items. Higher scores indicate higher perceived functional social support. Cronbach's alpha in the present study was .90.

Well-being

Participants’ subjective well-being was assessed using the Well-Being Index (WHO-5, Topp, Østergaard, Søndergaard, & Bech, 2015). This measure is composed of 5 items representing how participants have been feeling over the previous 2 weeks (e.g., “I have felt cheerful and in good spirits” and “I have felt calm and relaxed”). Items were answered on a 6-point scale ranging from 0 (Never) to 5 (All the time). A total score was computed by averaging the 5 items. The total score was then converted into a percentage by multiplying it by 5. Higher scores indicate higher subjective well-being. Cronbach's alpha in the present study was .86.

Perceived stress

The Perceived Stress Scale (PSS, Cohen, Kamarck, & Mermelstein, 1983; Lesage, Berjot, & Deschamps, 2012) was used to assess the perceived stress experienced by participants. This measure is composed of 4 items assessing how much participants perceive their lives as unpredictable, uncontrollable, and overloaded (Cohen et al., 1983). A sample item is “In the last month, how often have you felt that you were unable to control the important things in your life?” Items were answered on a 5-point scale ranging from 1 (Often) to 5 (Never). A total score was computed by averaging the score on each of the 4 items. Higher scores indicate higher perceived stress. Cronbach's alpha in the present study was .73.

Depressive symptoms

The presence and intensity of depressive symptoms were estimated using the Patient Health Questionnaire (PHQ-9, Kroenke, Spitzer, & Williams, 2001). Participants were asked to report, on a 4-point scale ranging from 0 (never) to 3 (nearly every day), how often they experienced each of the 9 symptoms listed in the previous 2 weeks (e.g., “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless”). A total score was computed by summing the scores of the nine items. Higher scores indicate more severe depressive symptomatology. Cronbach's alpha in the present study was .77.

Loneliness

Emotional loneliness was measured with the De Jong Gierveld Scale (Gierveld & Tilburg, 2006). This scale is composed of 6 items such as “I experience a general sense of emptiness” and “I miss the pleasure of the company of others.” Participants were asked to indicate whether each item represented their current situation or not. Each “yes” was given a score of 1. A total loneliness score was obtained by summing the scores of the 6 items. Cronbach's alpha in the present study was .53.

Family functioning

The Family APGAR tool was used to assess family functioning (Smilkstein et al., 1982). This tool measures the adaptation, partnership, growth, affection, and problem solving within families (Smilkstein et al., 1982). It contains 5 items, such as “I am satisfied with the way my family talks about things with me and shares problems with me”. Items were answered on a 3-point scale ranging from 0 (Nearly never) to 2 (Nearly always). The average of the 5 items was computed to obtain a total score. Higher scores indicate better functioning. Cronbach's alpha in the present study was .81.

Parental satisfaction

Parents’ parental satisfaction was assessed with 12 items (Morisset-Bonapace, 2015): 6 items assessing their dissatisfaction (e.g., “When I go to bed at night, I feel like I did not do much for my child”), drawn from the Parenting Sense of Competence scale (PSOC; Johnston & Mash, 1989), and 6 items assessing their satisfaction (e.g., “I consider that I dedicate enough time to my child”) adapted from the Cleminshaw-Guidubaldi Parent Satisfaction Scale (CGPSS; Guidubaldi & Cleminshaw, 1985). Items were answered on a 6-point scale ranging from 1 (Completely disagree) to 6 (Completely agree). Dissatisfaction items were recoded before the average of the 12 items was computed to obtain a total score. High total scores indicate higher satisfaction. Cronbach's alpha in the present study was .85.

Data analysis

First, descriptive statistics were conducted with IBM SPSS Statistics for Windows version 20.0 (IBM Corp., 2013) in order to better describe our sample and to carry out a first exploration of the relationships at play between the study variables. The distributions of the study variables were inspected. Two variables presented non-normal distributions: social support and family functioning. A square root transformation was performed for social support and a log transformation was performed for family APGAR. Both transformations were successful in restoring the normality of the distributions. In order to create a latent variable of ill-being, the WHO-5 total scores were first recoded so that higher scores represented lower well-being. Second, the WHO-5 (recoded), the PSS, the PHQ, and the loneliness scores were standardized. And finally, an ill-being score was computed by averaging the scores on all four indicators of poor psychological functioning.

Second, path analyses were modelled using the Analysis of Moment Structures (AMOS) software, version 21 (IBM Corp., 2013) in order to study the simultaneous relationships between the study variables, explore potential causal pathways, and test the mediational role of perceived social support and ill-being. Indirect effects were estimated with a bias-corrected bootstrapped 95% confidence interval (CI) (see Preacher and Hayes 2008; Shrout and Bolger 2002) to determine the mediating role of perceived social support and ill-being in the relationship between the independent variables and the dependent variables.

Results

Description of the study sample

A total of 203 participants (93% females) completed the questionnaire. The mean age was 41.53 (SD  =  5.68). Most participants had at least some university-level education (78.1%) and were either married (45%) or in a common-law relationship (37.1%). The majority (74.3%) of participants had a household income of $80,000 (CAN) or more. Only 12.4% of the participants had only one child while 52.5% had two children, 23.3% had three, and 11.9% had four or more children. Nearly all (87.6%) of the participants cohabited 100% of the time with at least one child. A third of the sample (37.1%) reported having been previously diagnosed with a mental health condition, primarily anxiety (17.3% of total) and depression (22.3% of total). Of these participants who reported a mental health diagnosis, 46.7% reported currently taking a medication to treat the condition. One third of the sample (32.2%) reported having been previously diagnosed with a physical health condition. However, 79.2% of participants evaluated their current health as good to excellent.

Before the pandemic, 75.6% of the participants were working full-time and 12.4% were working part-time. However, 25.2% declared that their occupation changed after the start of the pandemic, and income losses were reported for 28.7% of the participants’ households. A total of 60.9% of participants reported working from home with children at home while 22.3% reported working for an essential service.

Since the start of the pandemic, 22.8% of participants reported that someone in their housesold had experiences cold or flu symptoms, and 10.9% reported that they or someone in their household had been tested for COVID-19, but only one test was positive.

Descriptive statistics of the study variables

Table 1 presents the descriptive statistics (prior to transformations) as well as the bivariate correlations between the study variables. Correlations showed that most variables were significantly related to each other in predictable ways. Perceptions about positive effects of the pandemic were found to be significantly associated with higher social support, lower ill-being, as well as higher family functioning and parental satisfaction. Impact of the COVID-19 pandemic on family was found to be significantly associated with lower social support, higher ill-being, and lower family functioning. Participants’ health preoccupation due to the pandemic was found to be significantly associated with higher ill-being. Furthermore, perceived functional social support was significantly associated with lower ill-being as well as with higher family functioning and parental satisfaction.

Table 1.

Bivariate correlations among the variables.

Perceptions of positive effects Impact of COVID-19 Health preoccupation due to COVID-19 Perceived Social support Ill-being Parental functioning Parental satisfaction
Impact of COVID-19 –.30***
Health preoccupation due to COVID-19 –.08 –.00
Perceived social support .26*** -.19** -.10
Ill-being –.31*** .25*** .24*** –.35***
Parental functioning .31*** –.20** –.07 .48*** -.33***
Parental satisfaction .19** –.05 –.08 .27*** –.35*** .46***
Mean 5.13 1.39 5.85 29.02 –0.01 8.42 4.92
Standard deviation 2.31 0.87 2.76 5.42 0.76 1.94 0.66
Open in a new tab

Note: N  =  203, ** p < .01, *** p < .01.

Mean and standard deviation for social support and parental functioning are of pre-transformation variables.

Ill-being is computed by averaging the standardised scores of WHO-5 (reversed), PSS-4, PHQ-9, and Jong Gierveld Loneliness Scale.

Path analysis: the mediating role of perceived social support and ill-being

A structural equation modeling path analysis was then conducted to model the different relationships at play between the study variables, detect potential causal pathways, and explore the mediational role of perceived social support and ill-being. The model was composed of 7 observed variables: three exogenous variables (perceptions of positive effects, impact of COVID-19 on family, health preoccupation due to COVID-19) and four endogenous variables (functional social support, ill-being, family functioning, parental satisfaction). First, we modelled the three exogenous variables as predictors of functional social support, which was then modelled as a predictor of ill-being, which was finally modelled as a predictor of family functioning and parental satisfaction. A covariance was specified between the two outcome variables as well as between the exogenous variables. This initial model did not show adequate fit to the data (χ2 (df  =  11, N  =  203)  =  73.83, p < .001, RMSEA  =  .17 [.13; .21], NFI  =  .66, CFI  =  .68, GFI  =  .92, AGFI  =  .78, and SRMR  =  .13). Inspection of the results to identify non-significant paths and modification indices suggested a number of changes. First, only perceptions of positive effects of the pandemic seemed to be significantly related to functional social support. Second, all three exogenous variables appeared to be directly associated with ill-being. Third, functional social support appeared to also be directly related to family functioning and parental satisfaction. Finally, a direct path between perceptions of positive effects of the pandemic and family functioning was suggested. This second model showed adequate fit to the data (χ2 (df  =  7, N  =  203)  =  7.90, p  =  .34, RMSEA  =  .03 [.00; .09], NFI  =  .96, CFI  =  1.00, GFI  =  .99, AGFI  =  .96, and SRMR  =  .05). Inspection of the modification indices did not suggest any additional significant relationships. This modified model was thus retained as the final model.

Figure 1 depicts the final model. Overall, the results supported our hypothesis, highlighting some family functioning risks and protective factors in the pandemic context. First, participants’ perceptions of positive effects of the COVID-19 pandemic were found to be a direct positive predictor of their functioning as a family as well as the extent to which they perceived their environment as providing them with functional support. Second, participants’ perceptions of positive effects of the pandemic, as well as perceived social support, were found to be negatively related to their overall ill-being. This suggests that the participants who experienced the most growth and who perceived the most social support also presented better indicators of well-being. Third, higher levels of preoccupation about one's health and that of one's relatives, as well as higher concrete impacts of COVID-19 on the family, were predictive of higher ill-being. Fourth, higher perceived social support was found to be associated with higher family functioning and parental satisfaction, while higher ill-being was found to be related to worse family functioning and parental satisfaction.

Figure 1.

Figure 1.

Open in a new tab

Standardized path model for the direct and indirect effects.

Note: * : p < .05; ** : p < .01; *** : p < .001.

Table 2 presents the results of the bias-corrected bootstrapped estimates of the mediating role of perceived functional social support and ill-being in the relationships between the independent variables and the parental functioning and parental satisfaction variables. Bootstrap analysis indicates all indirect effects are significant, provided support for all mediations, with participants’ perceptions of positive effects of the pandemic, health preoccupations, and concrete COVID-19 impact having significant indirect effects on their family functioning and satisfaction as parents via the support they perceive having and their ill-being.

Table 2.

Bias-Corrected bootstrapped Estimates of the Mediations.

Bootstrapping point estimate Bias-corrected bootstrapped 95% confidence interval estimate p-value
Perceptions positive effects → Perceived social support → Ill-being –.022 (.008) (–.042; –.009) .001
Perceptions positive effects → Ill-being → Parental functioning .019 (.005) (.010; .001) .002
Perceptions positive effects → Ill-being → Parental satisfaction .033 (.009) (.017; .055) .001
Perceived social support → Ill-being → Parental functioning .011 (.006) (.001; .023) .025
Perceived social support → Ill-being → Parental satisfaction .046 (.016) (.021; .087) .001
Impact COVID-19 → Ill-being → Parental functioning –.007 (.005) (–.023; –.001) .022
Impact COVID-19 → Ill-being → Parental satisfaction –.032 (.016) (–.068; –.006) .009
Preoccupation COVID-19 → Ill-being → Parental functioning –.003 (.002) (–.008; .000) .021
Preoccupation COVID-19 → Ill-being → Parental satisfaction –.014 (.006) (–.029; –.005) .001
Open in a new tab

Note: N  =  203.

Discussion

Overall, the results of the present study supported our hypothesis, highlighting some family functioning risk and protective factors in the pandemic context. More precisely, the results highlighted that participants’ perceptions of positive effects of the COVID-19 pandemic and perceived social support seem to be protective factors for family functioning and parental well-being, while preoccupations about one's health and that of one's relatives, as well as greater concrete impacts of COVID-19 on the family are risk factors., The importance of family beliefs, social support, and systems theory as key elements for better understanding and promoting family functioning in the context of a pandemic will be discussed in this section.

Studies on families and the lockdowns have identified numerous negative impacts of public health measures, including parenting stress (Lucassen et al., 2021), impaired family functioning and increased family conflict (Ares et al., 2021, Mazza et al., 2021). In this context, the protective effect of positive perception about the effects of the pandemic on family functioning and perceived social support is a particularly interesting result of our study. These findings confirm that the ability to find meaning in adverse events is a protective factor for families and it contributes to family resilience (Walsh, 2015). In a similar way, Shajani and Snell (2019) proposed that the sharing of facilitating beliefs that alleviate suffering and open possibilities for growth even in difficult situations seems to protect health of the families. In the context of the pandemic, perceiving that this event contributes to a sense of closeness with family members, friends, or community, as well as more time for leisure and feelings of gratitude and empathy, is associated with better family functioning, but also with perceiving the availability of more social support in the surrounding environment, while good family functioning during the lockdown was also associated with better children functioning ( Gervais et al., submitted 2021). Thus, believing that the pandemic also has positive impacts seems to limit the negative effects of the pandemic on the external structure of families.

The results of this study also provide insight into the impact of the pandemic on family social support. Although the pandemic has altered the ways in which families interact with their formal and informal networks, it appears that the intensity of exposure to COVID-19 in the early months of the pandemic did not affect the emotional, instrumental, and informational support that parents perceived to which they had access. Access to and increased use of communication technologies during the pandemic (Long et al., 2022), including the internet, which allowed families to stay in touch with their loved ones and be informed of COVID-19 prevention and protection measures, likely helped limit the social isolation and anxiety felt by parents (Van Mulukom et al., 2021). Furthermore, the fact that perceived social support was associated with both individual parental ill-being, parental satisfaction, and family functioning confirms its importance for individual and family health.

Our results also confirm that exposure and fears related to COVID-19 are associated with impaired parental well-being and mental health (Généreux et al., 2020; Suffren et al., 2021). While this finding is easily understood, it raises questions for nurses, who play an important role in health education and in disease prevention and health promotion. While fear of COVID-19 poses a threat to mental health, it also represents a motivation to comply with public health regulations (Phélinas et al., 2021). This paradox underscores the importance of seeking balance in both the quantity and quality of health messages delivered. On this issue, receiving too much information about COVID-19 would be unfavorable to psychological health (Généreux et al., 2020), while receiving little or incorrect information would also negatively affect health (Lin et al., 2022). Yet, while it is essential to educate families about prevention measures, campaigns focused solely on hygiene and the risks of COVID-19 transmission could create compulsive behaviors such as excessive cleaning or avoidance of all social interactions, as highlighted by Ares et al. (2021). Added to this is the loneliness and anxiety of young people who find it particularly difficult to give up seeing their grandparents for fear of infecting them (Côté et al., 2022). To encourage adherence to prevention measures while preserving the mental health of individuals and families’ functioning, it appears essential to adapt messages to the realities of families to limit the impact on children

Finally, results on indirect effects of the pandemic situation on families resonate with Family Systems Theory (Minuchin, 1998) and provide a better understanding of the mechanisms by which the pandemic affects the various dimensions of individual and family functioning. Indeed, the family is composed of several subsystems (e.g., parent, child, parent-child relationships, co-parent relationships, etc.), each subsystem being dynamic and constantly influenced by and influencing the other subsystems, as well as the larger systems in which it is embedded.

Our results confirm that parental well-being acts as a funnel through which social disruptions due to COVID-19 infiltrate family functioning (Prime et al., 2020), and highlighted the protective effects of perceived social support for parental mental health, parental satisfaction, and family functioning. These results invite the adoption of a systemic family approach to consider the effects of the pandemic and the social and health measures on all individuals who compose the families, as well as on all the systems with which the families interact.

In addition to providing a better understanding of the systemic interactions that contribute to and detract from family functioning in the context of a pandemic, the results identify some promising interventions to support family health. As perceptions of positive effects of the pandemic were found to be related to participants’ higher perceived social support, lower ill-being, and better family functioning, practitioners should prioritize interventions which develop or strengthen facilitating beliefs. Inviting families to share their experiences of the pandemic and exploring their beliefs about the effects of the pandemic while also discussing its positive effects appears to be a promising intervention to protect parental mental health and family functioning. Moreover, the role for nurses regarding communication within families and between family members and their network is essential (Shajani & Snell, 2019). Nurses should encourage and help family members to draw on family support and explore new modes of communication and rituals to encourage family members to remain engaged in each other's lives despite the social and health restrictions associated with COVID-19. Nurses should also support families in the interpretation of public health directions and measures. By giving information tailored to each family situation, nurses can support families to integrate protective measures into their lives and help them limit these measures’ detrimental effects. For example, as grandparents are important actors in children life (Côté et al., 2022), they can discuss with families how to keep grandparents involved in their lives in a safe way, even during a pandemic. Nurses, when offering information and opinions related to COVID-19 prevention or treatment to families, are invited to include information about the importance of taking care of oneself as well as some tips to preserve family functioning through the different stages of the pandemic.

Limitations

Due to the cross-sectional design of this study, it is not possible to establish causal relationships. Thus, links between hardship, caregiver well-being, and family well-being are unidirectional and operate within a mutually reinforcing system (Prime et al., 2020). It is thus possible that family functioning and parental satisfaction contribute to parental individual functioning, which in turn contributes to the social support perceived. The specificity of the sample is also a limitation of the study, which requires the data presented to be interpreted with caution. Indeed, despite the efforts made during recruitment, the parental sample is predominantly made up of relatively affluent mothers, so our results do not reflect fathers’ experiences or that of the more vulnerable families who were more negatively impacted by the pandemic. An additional limitation is that 37% of the sample have pre-existing mental health disorders. Health preoccupations could be influenced by these previous health issues, further exacerbating the feelings of ill-being, negative family functioning, and parental satisfaction that were observed in the study. Another limitation pertains to the rapid development of some of the study measures to assess elements of the COVID-19 context. Due to the time-sensitive nature of this research, these measures, which were nonetheless developed through consensus among the study authors to ensure high face validity, could not be developed following rigorous validation guidelines. However, we believe that we were able to adequately capture the unique experiences of parents during this unprecedented time. In line with the previous limitation, it should be highlighted that although most of the measures included in the present study showed adequate levels of internal consistency, some measures such as the loneliness measure, showed lower than expected indices of reliability. Finally, data were collected during the first months of the pandemic, when it was easier to perceive some positive effects of the pandemic. Despite the fact that lockdown was the most restrictive measure, it also allowed family members to share good times and begin new activities together, which was appreciated by children (Stoecklin et al., 2021) and parents (Carroll et al., 2020). Subsequent waves of contagion as well as the maintenance of restrictive social and health measures over time and the resulting exhaustion probably contribute to a different experience of the pandemic for families two years later. Longitudinal studies are needed to better understand the pandemic’ s impacts on family development, as well as how negative consequences were produced over time, and which family strengths allowed to limit these.

Conclusion

The emergence of new variants of the SARS-CoV-2 virus, as well as the increased risk of other pandemics posed by climate change, put increasing pressure on family functioning, compromising the health of individuals and family systems. This study provides a better understanding of the mechanisms by which family members are influenced and influence the subsystems in which they are embedded, highlighting the importance of the perception of an adverse event and the social support for parents’ mental health, parental satisfaction, and family functioning in the context of lockdown. Through systemic family interventions, nurses can effectively support family health and contribute to family resilience by supporting communication within families and between family members and their network, and by supporting families in the interpretation of public health directions and measures so that they can better integrate them into their lives. Therapeutic conversations with families should also include questions to help family members perceive the positive effects of adverse events, such as pandemics, as well as suggestions to encourage families to mobilize their formal and informal support networks (Gervais et al., 2020).

Aknowledgements

The authors would like to thank the participating families and the research assistants who contributed to the data collection for the study.

Author Biographies

Christine Gervais, PhD, RN, Professor, Nursing Department, Université du Québec en Outaouais.

Isabel Côté, PhD, Professor, Social Work Department, Université du Québec en Outaouais.

Tamarha Pierce, PhD, School of Psychology, Université Laval.

Sandrine Vallée-Ouimet, MSc, RN, Research Assistant, Nursing Department, Université du Québec en Outaouais.

Francine de Montigny, PhD, RN, Professor, Nursing Department, Université du Québec en Outaouais.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from the Social Sciences and Humanities Research Council, the Ministère de la famille du Québec, the Partenariat de recherche Familles en mouvance and research team Paternité, famille et société.

ORCID iD: Christine Gervais https://orcid.org/0000-0001-5695-9358

References

  1. Ares G., Bove I., Vidal L., Brunet G., Fuletti D., Arroyo & Blanc M.V. (2021). The experience of social distancing for families with children and adolescents during the coronavirus (COVID 19) pandemic in Uruguay: Difficulties and opportunities. Children and Youth Services Review, 121. 10.1016/j.childyouth.2020.105906 [DOI] [PMC free article] [PubMed]
  2. Bradbury-Jones C., Taylor J. (2015). Engaging with children as co-researchers: challenges, counter-challenges and solutions. International Journal of Social Research Methodology, 18(2), 161–173. 10.1080/13645579.2013.86458 [DOI] [Google Scholar]
  3. Brown S. M., Koppels T., Doom J. R., Watamura S. E., Lechuga-Pena S. (2020). Stress and parenting during the global COVID19 pandemic. Child Abuse and Neglect, 110, part 2. 10.1016/j.chiabu.2020.104699 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Carroll N., Sadowski A., Laila A., Hruska V., Nixon M., … Haines J. (2020). The impact of COVID19 on health behavior, stress, financial and food security among middle to high income Canadian families with young children. Nutrients, 12(8), 2352–2352. 10.3390/nu12082352 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cluver L., Lachman J. M., Sherr L., Wessels I., Krug E., Rakotomalala S., … McDonald K. (2020). Parenting in a time of COVID19. The Lancet, 395(10231), 64. 10.1016/S0140-6736(20)30736-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cohen S., Kamarck T., Mermelstein R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. 10.2307/2136404 [DOI] [PubMed] [Google Scholar]
  7. Côté I., Gervais C., Doucet S., Lafantaisie V. (2022). « Je m’ennuie beaucoup de mamie et papi ». Impacts des mesures socio-sanitaires sur les liens grands-parents et petits-enfants. Enfances, Familles, Generations ,40. https://journals.openedition.org/efg/13435 [Google Scholar]
  8. Coyne L. W., Gould E. R., Grimaldi M., Wilson K. G., Baffuto G., Biglan A. (2021). First things first: Parent psychological flexibility and self-compassion during COVID19. Behavior Analysis in Practice, 14(4), 1092–1098. 10.1007/s40617-020-00435-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Del Boca D., Oggero N., Profeta P., Rossi M. (2020). Women's and men's work, housework and childcare, before and during COVID19. Review of Economics of the Household, 18(4), 1001–1017. 10.1007/s11150-020-09502-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fegert J. M., Vitiello B., Plener P. L., Clemens V. (2020). Challenges and burden of the coronavirus 2019 (COVID19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health, 14(20). 10.1186/s13034-020-00329-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gassman-Pines A., Ananat E. O., Fitz-Henley J., 2nd(2020). COVID19 And parent-child psychological well-being. Pediatrics, 146(4), e2020007294. 10.1542/peds.2020-007294 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Généreux M., Schluter P. J., Hung K. K. C., Wong C. S., Mok C. P. Y., Chan E. Y. Y., … Roy M. (2020). One virus, four continents, eight countries: An interdisciplinary and international study on the psychosocial impacts of the COVID19 pandemic among adults. International Journal of Environmental Research and Public Health, 17(22), 1–16. 10.3390/ijerph17228390 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gervais C, Côté I, Tourigny S, Pierce T, De Montigny F, Lafantaisie V. (Submitted 2021). Family well-being and child functioning during the first COVID19 pandemic lockdown: a cross-sectional study. Journal of Child and Family Studies. [Google Scholar]
  14. Gervais C., Verdon C., deMontigny F., Leblanc L., Lalande D. (2020). Creating a space to talk about one's experience of suffering: Families’ experience of a family nursing intervention. Scandinavian Journal of Caring Sciences, 34(2), 446–455. 10.1111/scs.12748 [DOI] [PubMed] [Google Scholar]
  15. Gierveld J. D. J., Tilburg T. V. (2006). A 6-item scale for overall, emotional, and social loneliness. Research on Aging, 28(5), 582–598. 10.1177/0164027506289723 [DOI] [Google Scholar]
  16. Golding M. A., Salisbury M. R., Reynolds K., Roos L. E., Protudjer J. L. P. (2021). COVID19-related media consumption and parental mental health. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 53(3), 371–376. 10.1037/cbs0000280 [DOI] [Google Scholar]
  17. Guidubaldi J., Cleminshaw H. K. (1985). The development of the cleminshaw-guidubaldi parent satisfaction scale. Journal of Clinical Child Psychology, 14(4), 293–298. 10.1207/s15374424jccp1404_4 [DOI] [Google Scholar]
  18. IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 20.0 . [Computer program]. IBM SPSS
  19. International Family Nursing Association (INFA). (2020, 27 mars). COVID19 Pandemic and Family Nursing: IFNA President and President-Elect Offer a Message to Members. INFA. https://internationalfamilynursing.org/2020/03/27/COVID19-pandemic-ifna-president-and-ifna-president-elect-offer-a-message-to-members/
  20. Janssen L. H. C., Kullberg M. L. J., Verkuil B., van Zwieten N., Wever M. C.M., Van Houtom L., Wentholt W., Elzinga B. M. (2020). Does the COVID19 pandemic impact parents’ and adolescents’ well-being? An EMA-study on daily affect and parenting. PLOS ONE 15(10): e0240962. 10.1371/journal.pone.0240962 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Johnston C., Mash E. J. (1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology ,18(2), 167–175. 10.1207/s15374424jccp1802_8 [DOI] [Google Scholar]
  22. Kowal M., Coll-Martín T., Ikizer G., Rasmussen J., Eichel K., Studzińska A., Koszałkowska K., Karwowski M., Najmussaqib A., Pankowski D., Lieberoth A., Ahmed O. (2020). Who is the most stressed during the COVID19 pandemic? Data from 26 countries and areas. Applied Psychology: Health And Well-Being, 12(4), 946–966. 10.1111/aphw.12234 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kroenke K., Spitzer R. L., Williams J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. 10.1046/j.1525-1497.2001.016009606.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Lawson M., Piel M. H., Simon M. (2020). Child maltreatment during the COVID19 pandemic: Consequences of parental job loss on psychological and physical abuse towards children. Child Abuse & Neglect, 110(Pt 2), 104709. 10.1016/j.chiabu.2020.104709 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lee S. J., Ward K. P., Chang O. D., Downing K. M. (2021). Parenting activities and the transition to home-based education during the COVID-19 pandemic. Children And Youth Services Review, 122, 105585. 10.1016/j.childyouth.2020.105585 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lesage F. X., Berjot S., Deschamps F. (2012). Psychometric properties of the French versions of the perceived stress scale. International Journal Of Occupational Medicine And Environmental Health, 25(2), 178–184. 10.2478/S13382-012-0024-8 [DOI] [PubMed] [Google Scholar]
  27. Lin T.-H., Chang M.-C., Chang C.-C., Chou Y.-H. (2022). Government-sponsored disinformation and the severity of respiratory infection epidemics including COVID19: A global analysis, 2001–2020. Social Science & Medicine, 296, 114744. 10.1016/j.socscimed.2022.114744 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Long E., Patterson S., Maxwell K., Blake C., Bosó Pérez R., Lewis R., … Mitchell K. R. (2022). COVID19 Pandemic and its impact on social relationships and health. Journal of Epidemiology and Community Health, 76(2), 128–132. 10.1136/jech-2021-216690 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Lucassen N., de Haan A. D., Helmerhorst K. O. W., Keizer R. (2021). Interrelated changes in parental stress, parenting, and coparenting across the onset of the COVID-19 pandemic. Journal of Family Psychology, 35(8), 1065–1076. 10.1037/fam0000908 [DOI] [PubMed] [Google Scholar]
  30. Mackolil J., Mackolil J. (2020). Addressing psychosocial problems associated with the COVID19 lockdown. Asian Journal Of Psychiatry, 51, 102156. 10.1016/j.ajp.2020.102156 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Mazza C., Marchetti D., Ricci E., Fontanesi L., Di G. S., Verrocchio M. C., Roma P. (2021). The COVID19 lockdown and psychological distress among Italian parents: Influence of parental role, parent personality, and child difficulties. International Journal of Psychology : Journal International De Psychologie, 56(4), 577–584. 10.1002/ijop.12755 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Mazza C., Ricci E., Marchetti D., Fontanesi L., Di Giandomenico S., Verrocchio M. C., Roma P. (2020). How personality relates to distress in parents during the COVID19 lockdown: The mediating role of child's emotional and behavioral difficulties and the moderating effect of living with other people. International Journal Of Environmental Research And Public Health, 17(17), 6236. 10.3390/ijerph17176236 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Mikocka-Walus A., Stokes M., Evans S., Olive L., Westrupp E. (2021). Finding the power within and without: how can we strengthen resilience against symptoms of stress, anxiety, and depression in Australian parents during the COVID19 pandemic? Journal of Psychosomatic Research, 145. 10.1016/j.jpsychores.2021.110433 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Minuchin S., Nichols M. P. (1998). Family Healing: Strategies for Hope and Understanding. The Free Press. [Google Scholar]
  35. Morisset-Bonapace M. (2015). Contribution des attitudes et motivations maternelles à l’expérience paternelle suivant la naissance d’un premier enfant. Université Laval. [Google Scholar]
  36. National de Santé Publique du Québec. (2022). Ligne du temps de la COVID-19 au. https://www.inspq.qc.ca/covid-19/donnees/ligne-du-temps [Google Scholar]
  37. Patrick S. W., Henkhaus L. E., Zickafoose J. S., Lovell K., Halvorson A., Loch S., Letterie M., Davis M. M. (2020). Well-being of parents and children during the COVID19 pandemic: A national survey. Pediatrics, 146(4), e2020016824. 10.1542/peds.2020-016824 [DOI] [PubMed] [Google Scholar]
  38. Phélinas P., Hernandez V., Ciriez C. (2021). Perception de la COVID19 et comportement des ménages en Argentine .Études et Documents, n°11, CERDI.
  39. Preacher K. J., Hayes A. F. (2008). Contemporary approaches to assessing assessing mediation in communication research. In Hayes A., Slater M., Snyder L. (Eds) The sage sourcebook of advanced data analysis methods for communication research. (pp. 13–54). Sage Publications. [Google Scholar]
  40. Prime H., Wade M., Browne D. T. (2020). Risk and resilience in family well-being during the COVID19 pandemic. American Psychologist, 75(5), 631–643. 10.1037/amp0000660 [DOI] [PubMed] [Google Scholar]
  41. Roos L. E., Salisbury M., Penner-Goeke L., Cameron E. E., Protudjer J. L. P., Giuliano R., Afifi T. O., Reynolds K. Kyoung-Sae. (2021). Supporting families to protect child health: Parenting quality and household needs during the COVID19 pandemic. Plos One, 16(5), e0251720. 10.1371/journal.pone.0251720 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Russell B. S., Hutchison M., Tambling R., Tomkunas A. J., Horton A. L. (2020). Initial challenges of caregiving during COVID19: Caregiver burden, mental health, and the parent-child relationship. Child Psychiatry And Human Development, 51(5), 671–682. 10.1007/s10578-020-01037-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Schwarz G. M., Stensaker I. (2020). Researching a pandemic: Letting COVID-19 drive our research. The Journal of Applied Behavioral Science, 56(3), 261–265. 10.1177/0021886320937820 [DOI] [Google Scholar]
  44. Shajani Z., Snell D. (2019). Wright and leahey's nurses and families: a guide to family assessment and intervention. F.A. Davis Company. [Google Scholar]
  45. Sherbourne C. D., Stewart A. L. (1991). The MOS social support survey. Social Science and Medicine, 32(6), 705–714. 10.1016/0277-9536(91)90150-B [DOI] [PubMed] [Google Scholar]
  46. Shrout P. E., Bolger N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422–445. 10.1037/1082-989X.7.4.422 [DOI] [PubMed] [Google Scholar]
  47. Smilkstein M., Ashworth C., Montano D. (1982). Validity and reliability of the family apgar family function test. Journal of Family Practice, 15(2), 303–311. [PubMed] [Google Scholar]
  48. Spinelli M., Lionetti F., Pastore M., Fasolo M. (2020). Parents’ stress and children's psychological problems in families facing the COVID19 outbreak in Italy. Frontiers In Psychology, 11, 1713. 10.3389/fpsyg.2020.01713 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Stoecklin D., Gervais C., Kutsar D., Heite C. (2021). Lockdown and children’s well-being: Experiences of children in Switzerland, Canada and Estonia. Childhood Vulnerability Journal, 3(1-3), 41–59. 10.1007/s41255-021-00015-2 [DOI] [Google Scholar]
  50. Suffren S., Dubois-Comtois K., Lemelin J. P., St-Laurent D., Milot T. (2021). Relations between child and parent fears and changes in family functioning related to COVID19. International Journal Of Environmental Research And Public Health, 18(4), 1786. 10.3390/ijerph18041786 [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Sy M., O’leary N., Nagraj S., El-Awaisi A., O’carroll V., Xyrichis A. (2020). Doing interprofessional research in the COVID-19 era: A discussion paper. Journal of Interprofessional Care, 34(5), 600–606. 10.1080/13561820.2020.1791808 [DOI] [PubMed] [Google Scholar]
  52. Tedeschi R. G., Calhoun L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal Of Traumatic Stress, 9(3), 455–471. 10.1002/jts.2490090305 [DOI] [PubMed] [Google Scholar]
  53. Thorell, L. B., Skoglund, C., de la Peña Almudena Giménez, B. D., Fuermaier, A. B. M., & Groom, M. J., … Christiansen, H. (2021). Parental experiences of homeschooling during the COVID19 pandemic: differences between seven European countries and between children with and without mental health conditions. European Child & Adolescent Psychiatry, 31(20210107), 649–661. 10.1007/s00787-020-01706-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Topp C. W., Østergaard S. D., Søndergaard S., Bech P. (2015). The WHO-5 well-being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167–176. 10.1159/000376585 [DOI] [PubMed] [Google Scholar]
  55. Toran M., Sak R., Xu Y., Şahin-Sak İ. T., Yu Y. (2021). Parents and children during the COVID-19 quarantine process: Experiences from Turkey and China. Journal of Early Childhood Research ,19(1), 21–39. 10.1177/1476718X20977583 [DOI] [Google Scholar]
  56. Tourette-Turgis C., Chollier M. (2021). Lifestyle changes and psychosocial impact of COVID-19 lockdown. Medecine Des Maladies Metaboliques, 15(1), 40–44. 10.1016/j.mmm.2020.12.006 [DOI] [Google Scholar]
  57. Van Mulukom V., Muzzulini B., Rutjens B. T., Van Lissa C. J. & Farias M. (2021). The psychological impact of threat and lockdowns during the COVID19 pandemic: Exacerbating factors and mitigating actions. Translational Behavioral Medicine, 11(7), 1318–1329. 10.1093/tbm/ibab072 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Walsh F. (2015). Strengthening family resilience (Third). Guilford Press. [Google Scholar]
  59. World Health Organization. (2020). Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus ( 2019-nCoV ). https://www.who.int/fr/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
  60. Wright L. M., Leahey M. (2013). Nurses and Families: A Guide to Family Assessment and Intervention (6th ed.). F.A. Davis Company. [Google Scholar]

Articles from The Canadian Journal of Nursing Research are provided here courtesy of SAGE Publications

RESOURCES