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. 2022 Oct 5:10664807221131006. doi: 10.1177/10664807221131006

The Impact of COVID-19 Pandemic on Family Well-Being: A Literature Review

Maria Gayatri 1,✉, Mardiana Dwi Puspitasari 2
PMCID: PMC9535451

Abstract

Background: COVID-19 has changed family life, including employment status, financial security, the mental health of individual family members, children's education, family well-being, and family resilience. The aim of this study is to analyze the previous studies in relation to family well-being during the COVID-19 pandemic. Methods: A literature review was conducted on PubMed, Medline, Web of Science, and Scopus for studies using a cross-sectional or quasi-experimental design published from their inception to October 15, 2020, using the keywords “COVID-19,” “pandemic,” “coronavirus,” “family,” “welfare,” “well-being,” and “resilience.” A manual search on Google Scholar was used to find relevant articles based on the eligibility criteria in this study. The presented conceptual framework is based on the family stress model to link the inherent pandemic hardships and the family well-being. Results:The results show that family income loss/economic difficulties, job loss, worsening mental health, and illness were reported in some families during the COVID-19 pandemic. Family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to curb the spread of coronavirus. During the pandemic, it is important to maintain family well-being by staying connected with communication, managing conflict, and making quality time within family. Conclusion: The government should take action to mitigate the social, economic, and health impacts of the pandemic on families, especially those who are vulnerable to losing household income. Promoting family resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.

Keywords: COVID-19, family, pandemic, resilience, welfare, well-being

Introduction

Coronavirus disease 2019 (COVID-19) is a form of pneumonia caused by the severe acute respiratory coronavirus syndrome 2 (SARS-CoV-2) (Lai et al., 2020). The appearance of COVID-19 becomes an outbreak in December 2019 in China. The coronavirus disease can be transmitted through the respiratory tract, digestive system, and also mucosal surface (Ye et al., 2020). Fever, cough, shortness of breath, and diarrhea are the symptoms of COVID-19 infection at the onset. The pandemic of COVID-19 has brought many changes to all the communities, workers, and families to reduce the spread of the coronavirus and limit its impact on health, societal, and economic consequences. This pandemic had a powerful impact on family life. Mental resilience is required for coping strategies during the pandemic (Barzilay et al., 2020).

COVID-19 has changed family life, including employment, financial instability, the mental health of family members, children's education, family well-being, and family resilience. People start to protect themselves from the spread of the coronavirus by physical and social distancing, sheltering-in-place, restricting travel, and implementing health protocols. Some public places are abrupt closures, such as schools, childcare centers, community programs, religious places, and workplaces. This change impacts social life, such as isolation, psychological distress, substantial economic distress, depression, and also domestic violence, including child abuse (Campbell, 2020; Patrick et al., 2020). The Internet has become the most important thing to support all activities while staying at home and staying connected with others.

Families are forced to maintain a work–life balance in the same place with all family members during the pandemic (Fisher et al., 2020). Parents are working from home while children are in school. Therefore, parents and children should share the space for their activities at home. On the one hand, parents should focus on their job to maintain their working target in order to avoid losing their job, heighten their financial concerns, sustain their food security, maintain healthy habits, and keep their family members safe from COVID-19. Balancing life during the pandemic is challenging (Fisher et al., 2020). Fathers and mothers should work together not only on the paid job but also on domestic chores, childcare, and teaching their children.

The aim of this literature review is to identify the impact of the COVID-19 pandemic on family well-being based on the previously published articles.

Literature Review

The coronavirus pandemic has become a public health crisis or disaster that has had an impact on family well-being both directly and indirectly. An infectious disease outbreak has spread rapidly, severely disrupted the world, and resulted in morbidity and mortality. This pandemic produced not only a health crisis, but also a social crisis among the population (Murthy, 2020).

The conceptual framework was adapted from McCubbin and Patterson's family stress model. Using McCubbin and Patterson's family stress model, stressful life events (external stressors) had an impact on family life. During the COVID-19 pandemic, there was a profound impact on Indonesian economic growth and labor market, indicating that more people were living in poverty (Gandasari & Dwidienawati, 2020; Olivia et al., 2020; Suryahadi et al., 2020). Stress-frustration theory indicates that diminished economic resources in the family could add to stress, frustration, and conflict in interpersonal interactions, which might increase the risk of men committing violence against women (Kaukinen, 2020). It means that unemployment and economic instability contributed to the family stress. Furthermore, the underlying pandemic difficulties posed a threat to Indonesian people's mental health (Abdullah, 2020; Megatsari et al., 2020). A higher risk of stress could lead to domestic violence. Domestic violence was defined as a coping mechanism for stress induced by social-systemic variables, such as poverty, unemployment, homelessness, loneliness, and ecological characteristics (Zhang, 2020). Individual stress and other factors (such as job loss, lower income, limited resources and support, and hazardous and harmful alcohol use) were associated with domestic violence during the COVID-19 pandemic (Campbell, 2020). Indonesian children were also affected. A recent study found that the financial burden within the family constituted a risk to Indonesian child competency and adjustment (Riany & Morawska, 2021). The well-being of children might be dependent on the well-being of their parents (Dahl et al., 2014). As a result, the inherent pandemic hardships posed a risk to family well-being.

According to the family stress model, the family must engage in an active process to balance external stressors with personal and family resources and a positive outlook on COVID-19 in order to develop and sustain an adaptive coping strategy to face the inherent pandemic hardships and eventually reach a level of family well-being. Mental health and prevention from the risk of mental disorders were required by incorporating individuals, families, communities, and government during and after pandemic events, so that family well-being and resilience could be achieved and improved (Murthy, 2020). Resilience was characterized as a process that encompassed not just successfully adapting and functioning after experiencing adversity or crisis, but also the possibility of personal and relationship transformation and positive growth as a result of adversity (Walsh, 1996). There were three fundamental processes to becoming resilient: shared belief systems, organizational patterns, and communication processes within the family (Walsh, 1996).

Methods

A literature review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). This study was conducted from the beginning of March 2020, when the first positive case occurred in Indonesia, to October 1, 2020.

In order to meet the research objective, the authors carried out the literature review by searching various databases. The present study uses an integrative review to summarize the existing evidence to obtain a comprehensive understanding of the impact of the COVID-19 pandemic on family welfare. PubMed, Medline, Web of Science, and Scopus are selected as the main sources of the article's database. A manual search on Google Scholar is also conducted to find relevant articles based on the study’s eligibility criteria. The following keywords are used to perform the search, such as “COVID-19,” “pandemic,” “coronavirus,” “family,” “welfare,” “resilience,” and “mental health.” A total of 67 articles with the matching keywords were primarily retrieved.

Studies were eligible for inclusion if the studies are cross-sectional, experimental designs, or cohort studies describing the impact of the pandemics on family well-being both physical and mental well-being. Studies had to be published from the inception of the pandemic to October 15, 2020, in a journal with impact factors, English-language studies, and related to the COVID-19 pandemic. However, some articles are excluded because they are duplicate articles or studies in non-English language. We also excluded opinions, letters to the editor, and systematic reviews or meta-analyses. Moreover, unpublished articles and reports are also excluded from this study. Finally, based on the inclusion and exclusion criteria, eight articles met the inclusion criteria, and the data were extracted for the next analysis.

Based on eight articles, the data were extracted to include some important information, such as (1) Country/Region, (2) The purpose of the study, (3) Methods of the study, (4) The respondents (sample size and sample characteristics), (5) the main result of the study. The data extraction is done using a form on Microsoft Excel. All articles in this study were evaluated using narrative synthesis and presented data in the table forms.

Results

A total of eight articles were selected for this study, with various subjects consisting of children, adolescents, adults, and parents. The literature review in this study is based on previous studies in the United States, Canada, Brazil, the United Kingdom, Germany, Ireland, Israel, China, Taiwan, Japan, and Bangladesh. Common impacts are physiological stress, anxiety, depression, income loss, fear, economic hardship, food insecurity, and family violence. Higher resilience is associated with fewer COVID-19-related worries, lower anxiety, and lower depression. Greater parental control is associated with lower stress and a lower risk of child abuse. Positive children were infected by the household contact. The results of the review are shown in Table 1.

Table 1.

Characteristics of the Studies.

Reference Country Purpose Method Respondents Main result
Patrick et al. (2020) The United States To determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020 Online research panel created by using probability-based address sampling of U.S. households. National survey of parents using the Ipsos Knowledge Panel. Households without Internet at the time of recruitment are provided with an Internet-enabled tablet 1,011 parents with at least one child under the age of 18 years old in the household 27% of parents reported worsening mental health themselves, and 14% reported worsening behavioral health of their children. The proportion of families with moderate or severe food insecurity increased. Employer-sponsored insurance coverage for children decreased, and parents reported a loss of regular childcare
Islam et al. (2020) Bangladesh To investigate the relationships between human COVID-19 stress with basic demographic, fear of infection, and insecurity-related variables, which can be helpful in facilitating mental health policies and strategies during the COVID-19 crisis period Online-based survey 340 Bangladeshi adult populations (65.9% male) About 85.60% of the participants are in COVID-19-related stress, which results in sleep shortness, short temper, and chaos in family. Fear of COVID-19 infection (i.e., self and/or family member(s), and/or relatives), hampering scheduled study plans and future career, and financial difficulties are identified as the main causes of human stress Economic hardship and food shortages are linked together and cause stress for millions of people, while hamper of formal education and future plan create stress for job seekers
Kimhi et al. (2020) Israel To investigate the extent to which individual resilience, well-being, and demographic characteristics may predict two indicators of the coronavirus pandemic: distress symptoms and perceived danger Online survey: an Internet panel company and an Internet survey through social media by using snowball sampling 605 Jewish Israelis from the Internet survey company and 741 respondents from the Internet sample Individual resilience and well-being were the strongest predictors of distress symptoms and a sense of danger
Barzilay et al. (2020) The United States, Israel, and other countries (the United Kingdom, Canada, Brazil, Germany, Ireland, etc.) To measure resilience using self-reported surveys and explore differences in COVID-19-related stress and resilience Online survey on a crowdsourcing research website 3,042 participants of healthcare providers and non-healthcare providers (engineering, computers, finance, research, legal, government, administration, student, teaching). Respondents were more distressed about family members contracting COVID-19 and unknowingly infecting others than they were about contracting COVID-19 themselves Higher resilience scores were associated with fewer COVID-19-related worries. Increasing resilience score was associated with a reduced rate of anxiety and depression
Brown et al. (2020) United States To examine the impacts of the COVID-19 pandemic in relation to parental perceived stress and child abuse potential Online survey via Qualtrics 183 parents with a child under the age of 18 years old in the western United States Greater COVID-19-related stressors and high anxiety and depressive symptoms are associated with higher parental perceived stress. Receipt of financial assistance and high anxiety and depressive symptoms are associated with higher child abuse potential. Conversely, greater parental support and perceived control during the pandemic are associated with lower perceived stress and child abuse potential. The results also indicate racial and ethnic differences in COVID-19-related stressors
Su et al. (2020) China To analyze the different clinical characteristics between children and their families infected with severe acute respiratory syndrome coronavirus 2 Retrospective review of the clinical, laboratory, and radiologic tests 9 children and their 14 families All the children were diagnosed with positive results after their family's onset, which indicated that they were infected by the household contact. A positive PCR among children may relate to mental health after discharge. The duration of positive PCR among children is longer compared with their adult families
Yeh et al. (2020) Taiwan To explore family members’ concerns for their relatives during the lockdown period, assess their level of acceptance of the visiting restriction policy, and determine the associated factors Telephone interviews of family members of residents in long-term care facilities comprising 186 beds 156 family members The most common concerns of the family members for their relatives were psychological stress (such as feelings of loneliness among residents), followed by nursing care, and daily activity. More than 80% of respondents accepted the visiting restriction policy, and a higher satisfaction rating was independently associated with acceptance of the visiting restriction policy
Tanoue et al. (2020) Japan To examine the relationship between the presence or absence of a COVID-19 patient in a close setting and psychological distress levels Administrative survey using social networking service (SNS): chatbot on LINE 16,402 people aged 15 years and older In the groups under the age of 60 years old, respondents with COVID-19 patients in a close setting had higher psychological stress
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Discussion

Coronavirus diseases put families in uncertain conditions without clarity on how long the pandemic situation will last. The pandemic has caused many challenges that impact on family unit and the functions of the family unit, including distraction in family relationships (Luttik et al., 2020). These challenges will have an influence on family well-being in many aspects, such as loss of community, loss of income, resources, planned activities, and travel due to quarantine. The concern about nuclear family members increased because they did not want their family to become ill from the coronavirus. It is suggested to not visit the older members or those with serious illnesses who are more vulnerable to the virus.

Family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to curb the spread of coronavirus. Physical and social distancing are effective mitigations to reduce the spread of the coronavirus during the outbreak. However, distancing requires adaptation among family members to improve family well-being. Sheltering-in-place makes more frequent interactions among family members because they have limited opportunities to have a leisure time into the outside world. This condition, on the one hand, can create a quality time and intimate interactions among family members, but on the other hand, it may lead to long-standing high conflicts, occasionally domestic violence, and divorce (Lebow, 2020b). In this condition, a home can be described as a place of warmth, love, and safety or as a place of intimidation, abuse, and fear (Hitchings & Maclean, 2020). Other studies found a positive outlook on the COVID-19 pandemic regarding the necessity of focusing on and enjoying family relationships, especially taking advantage of the pandemic's gift of extended time together (Evans et al., 2020; Holmberg et al., 2021). This optimistic attitude could function as a shared belief system within the family, resulting in family resilience. Working life balance at home during the time of COVID-19 provides a new chance for internal conflicts, disagreements, and arguments in which parents try to play their multi-roles with all family members to mitigate some problems such as unemployment and financial instability (Lebow, 2020b). Family income loss/economic difficulties, job loss, experienced hardships during the pandemic, worsening mental and behavioral health, stress, high anxiety, distress about family contracting COVID-19, and illness are reported in some families during the COVID-19 pandemic.

Domestic violence related to mental and physical health may happen during the COVID-19 quarantine. Family members lived in complex situations during the pandemic, which increased the risk of overexposure by increasing the levels of stress, anxiety, and instability. The increase in domestic violence during the pandemic is reported in many countries, such as China, Brazil, the United States, and Italy, which may represent as “tip of the iceberg” since many victims do not have the freedom to report the abuse (Campbell, 2020). Domestic violence is reported as physical harm, emotional harm, and abuse. Intimate partner violence is a common form of family violence during the COVID-19 pandemic (Kaukinen, 2020; Zhang, 2020). There are three factors of family violence, such as the opportunities of family violence during lockdown and isolation at home, the economic crisis in the households, and insufficient social support for the victims of domestic violence (Zhang, 2020). Individual resilience is a strong predictor of the willingness of people to cope with emergencies and challenges of different kinds, including the COVID-19 pandemic (Kimhi et al., 2020). Individual resilience and well-being are significant factors influencing distress symptoms and a sense of danger (Kimhi et al., 2020). Physical abuse, emotional abuse, and stalking are kinds of intimate partner violence that are experienced by some women during the COVID-19 quarantine (Mazza et al., 2020).

Family violence is one of the causes of divorce. Family violence has become a serious social problem. During the pandemic in China, some couples decide to divorce due to family violence in their spousal relationship (Zhang, 2020). Divorcing partners in the wake of COVID-19 have more complex issues because they should physically and emotionally separate in their households. It is suggested to involve family therapy so they can share their problems that arise readily to prevent anger, contempt, and other problematic conflicts (Lebow, 2020b). A good cooperation and communication among divorced parents may help children achieve their goals through this hard time. A recent study found that communication between two single parents discussing the impact of the COVID-19 epidemic on their family life could acquire something considerably more significant than just support and self-discovery (Abdellatif & Gatto, 2020).

Financial distress, economic depression, unemployment, poverty, and added stressors such as the care and homeschooling of children, social distancing, and family isolation have increased the opportunities for family violence (Kaukinen, 2020; Zhang, 2020). Family members with lower financial income, lower education status, and lower occupational status are more likely to experience family violence, including family conflicts, economic distress, high tension, lower mental well-being, and insufficient support during physical distancing or lockdown (Zhang, 2020). Families have been dealing with threats from COVID-19 pandemics, both direct and indirect effects (Lebow, 2020a). The direct effects are the loss of family members, anxiety feelings related to family loss, increased unemployment, limited physical and social contact, family stress, conflict, and financial vulnerability. During the pandemic, families may have a virtual connection to maintain their communication. Therefore, geographic challenges are becoming less important due to virtual interconnection. Furthermore, a recent study found that virtual communication during the COVID-19 pandemic could improve family well-being and happiness (Gong et al., 2021). At this time, digital technology, which needs digital literacy, becomes essential (Hitchings & Maclean, 2020).

The coronavirus pandemic has increased the risk of mental health problems (such as mood disorders, fear, anxiety, depression, alcohol and smoking abuse) as well as physical health problems (such as sleep disturbance, gastrointestinal problems, poorer health condition) (Mazza et al., 2020). The mental problems are caused by work stress, financial stress, and changes in the social life. The coronavirus pandemic has increased the risk of mental disorders (such as mood disorders, anger, anxiety, depression, alcohol and smoking abuse) as well as physical disorders (such as sleep disturbance, gastrointestinal problems, poorer health condition). Children’s health and well-being are also in danger during the pandemic, because most of the children may get the transmission of the virus from their adult family members who were previously infected (Su et al., 2020). Therefore, individual resilience and well-being as a part of family resilience and well-being should be maintained to cope with the threat of the coronavirus pandemic.

Homeschooling during the pandemic makes parental responsibilities extended to include being teachers, coaches, trainers, and mentors for their children's school from home and other extracurricular activities (Lebow, 2020b). The condition of staying at home may increase parental stressors, particularly for working parents who are responsible for their multi-task dealing with other stressful conditions as paid workers and also doing domestic tasks. Moreover, violence may increase among children during homeschooling. During this time, parents and children are similarly living with stress, fear, and many challenges because they share their activities in the same place for uncertain time. Some factors influence the home learning as a distance learning, such as poverty, the educational levels of parents, mental health, the availability of gadget, and Internet access. During the pandemic, however, parental involvement in their children's activities provided an opportunity to develop and preserve family well-being (Evans et al., 2020).

During the pandemic, it should be more widely focused on helping family members generate their individual space. A good and intensive family communication is needed to deal with the uncertainty of the COVID-19 pandemic. Some interventions are needed to improve maternal and child health and nutrition, such as strengthening the food supply chain, reducing food insecurity, building a net social security program, and a cash support program for the disadvantaged families during the COVID-19 pandemic. Based on the literature review, it is recommended to increase public awareness to staying connected and reporting if they find any family violence. Improving the readiness and knowledge of healthcare providers and counselors is needed to provide counseling services to help families who have physical and mental health problems. Fulfilling parents with updated information and guidance is important to deal with pandemic especially how to have working life balance and quality of life between working, guiding children in their homeschooling and other activities. Providing parenting resources during COVID-19 including conflict management is needed to have positive relationship and manage parenting stress. The government should take action to mitigate the social, economic, and health impacts of the pandemic on families, especially those who are vulnerable to losing household income. During the pandemic, it is important to maintain family well-being by staying connected with communication, managing conflict, and making quality time within family. Promoting family resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.

This study has some limitations. The limitation of this article is the possibility of omission of the potential article related to the family welfare during the COVID-19 pandemic. Moreover, the exclusion of unpublished articles will become another limitation. The findings of this literature review were mostly conducted in higher-income countries, which limits the generalization of the findings to low- and middle-income countries. The future research is required regarding family welfare as responses to women’s empowerment during the COVID-19 pandemic with homogenous family’s samples or with a large sample size with heterogeneity of welfare's status. The future research can be conducted by mixed methods between qualitative and quantitative methods.

Conclusion

COVID-19 outbreak around the world has become a public health concern. The coronavirus pandemic has had a substantial impact on the family's life. Physical and mental health problems, economic instability, and family violence are social issues during the pandemic that should be dealt with. The government should take action to mitigate the social, economic, and health impacts of the pandemic on families especially those who are vulnerable to losing household income. Promoting family welfare and resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.

Footnotes

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs: Maria Gayatri https://orcid.org/0000-0002-2792-5586

Mardiana Dwi Puspitasari https://orcid.org/0000-0002-6827-3350

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