Although researchers have addressed the tremendous impact of the COVID-19 pandemic on parent and child mental health (e.g., Feinberg et al., 2022; Russell et al., 2020), fewer efforts have focused specifically on parents of children with chronic medical conditions, who are generally at higher risk for psychological distress. Wauters et al. (2022) aimed to address this gap in the literature by surveying a broad sample of parents from pediatric clinics in Belgium during the early months of the COVID-19 pandemic.
Wauters et al. (2022) found that parents of children with chronic diseases reported significantly more anxiety compared to parents of healthy children. Furthermore, parent mental health outcomes (i.e., anxiety, depression, sleep, and burn-out) were significantly correlated with COVID-19 stressors including financial worries, less living space, and lower perceived quality of healthcare. Lastly, the authors found that the relationship between COVID-19 stressors and parent mental health was mediated by parent burn-out.
Several areas of focus from Wauters et al. (2022) offer guidance for further exploration of caregiver wellbeing during the COVID-19 pandemic including (a) exploring varying approaches to assessing risk factors, (b) burn-out and positive parenting as intervention targets, and (c) the importance of inclusion of racially and ethnically diverse participants.
Assessing Risk Factors
Wauters et al. (2022) assessed multiple categories of risk that may have contributed to parent mental health during the COVID-19 pandemic. Of those explored, parental burn-out and financial worries correlated most strongly with parental psychological functioning. Furthermore, their findings supported the growing evidence that mothers, single parents, and younger parents may be particularly vulnerable groups. These results suggest that psychosocial and demographic risk factors are crucial to consider when conceptualizing and assessing parent mental health.
Although Wauters et al. (2022) provided preliminary results for important stressors that contribute to caregiver wellbeing, parents of children with chronic medical conditions likely experience stressors beyond the domains assessed in this study, which may vary by medical population. For example, Colton et al. (2022) found that worry about finding safe food significantly predicted anxiety in parents of children with food allergies, beyond other risk factors. Future research will benefit from frameworks that include additional risk factors that might contribute to parent mental health and delineate whether cumulative risk models (i.e., summed accumulation of risk factors) or multivariate models (i.e., interactive effects of risk factors) are best suited to explore the impact of risks on parent mental health.
For example, Josie et al. (2008) found utility for a cumulative risk index, or a summed index score of accumulated risk factors, to predict family burden in families of children with traumatic brain injury. However, a linear approach to conceptualizing risk ignores the possibility that some factors may carry more impact or interact with other risk factors in a non-linear fashion. In parents of children with chronic medical conditions, sociodemographic factors, child disease-related factors, and individual factors, all likely present risk of maladjustment in an interactive and non-linear manner. Exploration of additive, bidirectional, or interaction risk models is warranted.
Burn-Out and Positive Parenting
Parental burn-out can result from high demands that are not sufficiently met by available resources, and it has been documented throughout the COVID-19 pandemic (Griffith, 2020; Kerr et al., 2021). In Wauters et al. (2022), parental burn-out mediated the relationship between COVID-19 stressors and parent mental health.
These findings provide guidance for intervention development. Addressing parental burn-out through clinical intervention could be an intervention target to improve caregiver wellbeing as the COVID-19 pandemic continues. For example, preliminary evidence for a group intervention targeting parent burn-out for chronically ill children suggested that this modality was well accepted and resulted in a significant reduction in parental burn-out (Lindström et al., 2016). In addition, although in Wauters et al. (2022) positive parenting experiences were not a significant mediator between stressors and parent mental health, it was strongly negatively associated with parental burn-out, suggesting that positive parenting may indirectly lead to improved mental health outcomes. A strengths-based approach to caregiver wellbeing, such as positive parenting, was highlighted in Wauters et al. (2022) and should be explored further.
Racial and Ethnic Diversity
The clinical sample in Wauters et al. (2022) was comprised of less than 4% of individuals of a non-White ethnicity. Although this reflects the demographics of Belgium, the sample demographics limit generalizability to racial and ethnic minorities within similar countries and others that are more heterogeneous. The authors found that parents identifying as having a non-White ethnicity experienced more parental anxiety and sleep problems.
The lack of racial and ethnic diversity in research participants is not unique to Wauters et al. (2022). The field of pediatric psychology has made a call for racial and ethnic minority samples to be prioritized and considered in all research efforts (Palermo et al., 2021). Buchanan et al. (2021) offers recommendations for improving diversity and addressing systemic racism in all stages of psychological science including conducting, reporting, reviewing, and disseminating research. Without the inclusion of these individuals, as well as the consideration of historical and continued racial and ethnic discrimination, we limit the conclusions that can be drawn from research findings, thus, limiting the impact we can have on the communities in which we serve.
Conclusions
Wauters et al. (2022) provide a framework for exploring mental health outcomes and potentially modifiable factors in pediatric caregivers during the COVID-19 pandemic. As the COVID-19 pandemic continues, research must focus on the persisting and long-term outcomes for caregivers of children with chronic medical conditions. The examination of COVID-19-specific stressors and mental health outcomes with racially and ethnically diverse parent samples in diverse countries such as the United States will add to the generalizability of Wauters et al. (2022). Future research might consider varying approaches to assessing risk factors, examining burn-out and positive parenting as avenues for parent intervention, and prioritizing the inclusion of racial and ethnic minority participants.
Conflicts of interest: None declared.
Contributor Information
Kelsey L Hill, Department of Psychology, Eastern Michigan University, USA.
Catherine C Peterson, Department of Psychology, Eastern Michigan University, USA; Division of Allergy and Immunology, University of Michigan Health System, USA.
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