Pre-Pandemic Factors Associated with Pandemic Impact and Psychosocial Distress Among Mothers of Young Children

Abstract

Objective:

To describe COVID-19 pandemic impact among mothers of young children (0-8 yrs.) and assess pre-pandemic factors associated with greater pandemic impact and psychosocial distress.

Methods:

Mothers from three US birth cohorts (n=301, mean child age 2.4 years) reported on demographics and psychosocial distress (anxiety, perceived stress, financial stress) before the pandemic (2/2015-2/2020). During the pandemic (7/2020-6/2021), they completed a supplemental survey about the impact of the pandemic on their families (Coronavirus Impact Scale) and psychosocial distress. Multivariable linear and ordinal logistic regression were used to evaluate pre-pandemic factors associated with pandemic impact overall and by domain.

Results:

Compared to pre-pandemic reports, maternal anxiety symptoms increased by 9.4%, perceived stress increased by 13.3%, and financial stress increased by 41.7%, of which all were statistically significant changes. Participants reported the most severe pandemic impact in family routines (72.4%), experiences of stress (40.2%), and social support (38.6%). Mothers with some college or a 4-year degree experienced higher overall pandemic impact compared to mothers with the least and highest education. Pre-pandemic distress was not associated with pandemic impact however, mid-pandemic, all three distress measures were significantly positively associated with overall CIS, with the largest effect size noted for perceived stress (B=1.36, 95% CI: 0.90,1.82).

Conclusions:

While, on average, mothers of young children experienced worsening psychosocial stress during the COVID-19 pandemic, pre-pandemic psychosocial stress alone was not prospectively associated with greater pandemic impact, suggesting that the COVID-19 pandemic may have both elaborated existing systemic social inequalities and created new burdens.

BACKGROUND

Throughout the COVID-19 pandemic, but particularly during the early lockdown phase, families around the globe experienced severe disruptions.^1,2 Families with young children were particularly vulnerable to these disruptions given 1) their dependence on childcare and schools, 2) increased caregiving responsibilities in the context of persistent childcare and school closures and quarantines, and 3) the lack of an FDA-authorized COVID-19 vaccine for children 0-5 years until June 2022. Many mothers, who are more likely to be primary caregivers, bore a dual burden as essential workers and caregivers and reported work and life disruptions.^3–5 Such disruptions have implications for child and family health. Prior research demonstrates that parent stress is related to less adaptive parenting behavior and more challenging child behavior^6–8, as well as child outcomes such as mental health, overweight, and obesity.

Pandemics, including COVID-19, H1N1, and SARS, have been linked with increases in family and parenting stress including excessive worry, symptoms consistent with post-traumatic stress, and increased financial burden.⁹ Among mothers of infants and young children, pandemic-related distress has been linked to greater family dysfunction and conflict.^10–12 Maternal psychosocial distress, including depressive and anxiety disorders as well as related sub-clinical levels of symptomatology, is linked to a range of child and family outcomes, including poorer child neurocognitive and social-emotional development.^13,14 Thus, it is plausible that maternal psychosocial functioning could play a role in the impact of the pandemic on families with young children. However, existing research has been primarily cross-sectional, assessing parents’ psychosocial pandemic impacts without the ability to consider their pre-pandemic circumstances.^15–18 A better understanding of pre-pandemic factors associated with greater pandemic-related psychosocial distress and pandemic impact could inform risk stratification and preventive interventions, highlight gaps in existing efforts, and suggest when resources should be deployed to reduce pandemic impacts on caregivers and children.

Using a sample of families in three US states (Florida, North Carolina, and Maryland), the objectives of this study were to 1) describe COVID-19 pandemic impact among mothers of young children (0-8 years) and their families and 2) to evaluate pre-pandemic maternal characteristics associated with greater pandemic impact and psychosocial distress (anxiety, depressive symptoms, financial stress). We hypothesized that pre-pandemic maternal psychosocial distress would be associated with greater distress during the pandemic and greater pandemic impact.

METHODS

Design and Participants

Data are from a convenience sample of three related birth cohorts chosen because they collected information about maternal functioning before the pandemic and implemented a survey of participating mothers during the pandemic. Pregnant people included in this analysis were initially recruited in Florida (PREDICT Cohort, 2015-20),^19,20 North Carolina (SHIP Cohort, 2017-20),^20,21 and Maryland (PROSPECT Cohort, 2018-19). Briefly, pregnant people were eligible if they were at least 18 years old, spoke and read English (PREDICT), or English or Spanish (SHIP, PROSPECT), and planned to deliver at a study-affiliated hospital. Pregnancies in which the fetus had a congenital anomaly or chromosomal abnormality, or the mother had HIV, Hepatitis C, or Hepatitis B were excluded. The average gestational age at enrolment was 20.8 weeks (SD = 6.9) for SHIP, 24.6 weeks (SD = 6.3) for PREDICT, and 33.6 weeks (SD 2.4) for PROSPECT.

At study enrollment (2/2015-2/2020), mothers reported on demographics, family social conditions, health, and psychosocial distress using surveys. Between July 2020 and June 2021, participants were invited to complete an optional supplemental survey about the impact of COVID-19 on their families. This supplemental survey included the same measures of psychosocial distress as the pre-pandemic survey. This study was approved by the relevant university Institutional Review Boards, and participants provided written informed consent.

Measures

Psychosocial Distress.

During pregnancy and again during the pandemic, maternal psychosocial distress was assessed using three indicators. These indicators capture the burden of mental health symptoms, daily stressors, and financial stressors.

Anxiety Symptoms.

Anxiety symptoms were measured using the PROMIS Emotional Distress-Anxiety-6a.²² This 6-item measure includes items such as “My worries overwhelmed me.” Items are scored on a 5-point scale from never [1] to always [5] (range: 6 to 30). Higher scores indicate more anxiety.

Perceived Stress.

Perceived stress was measured using the Perceived Stress Scale (PSS).²³ This 10-item measure evaluates the extent to which individuals appraise their experiences and circumstances in the last month as stressful. Items include, “In the last month, how often have you felt that you were unable to control the important things in your life?” rated on a 5-point Likert scale from never [0] to very often [4] (range 0-40). Higher scores indicate higher perceived stress.

Financial Stress.

Financial stress was measured using 5 items from Essex and colleagues adapted by Riis et al.²⁴ Items include “In the last three months, how often did you fear you might be laid off?” scored on a 5-point Likert scale from never [0] to always [4] (range: 0-20). Higher scores indicate more financial stress.

COVID Pandemic Impact.

The impact of the pandemic on families was assessed using the Coronavirus Impact Scale (CIS), which has been validated in English and Spanish.²⁵ The CIS assesses pandemic impact in eight domains: routines, income/employment, food, access to somatic and mental healthcare, support, personal stress, and family stress. Each domain is assessed as no change [0], mild [1], moderate [2], or severe impact [3]. Total pandemic impact score was calculated by summing across domains, with higher scores indicating greater impact. To allow for direct comparison with pre-pandemic data, the question about impact on income/employment was omitted from the scale and asked separately (as has been previously implemented in validation studies).²⁵ The range for the remaining 7 items was 0-21. The CIS also includes a question about whether the respondent had ever had a personal diagnosis of COVID-19 (yes/no).

Covariates:

Maternal education was categorized as 1) high school or less, 2) vocational/technical, or any college up to a 2-year college degree, 3) 4-year college degree, and 4) master’s degree and above. Annual family income was categorized as <$25,000, $25,000 to $49,999, $50,000 to $99,999, or >$100,000. Self-reported race and ethnicity were collected as a proxy for racialized stressors and to capture differential pandemic burdens among US racial and ethnic groups. Respondents indicated whether they were Hispanic/Latinx or not Hispanic/Latinx and their racial identity, including “other race” and “more than one race.” Maternal current relationship status, regardless of whether the partner was the other parent, was categorized as partnered (i.e., married, romantically involved/not married) vs. not partnered (i.e., separated/divorced/not in any kind of relationship). Mothers also self-reported whether they participated in one or more public programs (rental assistance, Temporary Assistance to Needy Families or cash welfare, Disability/Social Security, agency support to collect child support, visiting nurse, Healthy Start or other parenting class, Head Start/Early Head Start, Women, Infants and Children, early intervention, or Supplemental Nutrition Assistance Program), both pre-pandemic and mid-pandemic (coded as participated in 1+ program vs. none).

Statistical Analysis

Descriptive statistics (frequencies, means, SDs, proportions) were used to characterize pandemic impact, both by CIS total score and by domain of impact. Paired t-tests were used to compare maternal psychosocial distress (anxiety symptoms, perceived stress, financial stress) pre- to mid-pandemic. ANOVA and t-tests were used to evaluate differences in total pandemic impact by maternal characteristics. Then, multivariable linear and ordinal logistic regression were used to evaluate the association between maternal demographics and psychosocial distress with 1) total pandemic impact score (linear regression) and 2) each domain of pandemic impact (ordinal logistic regression). The three psychosocial distress measures were z-scored to facilitate comparison of effect sizes. All models were adjusted for maternal education, pre-pandemic family income, child age (as a proxy for time since baseline data collection), and pre-pandemic maternal relationship status. Odds ratios (ORs) from ordinal logistic regression models, betas from linear regression models, and accompanying 95% confidence intervals are reported to describe effect sizes, with statistical significance set at p<0.05. In models evaluating pandemic impact domains, we used Bonferroni corrected p-values (p<0.006) to account for multiple comparisons (p=0.05/8 domains). Analyses were conducted using Stata version 15 (Stata Corp, College Station, TX).

RESULTS

A total of 331 mothers completed the supplemental survey (participants in all cohorts: n=861), and response rates ranged from 30-53% across sites (overall response rate 35%). Participants with missing pre-pandemic psychosocial distress or CIS scores (8.9%) were excluded from the final analytic sample of n=301. Figure 1 summarizes sample selection. Mothers who completed the supplemental COVID-19 survey were more likely to live in Florida, identify as White, be partnered, and have higher incomes and educations than those who did not (Supplemental Table 1).

Figure 1. Sample Selection Details for PREDICT, SHIP and PROSPECT Cohorts.

Note: PREDICT was implemented in two phases. The first phase enrolled its first participant in 2014 (although the sample for the current analysis does not include participants from 2014). The second phase began recruiting in 2017. SHIP and the second phase of PREDICT were implemented together with the same protocol and data collection instruments between 2017 and 2020. PROSPECT was a pilot cohort, mirroring PREDICT, designed to evaluate the feasibility of a birth cohort of immigrants whose preferred healthcare language was Spanish.

Participant self-reported racial/ethnic identity was noted as 2% Asian, 20% Black/African American, 4% multiple races, 10% other race [as selected by respondents], 64% White, and 21% Hispanic/Latinx (Table 1). Thirty-six percent of participants were essential workers, more than a quarter had annual family incomes of <$25,000, and 62% had less than a 4-year college degree. Just over half (53%) of participants reported participating in a public benefit program during the pandemic. The mean age of the index child in the birth cohort study was 2.4 years (SD:1.3). Maternal anxiety symptoms, perceived stress, and financial stress all increased significantly from pre- to mid-pandemic (Table 1). Anxiety symptoms increased 9.4%, perceived stress increased 13.3%, and financial stress increased 41.7%.

Table 1.

Characteristics of participating mothers and their index children (n=301)

	Pre-pandemic	Mid-pandemic	p-value
Maternal Characteristics	n (%) or M (SD)	n (%) or M (SD)
Site, n (%)
Florida	184 (61%)	-
Maryland	21 (7%)	-
North Carolina	96 (32%)	-
Education level, n (%)
High school/vocational school or less	91 (30%)	-
Trade school, some college, 2-yr college	96 (32%)	-
4-year college degree	69 (23%)	-
Master’s degree or more	42 (14%)	-
Race, n (%)
Asian	6 (2%)	-
Black	59 (20%)
More than one racea	12 (4%)	-
Other racial identity	30 (10%)
White	194 (64%)
Ethnicity, n (%)
Hispanic or Latino	62 (21%)	-
Not Hispanic or Latino	237 (79%)
Essential worker n (%)	107 (36%)
Maternal romantic partner, n (%)
Partnered	271(91%)	-
Not Partnered	26 (9%)	-
Total household income, n (%)
<$25,000	73 (28%)	-
$25,000 to $49,999	67 (26%)	-
$50,000 to $99,999	64 (24%)	-
≥$100,000	57 (22%)	-
Participated in any public benefit program,b n (%)
Yes	50 (43%)	160 (53%)	ns
Personal diagnosis of COVID, n (%)	-	26 (9%)
Maternal psychosocial distress, M (SD)
Anxiety symptoms	9.6 (4.4); range:6-28	10.5(4.8); range: 6-30	*
Perceived stress	12.0 (6.4); range: 0-34	13.6 (6.3); range:0-32	*
Financial stress	3.6 (3.8); range: 0-18	5.1 (4.7); range: 0-20	*
Coronavirus Impact Scale score, M (SD)	-	6.8 (3.8); range: 0-18
Child characteristics	n (%)or M (SD)	N (%) or M (SD)
Age (years), M(SD)	-	2.4 years (1.3)
Female (assigned at birth), n (%)	131(45%)	-

SD: standard deviation

^aCategory self-selected by participants

^bParticipants in the SHIP cohort did not have information about pre-pandemic public assistance program participation

^*Indicates p<0.05 comparing pre- to mid-pandemic based on paired t-test

Overall Pandemic Impact

Total Coronavirus Impact Score (CIS) ranged from 0 to 18, with a mean of 6.8 (SD: 3.8). Impact severity varied across domains. Participants reported the most severe pandemic impact in family routines (72.4% reported moderate to severe impact), experiences of stress (40.2% reported moderate to severe impact), and social support domains (38.6% reported moderate to severe impact, Figure 2).

Figure 2:

Domain-specific pandemic impact scores, as reported by mothers of young children (moderate and severe categories are highlighted).

Impact also varied by maternal sociodemographic characteristics (Table 2). Specifically, Hispanic/Latinx mothers reported lower impact than non-Hispanic/Latinx mothers (CIS M=5.9 vs. 7.1, respectively). Mothers with the least and most educational attainment (HS/vocational school or less [CIS M=5.9] or master’s degree or more [CIS M=6.2]) reported lower pandemic impact than those with some college [CIS M=7.2] or a 4-year degree [CIS M=7.6]. Impact was higher among mothers who did not have a current romantic partner (compared to partnered mothers) and those who participated in a public program during the pandemic (compared to those who did not), although neither comparison reached statistical significance. There were no differences in overall pandemic impact by maternal racial identity, family income, essential worker status, or a personal diagnosis of COVID-19.

Table 2.

Differences in mean COVID Impact Score (CIS) by participant characteristics.

	Mean (SD)	p-value*
Site		0.964
Florida	6.8 (3.2)
Maryland	6.8 (5.2)
North Carolina	6.9 (4.4)
Education		0.008*
High school/vocational school or less	5.9 (4.3)
Trade school, some college, 2-yr college	7.6 (3.9)
4-year college degree	7.2 (2.9)
Master’s degree or more	6.2 (2.8)
Race		0.948
White	6.8 (3.2)
Other identitya	6.7 (4.4)
Black	6.9 (4.8)
Ethnicity		0.034*
Not Hispanic or Latino	7.1 (3.6)
Hispanic or Latino	5.9 (4.4)
Maternal romantic partner		0.055
Partnered	6.7 (3.6)
Not partnered	8.2 (4.6)
Pre-pandemic total household income		0.178
<$25,000	6.7 (4.2)
$25,000 to $49,999	7.8 (3.5)
$50,000 to $99,999	6.8 (3.2)
≥$100,000	6.8 (2.5)
Essential Worker		0.325
Yes	6.6 (3.9)
No/Don’t know	7.0 (3.7)
Participation in a public benefit program, mid-pandemic		0.052
Yes	7.2 (4.2)
No	6.4 (3.2)
Personal Diagnosis of COVID		0.145
Yes	7.8 (4.7)
No	6.7 (3.7)

Note: p values based on ANOVA or t-tests.

^aOther identity includes Asian, other (self-selected by participants), and more than one race

Pre- and Mid-Pandemic Maternal Psychosocial Distress and Pandemic Impact

As shown in Table 3, after adjusting for maternal education, pre-pandemic family income level, presence of a partner, and child age during the pandemic, none of the pre-pandemic maternal psychosocial distress measures (anxiety symptoms, perceived stress, financial stress) was significantly associated with overall pandemic impact. In contrast, mid-pandemic, all three psychosocial measures were significantly positively associated with CIS, with the largest effect size for perceived stress (B=1.36, 95% CI: 0.90,1.82).

Table 3.

Adjusted relationship of standardized pre- or mid-pandemic maternal psychosocial distress (anxiety symptoms, perceived stress, financial stress) with overall pandemic impact and domain-specific scores. (Higher scores indicate greater pandemic impact.)

	CIS Total Score	Family Routines	Experience of Stress	Access to Social Support	Stress/Discord in the Family	Somatic Health Care Access	Mental Health Care Access	Food Access
	B (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Anxiety, pre-pandemic	0.47 (0.01, 0.93)	1.19 (0.89, 1.60)	1.26 (0.94,1.68)	0.96 (0.72,1.28)	1.49 (1.09, 2.04)	1.12 (0.82, 1.54)	1.12 (0.77, 1.63)	1.16 (0.86, 1.57)
Anxiety, mid-pandemic	0.82 (0.36, 1.29)	1.03 (0.77, 1.37)	2.08 (1.54, 2.80)	1.23 (0.94,1.63)	1.44 (1.07, 1.93)	1.08 (0.80, 1.44)	2.77 (1.85, 4.14)	1.34 (1.00, 1.81)
Perceived stress, pre-pandemic	−0.10 (−0.58, 0.39)	0.86 (0.63, 1.17)	0.83 (0.60, 1.14)	0.91 (0.68,1.23)	1.08 (0.78, 1.50)	1.04 (0.76, 1.41)	1.16 (0.80, 1.69)	0.97 (0.71, 1.33)
Perceived stress, mid-pandemic	1.36 (0.90, 1.82)	1.50 (1.13, 2.00)	2.70 (1.97, 3.71)	1.32 (1.00,1.74)	2.79 (1.98, 3.93)	1.37 (1.02, 1.83)	1.91 (1.28, 2.85)	1.44 (1.06, 1.95)
Financial stress, pre-pandemic	0.05 (−0.46, 0.57)	1.22 (0.89, 1.68)	1.02 (0.74, 1.40)	1.08 (0.80, 1.47)	1.07 (0.77, 1.48)	0.91 (0.66, 1.24)	1.04 (0.71, 1.53)	0.82 (0.60, 1.14)
Financial stress, mid-pandemic	1.02 (0.55, 1.50)	1.33 (0.98, 1.81)	1.59 (1.19, 2.13)	1.28 (0.96, 1.71)	1.47 (1.08, 2.00)	1.29 (0.96, 1.72)	1.52 (1.06, 2.19)	2.19 (1.58, 3.04)

CIS: Coronavirus Impact Score; OR: Odds ratio

CIS total score was modeled using linear regression; domain-specific scores were modeled using ordinal logistic regression.

Note: All models are adjusted for maternal education, pre-pandemic family income level, and maternal romantic partner, child age

Bold values indicate Bonferroni-corrected p-value <0.006 (0.05/8= 0.00625)

As with the overall CIS, pre-pandemic anxiety symptoms, perceived stress, and financial stress were not significant predictors of COVID-19 impact in any of the seven domains evaluated (Table 3). However, accounting for multiple comparisons, poorer mid-pandemic maternal psychosocial functioning was associated with greater impact on family routines, experience of stress, stress and discord in the family, challenges with mental health care access, and food access. A one SD increase in mid-pandemic perceived stress was associated with 50% greater odds of higher impact on family routines (e.g., mild vs. moderate or moderate vs. severe impact), 2.7 times greater odds of higher impact on experience of stress, more than 2.8 times greater odds of higher impact on stress and stress and discord in the family, and 1.9 times greater odds of higher difficulty with mental health care access. A one SD increase in mid-pandemic anxiety was associated with 2.1 times greater odds of higher impact on experience of stress and 2.8 times greater odds of higher impact on mental health care access. Finally, a one SD increase in mid-pandemic financial stress was associated with 60% increased odds of higher impact on experience of stress and 2.2 times greater odds of higher impact on food access.

Discussion

In this geographically, racially, and socioeconomically diverse sample, we examined pre-pandemic factors associated with pandemic impact among mothers of young children in the US followed since pregnancy. Not surprisingly, we found increases in anxiety symptoms, perceived stress, and financial stress when comparing the pre-pandemic to mid-pandemic periods. These results are consistent with a recent meta-analysis evaluating the impact of the COVID-19 pandemic on reports of depression and anxiety in mothers during pregnancy and the perinatal period.¹⁵ Concerningly, these levels of increased stress are unlikely to have resolved post-pandemic. Work from the 2023 Stress in America study reflects that as a nation, we continue to recover from the “collective trauma of the pandemic,” and groups, including parents with children <18 yrs. of age, remain at high risk for persistent mental health burden.²⁶ In particular, compared to other adults, parents reported feeling “completely overwhelmed” on most days (48% vs. 26%) and consumed by worries regarding money (66% vs. 39%), highlighting the need for robust and continual investments in parental mental health as a fundamental pandemic recovery strategy. Additional data from our study may inform how we further support parents of young children.

Overall COVID Impact

Not all families were affected equally. Interestingly, mothers with the least and greatest amounts of education reported, on average, the lowest levels of overall pandemic impact. These findings may reflect that those with the most education may have had the resources and job flexibility to mitigate some impact of the pandemic, while mothers with intermediate college education found themselves in uncharted and precarious circumstances when lockdowns hit. Prior studies have found that working mothers, including those with intermediate education, were forced to cut back their employment or were often released from employment,²⁷ exposing them to new and often uncertain routines, childcare demands, and financial needs.

We were surprised to find that non-Hispanic/non-Latinx mothers reported greater pandemic impact than Hispanic/Latinx mothers. This finding is in contrast to prior research¹⁷ including focused work on Latinx mothers by Hibel et al.¹⁶ Prior studies suggest Latinx mothers experienced what may have been a perfect storm of challenges in navigating the pandemic based on racial, gender, and class-related biases, resulting in increased psychological and economic distress and these mothers did not find their psychosocial or financial burdens reduced by federal stimulus payments.¹⁶ Notably, in this prior study, 92% of mothers reported that at least one adult in the family identified as an essential worker, but our sample included 36% of mothers who identified as such. Thus, essential worker status within Latinx families of young children may be a stronger predictor of family pandemic impact than Hispanic ethnicity alone. Similarly, we did not observe differences in pandemic impact by race, yet this likely reflects limitations in our sample’s racial diversity given substantial ongoing research demonstrating the disproportionate impact of the pandemic on individuals with minoritized racial identities.²⁸

Next, we found that mothers who participated in one or more public benefits programs had a greater pandemic impact than those who did not, as did those without a current romantic partner (compared to those with a partner), although neither reached statistical significance. These findings may highlight the potential role of material and social supports that may buffer families from the effects of the pandemic. Consistent with our findings, Parolin et. al found that expansion of income transfers largely buffered against potential increases in economic hardship, yet levels of worry and distress among not-partnered parents continued to worsen throughout the pandemic²⁹ suggesting that partnership may buffer financial stress. Similarly, mothers participating in public benefits programs such as now-expired federal policies including the child tax credits,³⁰ eviction extensions,³¹ and unemployment expansion,³² may have had greater opportunity to buffer pandemic-exacerbated financial stressors regardless of partnership status.

We noted the greatest severity of COVID impact in family routines, maternal experiences of stress, and social support. In work by Ganderman et. al, maintaining family routines was the most frequently identified parent-identified support to help their child cope with pandemic-related stress (54%), more so than maintaining a healthy lifestyle (41%) or connecting with friends (36%).¹ Qualitative studies of expectant mothers revealed that many felt the need to minimize and control the chaos in their lives during the pandemic.³³ These data suggest that parents may see the preservation of family routines as critical to family well-being, highlighting opportunities for interventions to focus on supporting family routines in times of crisis, not just for child health, but also for maternal well-being.

It is not surprising that mothers frequently reported severe pandemic increases in their experiences of stress. This could include, for example, the fear of contracting COVID or having their child/children contract COVID, politicized decisions about following quarantine recommendations, testing, and vaccination, all of which may have strained family and community relationships and caused increased stress.^34,35 Similarly, it is well documented that the pandemic led to a widespread increase in social isolation.³⁶ Mothers without a partner to rely on may have been particularly impacted by loss of community-level social supports. Building capacity for innovative strategies such as virtual parent support interventions and open-access tele-mental health resources are important potential considerations to mitigate the impact of future public health emergencies.

Association of Pre-Pandemic and Mid-Pandemic Maternal Psychosocial Distress with COVID Impact

Interestingly, we found that maternal anxiety symptoms, perceived stress, and financial stress, measured before the pandemic were not associated with future pandemic impact overall or in any domain. That is, among mothers of young children, pandemic impacts were not simply an elaboration of pre-existing psychosocial risks but rather a function of changing stressors, resources, or both. In contrast, mid-pandemic all three psychosocial distress measures were associated with increased overall pandemic impact. The associations between mid-pandemic measures and unique domains appeared to be highest between mid-pandemic anxiety and mental healthcare access, as well as mid-pandemic perceived stress and stress/discord in the family. While barriers to mental healthcare access are widely known, these results highlight the need to continue targeting mothers of young children where novel interventions such as digital mental health services may be particularly useful.³⁷ The impact of enhanced connectivity to mental health as well as other parent supports are highlighted by recent work describing predictors of family thriving during the pandemic identified that parents with low self-efficacy and increased self-criticism predicted family distress and negative child well-being.³⁸ It follows that mothers of young children may more frequently have experienced greater self-criticism during the pandemic, resulting in a broader experience of stress where opportunities for parent coaching and/or open-discussion forums related to parenting might further mitigate maternal distress. Mid-pandemic financial stress was also associated with impact on experiences of stress as well as food access. These findings support prior work that found associations between parental financial stress and worse outcomes during pandemic events.⁹

Limitations

The longitudinal design of this study and the inclusion of measures of stress before the COVID-19 pandemic fill a critical gap in our understanding of the psychosocial experiences of mothers of young children. Additionally, the inclusion of mothers from multiple sites within the US enhances the generalizability of our findings. Nonetheless, limitations of this study include the use of maternal self-report in assessing both psychosocial stress and family impact. Because the survey was not originally anticipated as part of data collection in an ongoing study, the COVID-19 supplement favored mothers with higher education, those with higher incomes, and those identifying as White. Moreover, mothers who declined to complete the survey or could not be reached may have experienced greater COVID impact. While it is not possible to quantify pandemic impact among non-responders, we did identify antecedent conditions indicative of risks among mothers who did not respond. Last, the persistent changes and continued evolution of the pandemic as it relates to childcare/school closures, as well as the availability of family-centered resources, limits the representativeness of these findings to a unique window of the pandemic period and the experiences of mothers of young children. However, these results highlight key maternal populations of interest as well as areas of impact unique to mothers of young children that can inform recovery efforts moving forward.

Conclusions

While, on average, mothers of young children experienced worsening psychosocial stress during the COVID-19 pandemic, pre-pandemic psychosocial stress alone was not prospectively associated with greater pandemic impact. That is, among mothers of young children, pandemic impacts were not just a reflection of pre-existing psychosocial risks. Our findings suggest that mothers who experience the most distress before a public health emergency and those who bear the greatest burden of psychosocial distress during an emergency may be distinct groups. Therefore, widespread assessment of mothers in need is important. The results of this study also raise the possibility that for mothers of young children, the COVID-19 pandemic may have both elaborated existing systemic social inequalities and created new burdens. Ongoing efforts to reduce disruptions to family routines, maternal social isolation, high levels of stress, and barriers to accessing healthcare resources are essential for families with young children.

What’s New:

While mothers of young children experienced worsening psychosocial distress during the pandemic, pre-pandemic psychosocial distress alone was not associated with greater family pandemic impact. The pandemic may have both exacerbated existing systemic social inequalities and created new burdens.