Abstract
Background
Due to COVID-19 pandemic and behavior restrictions, deterioration of family relations and mental health in child-rearing households has been reported. This study examined whether frequent parent-child exercise (PCE) is associated with improved family relations and parental mental health under COVID-19.
Methods
Using data from the Japan COVID-19 and Society Internet Survey (JACSIS), a nationwide survey conducted in August–September 2020, we extracted respondents with children aged 6 to 18 years (n = 2960). Logistic regression was performed to investigate the association between PCE frequency and changes in family relations and parental mental health.
Results
Compared with participants with 6–12-years old children, those with 13–18-years old children reported less PCE. Among participants with 6–12-years old children, compared to those without PCE, those conducted PCE more than once per week reported more improved relation with children and greater happiness (ORs ≥ 1.69), controlling covariates. Those conducted PCE 3 or more times a week also reported decreased loneliness (OR = 0.68). Whereas PCE conducted 1–2 times a month was not associated with any changes in participants with children of 6–12-years old, it was associated with more improved relations with children and spouses in participants with children of 13–18-years old (ORs ≥ 1.98).
Discussion
This study is the first to investigate the association of PCE with family relations and parental mental health under COVID-19. Our results suggest that PCE may enhance family relations and parental mental health and the effect may differ according to child's age.
1. Introduction
Due to the COVID-19 pandemic and the accompanying governmental lockdowns and behavior restrictions, the deterioration of mental health has become a serious social problem (Salari et al., 2020). For instance, large-scale surveys using self-reported inventories conducted in many countries such as China, Japan, and Italy reported prevalence of depressive symptoms being as high as 18.3 % to 48.3 % and that of anxiety symptoms being as high as 10.6 % to 22.6 % (Gao et al., 2020; Ueda et al., 2022; Mazza et al., 2020). Furthermore, a meta-analysis estimated that in response to the COVID-19 pandemic, the global prevalence of depressive and anxiety disorders increased by 27.6 % and 25.6 %, respectively (COVID-19 Mental Disorders Collaborators, 2021).
Notably, these mental health problems are particularly serious in child-rearing households. A survey conducted during COVID-19 reported that compared to those who do not have children or who spend little time for child-rearing, those who spend much time for child-rearing had higher depressive symptoms and lower life satisfaction (Bu et al., 2021). As the responsibility for child-rearing increased, mental health deteriorated and alcohol consumption increased (Romm et al., 2021). Furthermore, compared to pre-COVID-19, parental depressive and anxiety symptoms increased (Westrupp et al., 2021) while positive parenting behavior and cooperation between parents decreased after COVID-19 (Feinberg et al., 2022). The latter indicates worsened family relations.
Family relations are closely related to parental mental health and positive family relations reduce the risk of mental illness (Repetti et al., 2011). Furthermore, both family relations and parental mental health influence children's cognitive and emotional development (Ramchandani et al., 2005; Masarik and Conger, 2017). Therefore, as COVID-19 becomes chronic, improving family relations and parental mental health in child-rearing households is an urgent issue. For such purpose, physical exercise may be one promising interventional strategy.
It has been frequently reported that physical exercise promotes mental health (Nakagawa et al., 2020; Chen et al., 2017). Several cohort studies showed that regular or habitual exercise prevents the development of depressive symptoms (Lucas et al., 2011; Harvey et al., 2018) and a meta-analysis of randomized controlled trials confirmed the antidepressant effect of exercise in clinical patients (Schuch et al., 2016). On the positive side, regular exercise has been associated with higher life satisfaction and happiness (An et al., 2020; Richards et al., 2015). Exercise may also help enhance family relations (Chen, 2017). For instance, it has been reported that children's physical exercise is associated with positive family relations (Iannotti et al., 2009) and children's sports participation is associated with decreased parental psychological stress (Sutcliffe et al., 2021). In interventional studies, parent-child exercise (PCE) reduces symptoms of depression and anxiety in children and increases their prosocial behaviors (Wong et al., 2020). Furthermore, PCE intervention improves parent-child relations and increases parental self-esteem (Young et al., 2019).
Although there have been studies reporting a negative association between exercise and symptoms of depression and anxiety under COVID-19 (Deng et al., 2020; Pieh et al., 2020; Ejiri, 2022), to our knowledge, no study has investigated the association of PCE with family relations and parental mental health. In the present study, therefore, using a nationwide web survey dataset, we aimed to test the hypothesis that more frequent PCE is associated with improved family relations and better parental mental health.
2. Methods
2.1. Participants
We used data from a nation-wide, cross-sectional study known as the Japan COVID-19 and Society Internet Survey (JACSIS (Okubo et al., 2021), https://jacsis-study.jp/, explanations in Japanese). The JACSIS gathers data from the pooled panels of a Japanese internet research agency (Rakuten Insight, Inc. https://insight.rakuten.co.jp/). In brief, 224,389 male and female panelists aged 15 to 79 years were in selected and invited to participate in the survey based on random sampling stratified by sex, age, and prefecture (covering all 47 Japanese prefectures). 28,000 panelists responded and from the cleaned final dataset, we extracted all responders with children aged 6–18 years (n = 2960, including 1462 females, age 44.6 ± 6.56 years). Informed consent was obtained before the survey from all participants. The survey started on August 25, 2020 and ended on September 30, 2020. As an incentive, participants received E-points that can be used for online shopping. The research protocol for this study was approved by the Research Ethics Committee of the Osaka International Cancer Institute (approved June 19, 2020; Approval No. 20084).
For each participant, we extracted the following information: sex, age, education, marital status, number of children, annual family income, employment status, alcohol drinking, smoking, BMI, history of physical and mental illness, the frequency of PCE, the change of family relations, self-rated happiness, Kessler Psychological Distress Scale (K6), and the short form of the University of California, Los Angeles Loneliness Scale Version 3 (UCLA-LS3-SF3).
2.2. Parent-child exercise
The frequency of PCE was measured with a single item “Right now, how often do you exercise with your children for recreation”. Participants responded by choosing one of five options: “rarely/never”, “1–2 times a month”, “1–2 times a week”, “3–4 times a week”, and “almost every day”.
2.3. Dependent variables
Family relations were measured in terms of change in the relation with children and spouse in the past month compared to before January 2020. Participants chose among six options: “very much improved”, “somewhat improved”, “no change”, “somewhat deteriorated”, “very much deteriorated”, and “unknown”. Due to small number of responders, “very much improved” and “somewhat improved” were combined as “improved”, and “somewhat deteriorated” and “very much deteriorated” were combined as “deteriorated” for data analysis. Furthermore, few participants choosing “unknown” and therefore these subjects were removed from analysis of family relations.
To assess parental mental health, we used three measures, self-rated happiness, depressive symptoms evaluated by K6, and loneliness evaluated by UCLA-LS3-SF3.
Happiness was evaluated with one item, “Do you think you are happy?” Participants responded with a 10-point scale with 1 indicating not happy and 10 very happy. This single-item question was initially used in the Japan Gerontological Evaluation Study (JAGES) and has been reported to be a reliable measure of happiness (Ide et al., 2022). Following our previous study (Osawa et al., 2022), two cutoff values are used to define being high in happiness (i.e., 8 and 9 points).
K6 evaluates depressive symptoms in the past 30 days with six items, including nervousness, hopelessness, restlessness, depressed mood, everything being an effort, and worthlessness (Kessler et al., 2003; Furukawa et al., 2008). Responses were rated on a 5-point scale with 0 indicating none of the time and 4 indicating all of the time. Following previous studies, a score of 13 or higher is considered high depressive symptoms (Kessler et al., 2003).
UCLA-LS3-SF3 evaluates loneliness in the past 30 days with three items, including feeling lack companionship, feeling left out, and feeling isolated from others (Hughes et al., 2004; Arimoto and Tadaka, 2019). Here, responses were rated on a 5-point scale with 1 indicating never and 5 indicating always. Following our previous study, a cutoff point of 6 that corresponds to the upper tertile point was used to define being high in loneliness (Yamada et al., 2021).
2.4. Statistical analysis
Firstly, we compared the differences in the frequency of PCE in participants with children of three different age groups using the Chi-squared test: 6–12 years old (elementary school students), 13–15 years old (junior high school students), and 16–18 years old (high school students). When the participant had multiple children, the age of the youngest child was used for the above grouping.
Next, we investigated the association of PCE with family relations and parental mental health using binomial and multinomial logistic regression. We considered the possibility that the association would differ depending on the age of the children and therefore conducted the above analysis for different age groups separately. Here, given the small sample size of the 13–15-years old group and the 16–18-years old group (see Fig. 1 ), they were combined to one age group as 13–18 years.
Fig. 1.
Frequency of parent-child exercise in participants with children of different age groups. The total number of participants with children of each age group was, 1897 (6–12-years old), 545 (13–15-years old) and 518 (16–18-years old).
Furthermore, based on considerations of sample size, we reorganized the frequency of PCE for this analysis. Specifically, among participants with children of 6–12-years old, the sample size of “rarely/never”, “1–2 times a month”, “1–2 times a week”, “3–4 times a week”, and “almost every day” was 411, 550, 645, 184, and 107, respectively. Given the commonly believed 10-events-per-variable rule and that we have 1 independent variable and 12 covariates (see below), we combined “3–4 times a week” and “almost every day” to form a new frequency of “3 or more times a week” for data analysis, with the new frequency having a sample size of 291. Another reason we combined these two frequencies was that we considered the difference between “3–4 times a week” and “almost every day” being rather small. As a result, among participants with children of 6–12-years old, the frequency of PCE became “rarely/never”, “1–2 times a month”, “1–2 times a week”, and “3 or more times a week”.
Among participants with 13–18-years old children, the sample size of “rarely/never”, “1–2 times a month”, “1–2 times a week”, “3–4 times a week”, and “almost every day” was 781, 187, 62, 13, and 20, respectively. Notably, the sample size of the last three frequencies was quite small and since these three frequencies were largely different from “1–2 times a month”, we removed subjects with these three frequencies of PCE and as a result, the 13–18 years old group consisted of participants with only the following two frequencies of PCE: “rarely/never” (n = 781) and “1–2 times a month” (n = 187). This reorganization also allowed us to compare the association of PCE frequency between the 6–12 and the 13–18 years old groups.
The following variables were employed as covariates in the logistic regression: sex, age, education, marital status, number of children, annual family income, employment status, alcohol drinking, smoking, BMI, history of physical and mental illness. For the categorization of annual family income, we referred to the Japanese Comprehensive Survey of Living Conditions 2019 (Ministry of Health, 2019) and divided family income into four categories: <4 million JPY, ≥4 but <7 million JPY, ≥7 million JPY, and unknown (including would rather not say), with 4–7 million JPY representing family incomes of an average Japanese household. For physical illness, participants were asked to report the history of eight chronic conditions: hypertension, diabetes, asthma, angina pectoris, myocardial infarction, stroke, COPD, and cancer/malignant tumor. All analyses were conducted with IBM SPSS Statistics 28 and p < 0.05 is considered statistically significant.
3. Results
The frequency of PCE according to different children age groups is shown in Fig. 1. Chi-squared test indicated a significant between group difference (χ2 = 858.03, df = 8, p < 0.001). Pair-wise comparison showed that the proportion of participants with PCE conducted 3–4 times a week and almost every day was significantly lower in 13–15-years old group (1.1 % and 2.4 %, respectively) and 16–18-years old group (1.4 % and 1.4 %, respectively) compared to that in 6–12-years old group (9.7 % and 5.6 %, respectively, all p < 0.05). The proportion of participants with PCE conducted 1–2 times a week and 1–2 times a month became significantly lower in order from 6 to 12-years, 13 to 15-years, and 16 to 18-years old groups (for 1–2 times a week: 34.0 %, 8.8 %, 2.7 %; for 1–2 times a month: 29.0 %, 23.7 %, 11.2 %; all p < 0.05). In other words, as the child became older, the frequency of PCE gradually decreased.
We next analyzed the association of PCE with family relations and parental mental health in participants with children of 6–12-years old and 13–18-years old, respectively. The demographic information and characteristics of each group at different frequencies of PCE are shown in Table 1, Table 2 . Chi-squared test results of the association between parent-child exercise and demographic information are shown in Tables S1 and S2.
Table 1.
Characteristics of participants (child's age 6–12 years).
| Parent-child exercise |
||||||
|---|---|---|---|---|---|---|
| All, n = 1897 | Rarely/never |
1–2 times/month |
1–2 times/week |
3 or more times/week |
||
| (n = 411, 21.7 %) | (n = 550, 29.0 %) | (n = 645, 34.0 %) | (n = 291, 15.3 %) | |||
| Sex | Male | 955(50.3 %) | 162(17.0 %) | 300(31.4 %) | 356(37.3 %) | 137(14.3 %) |
| Female | 942(49.7 %) | 249(26.4 %) | 250(26.5 %) | 289(30.7 %) | 154(16.3 %) | |
| Age (years) | ≤39 | 635(33.5 %) | 97(15.3 %) | 161(25.4 %) | 258(40.6 %) | 119(18.7 %) |
| 40–44 | 484(25.5 %) | 94(19.4 %) | 139(28.7 %) | 172(35.5 %) | 79(16.3 %) | |
| 45–49 | 599(31.6 %) | 169(28.2 %) | 192(32.1 %) | 168(28.0 %) | 70(11.7 %) | |
| ≥50 | 179(9.4 %) | 51(28.5 %) | 58(32.4 %) | 47(26.3 %) | 23(12.8 %) | |
| Marital status | Married | 1797(94.7 %) | 380(21.1 %) | 519(28.9 %) | 627(34.9 %) | 271(15.1 %) |
| Single | 100(5.3 %) | 31(31.0 %) | 31(31.0 %) | 18(18.0 %) | 20(20.0 %) | |
| Number of children | 1 | 447(23.6 %) | 91(20.4 %) | 130(29.1 %) | 150(33.6 %) | 76(17.0 %) |
| 2 | 1017(53.6 %) | 219(21.5 %) | 293(28.8 %) | 348(34.2 %) | 157(15.4 %) | |
| ≥3 | 433(22.8 %) | 101(23.3 %) | 127(29.3 %) | 147(33.9 %) | 58(13.4 %) | |
| Family income (million JPY/year) | <4 | 231(12.2 %) | 61(26.4 %) | 67(29.0 %) | 70(30.3 %) | 33(14.3 %) |
| ≥4 but <7 | 703(37.1 %) | 142(20.2 %) | 201(28.6 %) | 246(35.0 %) | 114(16.2 %) | |
| ≥7 | 729(38.4 %) | 144(19.8 %) | 217(29.8 %) | 254(34.8 %) | 114(15.6 %) | |
| Unknown | 234(12.3 %) | 64(27.4 %) | 65(27.8 %) | 75(32.1 %) | 30(12.8 %) | |
| Educational level | University and above | 977(51.5 %) | 176(18.0 %) | 281(28.8 %) | 359(36.7 %) | 161(16.5 %) |
| Below university | 920(48.5 %) | 235(25.5 %) | 269(29.2 %) | 286(31.1 %) | 130(14.1 %) | |
| Employment | Employer | 62(3.3 %) | 13(21.0 %) | 16(25.8 %) | 22(35.5 %) | 11(17.7 %) |
| Self-employed | 88(4.6 %) | 17(19.3 %) | 29(33.0 %) | 28(31.8 %) | 14(15.9 %) | |
| Regular employee | 1006(53.0 %) | 169(16.8 %) | 313(31.1 %) | 375(37.3 %) | 149(14.8 %) | |
| Non-regular employee | 366(19.3 %) | 115(31.4 %) | 104(28.4 %) | 99(27.0 %) | 48(13.1 %) | |
| Unemployed | 375(19.8 %) | 97(25.9 %) | 88(23.5 %) | 121(32.3 %) | 69(18.4 %) | |
| Smoking | Never/ever | 1518(80.0 %) | 326(21.5 %) | 441(29.1 %) | 513(33.8 %) | 238(15.7 %) |
| Current | 379(20.0 %) | 85(22.4 %) | 109(28.8 %) | 132(34.8 %) | 53(14.0 %) | |
| Alcohol use | Never/ever | 840(44.3 %) | 207(24.6 %) | 214(25.5 %) | 276(32.9 %) | 143(17.0 %) |
| Current | 1057(55.7 %) | 204(19.3 %) | 336(31.8 %) | 369(34.9 %) | 148(14.0 %) | |
| BMI | <18.5 | 188(9.9 %) | 48(25.5 %) | 50(26.6 %) | 56(29.8 %) | 34(18.1 %) |
| ≥18.5 but <25 | 1379(72.7 %) | 296(21.5 %) | 402(29.2 %) | 470(34.1 %) | 211(15.3 %) | |
| ≥25 | 330(17.4 %) | 67(20.3 %) | 98(29.7 %) | 119(36.1 %) | 46(13.9 %) | |
| Physical illness | Never/ever | 1667(87.9 %) | 361(21.7 %) | 484(29.0 %) | 564(33.8 %) | 258(15.5 %) |
| Current | 230(12.1 %) | 50(21.7 %) | 66(28.7 %) | 81(35.2 %) | 33(14.3 %) | |
| Mental illness | Never/ever | 1815(95.7 %) | 383(21.1 %) | 528(29.1 %) | 621(34.2 %) | 283(15.6 %) |
| Current | 82(4.3 %) | 28(34.1 %) | 22(26.8 %) | 24(29.3 %) | 8(9.8 %) | |
| Relation with child | Improved | 196(10.3 %) | 31(15.8 %) | 41(20.9 %) | 84(42.9 %) | 40(20.4 %) |
| No change | 1548(81.6 %) | 333(21.5 %) | 465(30.0 %) | 521(33.7 %) | 229(14.8 %) | |
| Deteriorated | 107(5.6 %) | 32(29.9 %) | 31(29.0 %) | 30(28.0 %) | 14(13.1 %) | |
| Unknown | 46(2.4 %) | 15(32.6 %) | 13(28.3 %) | 10(21.7 %) | 8(17.4 %) | |
| Relation with spouse | Improved | 129(7.2 %) | 22(17.1 %) | 27(20.9 %) | 53(41.1 %) | 27(20.9 %) |
| No change | 1466(81.8 %) | 304(20.7 %) | 436(29.7 %) | 509(34.7 %) | 217(14.8 %) | |
| Deteriorated | 151(8.4 %) | 38(25.2 %) | 40(26.5 %) | 51(33.8 %) | 22(14.6 %) | |
| Unknown | 46(2.6 %) | 13(28.3 %) | 14(30.4 %) | 11(23.9 %) | 8(17.4 %) | |
| Happiness | ≤7 | 909(47.9 %) | 238(26.2 %) | 276(30.4 %) | 280(30.8 %) | 115(12.7 %) |
| ≥8 | 988(52.1 %) | 173(17.5 %) | 274(27.7 %) | 365(36.9 %) | 176(17.8 %) | |
| Depression (K6) | ≤12 | 1761(92.8 %) | 369(21.0 %) | 514(29.2 %) | 606(34.3 %) | 272(15.4 %) |
| ≥13 | 136(7.2 %) | 42(30.9 %) | 36(26.5 %) | 39(28.7 %) | 19(14.0 %) | |
| Loneliness (UCLA-LS3-SF3) | ≤5 | 1336(70.4 %) | 265(19.8 %) | 386(28.9 %) | 468(35.0 %) | 217(16.3 %) |
| ≥6 | 561(29.6 %) | 146(26.0 %) | 164(29.2 %) | 177(31.6 %) | 74(13.2 %) | |
Table 2.
Characteristics of participants (child's age 13–18 years).
| Parent-child exercise |
||||
|---|---|---|---|---|
| All, n = 968 | Rarely/never |
1–2 times/month |
||
| (n = 781, 80.7 %) | (n = 187, 19.3 %) | |||
| Sex | Male | 502(51.9 %) | 391(77.9 %) | 111(22.1 %) |
| Female | 466(48.1 %) | 390(83.7 %) | 76(16.3 %) | |
| Age (years) | ≤39 | 28(2.9 %) | 21(75.0 %) | 7(25.0 %) |
| 40–44 | 98(10.1 %) | 76(77.6 %) | 22(22.4 %) | |
| 45–49 | 415(42.9 %) | 321(77.3 %) | 94(22.7 %) | |
| ≥50 | 427(44.1 %) | 363(85.0 %) | 64(15.0 %) | |
| Marital status | Married | 877(90.6 %) | 708(80.7 %) | 169(19.3 %) |
| Single | 91(9.4 %) | 73(80.2 %) | 18(19.8 %) | |
| Number of children | 1 | 402(41.5 %) | 333(82.8 %) | 69(17.2 %) |
| 2 | 472(48.8 %) | 376(79.7 %) | 96(20.3 %) | |
| ≥3 | 94(9.7 %) | 72(76.6 %) | 22(23.4 %) | |
| Family income (million JPY/year) | <4 | 105(10.8 %) | 93(88.6 %) | 12(11.4 %) |
| ≥4 but <7 | 264(27.3 %) | 207(78.4 %) | 57(21.6 %) | |
| ≥7 | 434(44.8 %) | 348(80.2 %) | 86(19.8 %) | |
| Unknown | 165(17.0 %) | 133(80.6 %) | 32(19.4 %) | |
| Educational level | University and above | 437(45.1 %) | 344(78.7 %) | 93(21.3 %) |
| Below university | 531(54.9 %) | 437(82.3 %) | 94(17.7 %) | |
| Employment | Employer | 38(3.9 %) | 27(71.1 %) | 11(28.9 %) |
| Self-employed | 54(5.6 %) | 42(77.8 %) | 12(22.2 %) | |
| Regular employee | 531(54.9 %) | 420(79.1 %) | 111(20.9 %) | |
| Non-regular employee | 196(20.2 %) | 168(85.7 %) | 28(14.3 %) | |
| Unemployed | 149(15.4 %) | 124(83.2 %) | 25(16.8 %) | |
| Smoking | Never/ever | 716(74.0 %) | 594(83.0 %) | 122(17.0 %) |
| Current | 252(26.0 %) | 187(74.2 %) | 65(25.8 %) | |
| Alcohol use | Never/ever | 393(40.6 %) | 319(81.2 %) | 74(18.8 %) |
| Current | 575(59.4 %) | 462(80.3 %) | 113(19.7 %) | |
| BMI | <18.5 | 81(8.4 %) | 73(90.1 %) | 8(9.9 %) |
| ≥18.5 but <25 | 680(70.2 %) | 540(79.4 %) | 140(20.6 %) | |
| ≥25 | 207(21.4 %) | 168(81.2 %) | 39(18.8 %) | |
| Physical illness | Never/ever | 770(79.5 %) | 624(81.0 %) | 146(19.0 %) |
| Current | 219(20.5 %) | 157(79.3 %) | 41(20.7 %) | |
| Mental illness | Never/ever | 911(94.1 %) | 735(80.7 %) | 176(19.3 %) |
| Current | 57(5.9 %) | 46(80.7 %) | 11(19.3 %) | |
| Relation with child | Improved | 77(8.0 %) | 53(68.8 %) | 24(31.2 %) |
| No change | 815(84.2 %) | 664(81.5 %) | 151(18.5 %) | |
| Deteriorated | 54(5.6 %) | 46(85.2 %) | 8(14.8 %) | |
| Unknown | 22(2.3 %) | 18(81.8 %) | 4(18.2 %) | |
| Relation with spouse | Improved | 51(5.9 %) | 35(68.6 %) | 16(31.4 %) |
| No change | 713(82.2 %) | 585(82.0 %) | 128(18.0 %) | |
| Deteriorated | 81(9.3 %) | 62(76.5 %) | 19(23.5 %) | |
| Unknown | 22(2.5 %) | 17(77.3 %) | 5(22.7 %) | |
| Happiness | ≤7 | 539(55.7 %) | 438(81.3 %) | 101(18.7 %) |
| ≥8 | 429(44.3 %) | 343(80.0 %) | 86(20.0 %) | |
| Depression (K6) | ≤12 | 905(93.5 %) | 737(81.4 %) | 168(18.6 %) |
| ≥13 | 63(6.5 %) | 44(69.8 %) | 19(30.2 %) | |
| Loneliness (UCLA-LS3-SF3) | ≤5 | 699(72.2 %) | 576(82.4 %) | 123(17.6 %) |
| ≥6 | 269(27.8 %) | 205(76.2 %) | 64(23.8 %) | |
3.1. Associations of parent-child exercise with family relations and parental mental health in participants with children of 6–12 years old
We used binomial and multinomial logistic regression to investigate the associations of PCE with family relations and parental mental health in participant with children of 6–12 years old. All the 12 covariates were included in each logistic regression. The results are shown in Table 3 and Fig. 2 .
Table 3.
Odds ratios of parent-child exercise (child's age 6–12 years).
| Parent-child exercise |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Rarely/never | 1–2 times/month |
1–2 times/week |
3 or more times/week |
||||||||
| OR | 95%CI | p value | OR | 95%CI | p value | OR | 95%CI | p value | |||
| Relation with child (no change as reference) | Improved | Ref | 0.955 | (0.581–1.570) | 0.856 | 1.694 | (1.076–2.666) | 0.023 | 1.753 | (1.048–2.930) | 0.032 |
| Deteriorated | Ref | 0.764 | (0.451–1.294) | 0.317 | 0.665 | (0.388–1.140) | 0.138 | 0.682 | (0.349–1.333) | 0.263 | |
| Relation with spouse (no change as reference) | Improved | Ref | 0.844 | (0.465–1.529) | 0.575 | 1.314 | (0.765–2.255) | 0.322 | 1.547 | (0.841–2.843) | 0.160 |
| Deteriorated | Ref | 0.829 | (0.514–1.339) | 0.444 | 0.947 | (0.596–1.505) | 0.818 | 0.954 | (0.539–1.689) | 0.872 | |
| Happiness | Cutoff = 8 | Ref | 1.293 | (0.988–1.691) | 0.061 | 1.698 | (1.302–2.215) | <0.001 | 2.002 | (1.454–2.757) | <0.001 |
| Cutoff = 9 | Ref | 1.153 | (0.829–1.602) | 0.397 | 1.397 | (1.015–1.923) | 0.040 | 1.917 | (1.333–2.757) | <0.001 | |
| Depression (K6) | Cutoff = 13 | Ref | 0.783 | (0.471–1.299) | 0.343 | 0.737 | (0.446–1.220) | 0.235 | 0.793 | (0.431–1.459) | 0.455 |
| Loneliness (UCLA-LS3-SF3) | Cutoff = 6 | Ref | 0.873 | (0.657–1.161) | 0.351 | 0.783 | (0.591–1.039) | 0.090 | 0.684 | (0.484–0.968) | 0.032 |
Ref, reference. Covariates: sex, age, marital status, number of children, family income, educational level, employment status, smoking, alcohol use, BMI, physical illness, mental illness.
ORs at p < 0.05 are shown in bold.
Fig. 2.
For family relations, compared to rarely/never, PCE at the frequency of 1–2 times a week (OR = 1.69, 95%CI [1.08–2.67]) and 3 or more times a week (OR = 1.75, 95%CI [1.05–2.93]) was associated with higher odds of improved relation with child (with no change in relation with child as reference). There was no association between PCE and change in relation with spouse.
For happiness, compared to rarely/never, PCE at the frequency of 1–2 times a week (OR = 1.70, 95%CI [1.30–2.22] for cutoff of 8; OR = 1.40, 95%CI [1.02–1.92] for cutoff of 9) and 3 or more times a week (OR = 2.00, 95%CI [1.45–2.76] for cutoff of 8; OR = 1.92, 95%CI [1.33–2.76] for cutoff of 9) was associated with higher odds of happiness. For loneliness, compared to rarely/never, PCE at the frequency of 3 or more times a week was associated with lower odds of loneliness (OR = 0.68, 95%CI [0.48–0.97]). None of the other associations were significant.
3.2. Associations of parent-child exercise with family relations and parental mental health in participant with children of 13–18 years old
Similarly, we used binomial and multinomial logistic regression to investigate the associations of PCE with family relations and parental mental health in participants with children of 13–18 years old. All the 12 covariates were included in each logistic regression. The results are shown in Table 4 and Fig. 2.
Table 4.
Odds ratios of parent-child exercise (child's age 13–18 years).
| Parent-child exercise |
|||||
|---|---|---|---|---|---|
| Rarely/never | 1–2 times/month |
||||
| OR | 95%CI | p value | |||
| Relation with child (no change as reference) | Improved | Ref | 2.112 | (1.232–3.618) | 0.007 |
| Deteriorated | Ref | 0.718 | (0.324–1.588) | 0.413 | |
| Relation with spouse (no change as reference) | Improved | Ref | 1.978 | (1.038–3.770) | 0.038 |
| Deteriorated | Ref | 1.311 | (0.736–2.335) | 0.358 | |
| Happiness | Cutoff = 8 | Ref | 1.113 | (0.795–1.560) | 0.532 |
| Cutoff = 9 | Ref | 1.307 | (0.873–1.956) | 0.194 | |
| Depression (K6) | Cutoff = 13 | Ref | 1.774 | (0.960–3.277) | 0.067 |
| Loneliness (UCLA-LS3-SF3) | Cutoff = 6 | Ref | 1.430 | (0.996–2.054) | 0.053 |
Ref, reference. Covariates: sex, age, marital status, number of children, family income, educational level, employment status, smoking, alcohol use, BMI, physical illness, mental illness.
ORs at p < 0.05 are shown in bold.
For family relations, compared to rarely/never, PCE at the frequency of 1–2 times a month was associated with higher odds of improved relation with child (with no change in relation with child as reference, OR = 2.11, 95%CI [1.23–3.62]) as well as higher odds of improved relation with spouse (with no change in relation with spouse as reference, OR = 1.98; 95%CI [1.04–3.77]). None of the other associations were significant.
4. Discussion
In the present study, we investigated the association of PCE with family relations and parental mental health under the pandemic of COVID-19. Firstly, regarding the descriptive data of the frequency of PCE, as one may expect, as the child becomes older, the frequency of PCE decreases. For instance, the proportion of participants reporting rarely/never exercised with their child was 21.7 %, 64.0 %, and 83.4 % for 6–12, 13–15, and 16–18 years old groups, respectively. This is explained by the fact that as children grow up, there become more separate and independent from their parents. When children go into junior and senior high schools, they typically spend more time with friends and less time with family (Larson and Richards, 1991). Club activities at school are often the main exercise opportunities for many adolescents.
In participants with children of 6–12-years old, compared to participants reporting rarely/never exercised with their child, those reporting 1–2 times a week and 3 or more times a week PCE were more likely to have improved relation with child and reporting higher happiness (all OR ≥ 1.69). Furthermore, those reporting 3 or more times a week PCE were also more likely to report lower loneliness (OR = 0.68). Our observation that higher PCE frequency is associated with improved relations with child is consistent with previous reports with 5–12 years old girls and their fathers (Young et al., 2019). In contrast, PCE is not associated with lower odds of deteriorated relation with child, suggesting the possibility that PCE helps build stable, positive parent-child relations rather than buffering negative parent-child relations. Whereas it would be expected that relation with spouse improves accompanying the improvement of parent-child relation and increased parental happiness, no association between PCE and relation with spouse was observed, which calls for more in-depth investigations by future studies.
Furthermore, more frequent PCE was associated with greater happiness, which is consistent with previous reports that regular physical exercise is associated with enhanced happiness (An et al., 2020; Richards et al., 2015). Whereas previous studies have reported a negative association between regular physical exercise and depressive symptoms (Deng et al., 2020; Pieh et al., 2020), we did not observe such an association with PCE. It may be that exercise, when conducted together which children, tends to be limited to low intensities especially compared to when one exercises alone, which may be insufficient to achieve antidepressant effects. Whereas previous studies did not identify an association between the amount of physical exercise and loneliness (Schrempft et al., 2019; Meyer et al., 2020), we found that PCE conducted 3 or more times a week was associated reduced loneliness. Since PCE also involves social interactions, more frequent social interactions may be associated with lower loneliness.
However, in participants with children of 6–12-years old, none of the above changes were observed in participants with PCE at the frequency of 1–2 times a month. In contrast, in participants with children of 13–18 years old, we found that even this low frequency of PCE (i.e., 1–2 times a month) was associated with improved relation with child (OR = 2.11) as well as spouse (OR = 1.98). These findings suggest that whereas for parents with children aged 6–12 years, PCE of at least once per week is required to improve family relations and parental mental health, a lower frequency of PCE at 1–2 times per month is sufficient to improve family relations in parents with children of 13–18 years old. The reason may be that 13–18 years old children or adolescents generally spend less time with family and even occasional interaction with parents may have substantial benefits on their relations. On the other hand, associations with happiness, depressive symptoms, and loneliness were not observed in this age group, suggesting the possibility that more frequent PCE is required.
Our study has several limitations. Firstly, we measured only the frequency of PCE using a single item question “Right now, how often do you exercise with your children for recreation”. Future research is required to investigate the influence of the content and intensity of the PCE. Secondly, the number of participants with PCE at the frequency of 1–2 times a week, 3–4 times a week, and almost every day in the 13–15 and 16–18 years old groups was extremely small, which did not allow us to investigate the association of PCE with family relations and parental mental health in participants with children of these age groups. Given the small number of participants with high frequent PCE in this age group, future studies with bigger sample sizes are required to extend our findings. Thirdly, since this study used a cross-sectional design, we cannot specify the causal relationship in the associations we observed and it remains for future studies to employ prospective and interventional designs to clarify the associations.
This study is the first to investigate the association of PCE with family relations and parental mental health under the pandemic of COVID-19. Whereas in participants with children aged 6–12 years, PCE more than once a week was associated with improved parent-child relations and increase in happiness, in participants with children aged 13–18 years in which the frequency of PCE is greatly reduced, even exercising 1–2 times a month was associated with improved family relations. These results suggest that promoting PCE may help enhance family relation and parental mental health in child-rearing households and the effect may differ according to child's age, which has important implications for mental health promotion under the pandemic of COVID-19.
CRediT authorship contribution statement
Conceptualization and design: R.O., C.C., and T.T. Investigation: R.O. and T.T. Data analysis and manuscript preparation: T.K. and C.C. Manuscript revision: all authors.
Role of the funding source
The findings and conclusions of this article are the sole responsibility of the authors and do not represent the official views of the research funders.
Conflict of interest
The authors report no conflict of interest.
Acknowledgements
This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grants [grant numbers 17H03589; 19K10671; 19K10446; 18H03107; 18H03062; 19H03860; 21H04856], the JSPS Grant-in-Aid for Young Scientists [grant number 19K19439, 22K15764], Research Support Program to Apply the Wisdom of the University to tackle COVID-19 Related Emergency Problems, University of Tsukuba, and Health Labour Sciences Research Grant [grant numbers 19FA1005; 19FG2001; 19FA1012] and the Japan Agency for Medical Research and Development (AMED; grant number 2033648).
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jad.2023.01.001.
Appendix A. Supplementary data
Supplementary tables
References
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