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. 2023 Jan 13:1–12. Online ahead of print. doi: 10.1007/s12144-022-04129-0

Relations between maternal panic over COVID-19 and children’s depressive symptoms: the moderating role of children’s daily routines

Muzi Yuan 1, Xiaohua Bian 2, Junsheng Liu 1,3,✉, Hong Zhen 3, Robert J Coplan 4, Biao Sang 5
PMCID: PMC9838507  PMID: 36684461

Abstract

The sudden outbreak of COVID-19 and consequent quarantine policies have substantially altered family lives worldwide. Potential associations between parental negative emotional expressions towards the pandemic, family factors, and child psychological adjustment remain under-explored. Accordingly, the goal of the present study was to examine the relation between maternal panic over COVID-19 and children’s depressive symptoms, with a focus on the potential moderating role of children’s daily routines during a period of strict quarantine. Participants were N = 1,589 children (Mage = 13.13 years, SD = 1.54; 50.7% girls) and their mothers, from Zhengzhou, Henan Province, in Mainland China. Data were collected in April of 2020, when school closure policies were in effect. Mothers reported their panic over COVID-19 and children reported their depressive symptoms and daily routines during the quarantine period. Overall, results indicated a significant positive association between maternal panic over COVID-19 and child depressive symptoms. However, maintaining regular daily routines was found to be a significant moderator of this association, with higher levels of daily routines attenuating the link between maternal panic reactions and child psychological distress (i.e., buffering effect). The results highlight the protective role of regular daily routines in promoting psychological adjustment among Chinese children during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04129-0.

Keywords: Panic over COVID-19, Children, Depressive symptoms, Daily routines

Since December of 2019, the world has experienced dramatic changes due to the outbreak of Coronavirus Disease 19 (COVID-19). On January 30th of 2020, the World Health Organization (WHO) declared COVID-19 “a public health emergency of international concern, WHO’s highest level of alarm” (World Health Organization, 2021), which highlighted the pressure caused by a global pandemic on public health care systems.

Among many individuals, the rapid spread of COVID-19 has elicited panic reactions towards the disease, along with elevated psychological symptoms such as depression, anxiety and stress (e.g., Ornell et al., 2020; Qiu et al., 2020; Shigemura et al., 2020). Such negative effects may be exaggerated among children, due to their vulnerability towards psychological distress, as well as the preventive measures launched during the quarantine period (e.g., Imran et al., 2020; Liu et al., 2020). To reduce social contacts and virus transmission, the Chinese government initiated large-scale school closure policies starting in January of 2020. The goal of “School’s out, But Class’s on” was implemented until May/June of 2020 in most provinces in China (Zhou et al., 2020). During this prolonged quarantine period, students were instructed to stay at home and take lessons via online platforms. Such policies substantially increased the time that students spent at home with parents, further highlighting the already substantial impact of parental behaviors and emotions on child psychological adjustment during the quarantine period. According to family systems theory, emotional turmoil that affects one individual can permeate through the family and impact others in the system (Browne et al., 2021; Carr, 2015). In this regard, negative emotional reactions expressed by parents at home would be expected to further affect child psychological adjustment.

We are only just beginning to understand the underlying mechanisms that might connect or impact upon the links between such parental reactions and child psychological functioning. In the present study, we focused on daily routines, a construct that has recently been demonstrated to act as a potential buffer against the negative effects caused by the COVID-19 pandemic (Liu et al., 2021). There is evidence to suggest that maintaining regular and consistent routines is beneficial for the psychosocial well-being of children and adolescents, from both studies in pre-pandemic times (e.g., Bater & Jordan, 2017; Ren et al., 2019), and most recently, during the COVID-19 pandemic (Liu et al., 2021; Ren, He et al., 2021). Accordingly, the current study aims to examine the association between maternal panic over COVID-19 and child depressive symptoms, and whether children’s daily routines might moderate this association during the quarantine period in China.

Maternal panic over COVID-19 and children’s depressive symptoms

Depressive symptoms are one of the most common types of psychological distress that may arise following quarantine due to transmissible infectious diseases (e.g., Brooks et al., 2020; Hawryluck et al. 2004; Jeong et al., 2016). Recent studies suggest that children reported heightened levels of depressive symptoms during the COVID-19 pandemic, in part due to reduced social contacts with peers and extensive reliance on the Internet (Huang & Zhao, 2020; Wright et al., 2021). Considering the high general morbidity rate of depression and its high rate of comorbidity with other mental disorders (Hankin, 2015), it is important to identify risk and protective factors that might mitigate child depressive symptoms induced by the COVID-19 pandemic.

Parental panic reactions to COVID-19 could be a particularly important factor related to the development of children’s depressive symptoms under the circumstances of the pandemic (Dalton et al., 2020; Franic & Dodig-Curkovic, 2020). Considering the nature of the pandemic and its relatively high mortality rate, it was not surprising that people manifested increased panic and fear towards COVID-19, which was amplified and diffused through social media platforms (Nicomedes & Avila, 2020; Schimmenti et al., 2020; Shigemura et al., 2020). Clinically, panic attacks can be considered as a discrete form of anxiety characterized by a series of physiological reactions, including pounding heart, trembling, an overwhelming fear of death, and changes in behavior (Craske & Barlow, 2007; Nicomedes & Avila, 2020). Panic can also be defined as the arousal of fear at an inappropriate time, with the emotion of fear being a prominent feature (Barlow, 2004). Fear can also be emotionally contagious, leading to a collective panic that weakens rational thinking and reactions (Putinas-Neugebauer & Roland-Lévy, 2021).

Several characteristics of the COVID-19 pandemic might be expected to increase panic among parents, particularly during its earliest stages. These include its sudden onset and exponential diffusion, lack of knowledge about the transmission or treatment of the disease, inaccurate or even false information related to COVID-19 on the Internet, as well as uncertainty of the future impact of the disease. Taken together, these factors were particularly likely to induce heightened parental fear of being infected or infecting other family members. Many countries around the world also launched strict quarantine measures to prevent further transmission of COVID-19, generating additional stressors for parents during the pandemic. For example, the prolonged and unclear duration of quarantine has previously been found to increase anger and post-traumatic stress symptoms (Reynolds et al., 2008). Moreover, quarantine measures prevent parents from conducting normal professional activities and result in financial loss in families (Brooks et al., 2020; Hawryluck et al., 2004). All these factors could potentially exacerbate parents’ panic and anxiety towards the current COVID-19 pandemic. For example, research conducted in Canada found that 35.7% of parents reported being extremely or very anxious about COVOD-19 (McCormack et al., 2020).

Strict quarantine measures during the outbreak of COVID-19 also required children to stay at home, substantially increasing time spent with parents. In this context, panic over the pandemic expressed by parents might be expected to propagate even more through the family system and negatively affect child psychological adjustment. According to family systems theory and the spillover hypothesis (Sears et al., 2016), child development can be seen as a reciprocal process that occurs through the interaction between individuals (i.e., children themselves) and environments (i.e., their families). In this regard, parental stress is understood to spontaneously affect children’s moods via family interactions (Carr, 2015; Sameroff & Mackenzie, 2003). In support of this notion, results from recent studies conducted during the COVID-19 pandemic have highlighted spillover effects within the family context. For example, parental active media mediation was found to be positively related to their children’s psychological distress, possibly by drawing children’s attention to COVID-19 news (Eales et al., 2021). Results from a longitudinal study also indicated that family dysfunction positively predicted caregiver distress and child mental health problems two months later (Browne et al., 2021).

Previous studies have also highlighted the particular impact of maternal psychological maladjustment on children’s mental health (Donado et al., 2020). For example, results from a recent longitudinal study indicated that heightened maternal - but not paternal - depressive symptoms exacerbated child maladjustment (Pietikäinen et al., 2020). Therefore, the current study focused on maternal panic over COVID-19, and how it may be associated with child depressive symptoms. It is expected that maternal panic reactions of the COVID-19 pandemic would be positively associated with child depressive symptoms during the stay-at-home period.

Moderating role of daily routines

Daily routines have been defined as “observable, repetitive behaviors…which occur with predictable regularity in the daily or weekly life of the child” (Sytsma et al., 2001, p. 243), and are considered as critical in establishing children’s sense of predictability and security (Cassidy, 1992). The endorsement of regular and consistent routines, as argued by the behavioral view of child development, serves as predictable environmental cues that help children to develop rule-governed behaviors and compliance with instructions (Bater & Jordan, 2017; Sytsma et al., 2001). The beneficial role of maintaining a routinized life on child psychosocial adjustment has been well-documented in the extant literature, with more regular routines relating to fewer internalizing and externalizing problems, as well as more positive socioemotional functioning (Bater & Jordan, 2017; Bridley & Jordan, 2012; Ren et al., 2019).

Due to school closures and other quarantine policies enacted in China during the pandemic, children were constrained to take online lessons at home, disrupting their normal routines at school. These sudden changes resulted in increased unpredictability of daily activities at home. As a result, we might expect increases in children’s senses of inconsistency and insecurity, which in turn, might negatively affect their psychological health. In contrast, daily routines would be expected to help children to reestablish control over their lives and increase their sense of security under these stressful circumstances. There is recent empirical support for this assertion. For example, Larsen and Jordan (2020) found that more frequent family and child routines were associated with fewer externalizing problems among preschool-aged children, and Liu et al. (2021) reported that maintaining more consistent daily routines was associated with less psychological maladjustment in Chinese children and adolescents during the COVID-19 stay-at-home period.

As mentioned before, the quarantine requirements also increased children’s time spent at home with their parents, exposing them to the risk of being negatively affected by parental panic reactions to the pandemic. Daily routines, on the other hand, may act as moderator and buffer the negative effects by providing consistency and predictability in the family environment and helping children to reestablish their more stable lifestyles during the stay-at-home period. Moreover, specific routinized activities, such as sharing housework responsibilities with parents or communicating regularly with parents at meals, may also facilitate parent-child relationships, therefore mitigating the potential association between parental panic over the pandemic and children’s psychological distress. There has been some extant literature suggesting the moderating role of daily routines in buffering the association between negative environmental influences and child psychological maladjustment. Bridley and Jordan (2012) examined the relation between children’s daily hassles and their internalizing and externalizing conduct problems, and found that child routines moderated the relation between children’s daily hassles and internalizing problems, and children who maintained more frequent routines showed fewer internalizing problems even though they experienced elevated daily hassles. Recent studies conducted during the COVID-19 pandemic also provided some supporting evidence. For example, DesRoches (2021) suggested that routines moderated the association between home-based learning and peer and conduct problems in primary school children, and the adverse effect of home-based learning was absent at higher levels of routines. Moreover, daily living routines (i.e., a subset of routines comprised of basic aspects of mundane behaviors in everyday life, such as bedtime routines, meal routines, and social interactions with family members) have been found to moderate associations between community infection and depressive symptoms of adolescents. Specifically, those who report lower levels of daily routines also tend to report greater depressive symptoms if there have been confirmed COVID-19 cases in their communities (Ren, He et al., 2021). These findings indicate that the endorsement of regular routines may serve as a protective factor against negative effects within family systems. Therefore, the current study aims to examine the potential moderating role of daily routines in the association between maternal panic over COVID-19 and children’s depressive symptoms, with the expectation that higher levels of regular daily routines would attenuate this relation.

Gender and grade effects

Finally, when investigating links between daily routines and depressive symptoms, gender and grade differences were also considered. For example, during the COVID-19 pandemic, girls and primary school students displayed higher levels of daily routines compared to boys and middle school students respectively (Liu et al., 2021). Girls are also more likely to engage in certain activities (such as housework) at home due to gender role socialization (Cordero-Coma & Esping-Andersen, 2018), which may help them to maintain a more routinized life during quarantine. Therefore, similar differences were also expected in the current study.

For depressive symptoms, research has suggested that the onset of first episodes of depression occurs most frequently in middle to late adolescence, and the morbidity rates increase in prevalence from childhood to adolescence (Hankin, 2015). Accordingly, higher levels of depressive symptoms were expected to be reported by middle school students compared to their younger counterparts. In addition, adults around 30 years of age and below reported higher distress levels during the pandemic compared to older adults (e.g., Putinas-Neugebauer & Roland-Lévy, 2021; Qiu et al., 2020). However, differences in panic over COVID-19 among mothers of primary school and middle school students have not been specifically explored. Therefore, the current study also intends to examine potential gender and grade differences in maternal panic over COVID-19, child daily routines, and depressive symptoms.

The current study

The primary aim of the current study was to examine the association between maternal panic over COVID-19 and child depressive symptoms in a sample of mainland Chinese children and their mothers. Further, we sought to explore whether children’s experience of regular daily routines during the stay-at-home period would moderate this association. As empirical evidence for gender and grade differences in maternal panic over COVID-19, child depressive symptoms and daily routines during the pandemic was relatively scarce, our examination of such differences would remain exploratory and no specific hypotheses were raised. After exploring potential gender and grade differences, as suggested by previous studies (Liu et al., 2021; Ren, He et al., 2021), we also included these variables as covariates in subsequent analyses. Based on the extant literature, two hypotheses were proposed:

Hypothesis 1

Maternal panic over COVID-19 was expected to be positively associated with child depressive symptoms;

Hypothesis 2

Child daily routines were expected to moderate the association between maternal panic over COVID-19 and child depressive symptoms, such that higher levels of daily routines were expected to attenuate (i.e., buffer) the detrimental impact of maternal panic over COVID-19 on child depressive symptoms.

Method

Participants

Participants in the current study included N = 1,589 children aged 9–17 years (Mage = 13.13, SD = 1.54, 50.7% girls) and their mothers (Mage = 40.20, SD = 4.47) from Zhengzhou, the capital city of Henan Province in Mainland China. We used the convenience sampling method to recruit participants. Specifically, participants were recruited from four public schools located in the urban area of Zhengzhou, and we approached all the students from designated grades (grade 4–9). For students who agreed to participate, online consent forms were sent to their parents, and those with parental consent proceeded to provide their assent and constituted our sample group. Only participants who finished the survey were included in the current study, and they were from the two primary schools (n = 553, Mage = 11.48 years, SD = 0.95, grades 4–6, 46.7% girls) and two middle schools (n = 1,036, Mage = 14.01 years, SD = 0.95, grades 7–9, 52.8% girls) accordingly. Additional demographic information regarding participants and their households is presented in Table 1.

Table 1.

Demographic information of participants

M (SD) / N (%)
Adolescent characteristics
Age 13.13 (1.54)
Gender
 Boys 784 (49.3%)
 Girls 805 (50.7%)
Only child 216 (13.6%)
Family characteristics
Maternal age 40.20 (4.47)
Maternal education
 Middle school or below 588 (37%)
 High school or vocational school degree 570 (35.9%)
 Vocational college degree 253 (15.9%)
 Bachelor degree 173 (10.9%)
 Graduate degree or above 5 (0.3%)
Monthly income
 ¥ 2,000 or below 457 (28.8%)
 ¥2,000 - ¥5,000 803 (50.5%)
 ¥5,000 - ¥ 10,000 245 (15.4%)
 ¥10,000 - ¥15,000 49 (3.1%)
 ¥15,000 - ¥20,000 21 (1.3%)
 ¥20,000 or above 14 (0.9%)
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Procedure

Data collection was conducted in April of 2020. In Zhengzhou, the winter vacation from school was from January 17th to February 9th, 2020. However, the quarantine policy was still in effect afterwards due to severe circumstances of the pandemic. To comply with the strict quarantine requirements, students were instructed to remain at home and take online lessons when the spring semester began in February, 2020. As the severity of the pandemic situation lessened, primary and middle school students gradually returned to school from May 6th to 11th, 2020. Thus, at the time of data collection, school closure policies were still in effect and students were required to take online lessons at home.

Due to the school closure policies at the time, data collection was conducted via a Chinese online platform (Wenjuanxing). For those who agreed to participate in the study, research assistants organized online chat groups to communicate with participants. Then, participants were provided with the link to online questionnaires and brief information about the study. When completing the questionnaires, consent was first obtained from mothers, and they could proceed to the questionnaires only when the consent option was chosen. Children were also asked to provide their assent of participation before completing the questionnaires. The study procedure was approved by the *** Ethics Review Board (BLINDED FOR REVIEW).

Measures

Maternal panic over COVID-19

A five-item scale was developed to measure parental panic over COVID-19 in the current study. The scale was generated based on semi-structured interviews conducted with a sample of 20 parents in China between January 24 and 26 of 2020, when the pandemic was rather severe. Mothers were asked to rate how much each item (e.g., “I feel anxious and panic because of the current pandemic”, “I feel worried and afraid that my relatives and friends and I may be infected by COVID-19”; full version of the scale can be found in the Appendix) described their lives during the quarantine on a five-point Likert scale from 1 (not at all) to 5 (very much). After reverse coding, scores were averaged across the items, and higher mean scores indicated higher levels of panic over COVID-19 reported by mothers. The scale showed acceptable reliability (α = 0.68) in the current study.

Child depressive symptoms

Children reported their depressive symptoms using the 20-item Center for Epidemiologic Studies Depression Scale for Children (CES-DC; Weissman et al., 1980). CES-DC was modified to be more appropriate and easy for comprehension for children. It contained four subscales, namely somatic (7 items; e.g., “I was bothered by things that usually don’t bother me”), depressed (7 items; e.g., “I felt down and unhappy this week”), positive (4 items; e.g., “I felt like I was just as good as other kids”) and interpersonal (2 items; e.g., “I felt people didn’t like me this week”). The complete scale can be found in the Appendix. Items were rated on a 4-point Likert scale ranging from 1 (rarely or not at all) to 4 (most or all of the time). Items were all averaged to generate mean scores, and higher scores indicated higher levels of depressive symptoms. The four-factor CES-DC has been validated previously in samples of Chinese children (William Li et al., 2010), and the internal reliability was α = 0.91 in the present sample.

Child daily routines

Child daily routines were measured with a modified version of the Child Routines Inventory (CRI; Sytsma et al., 2001). Items that were inappropriate for the quarantine were excluded (e.g., “I show my parent schoolwork after school”), and items that captured adolescents’ regular activities during the quarantine were generated (e.g., “I can follow the school’s requirements to take online courses”). The modified 19-items CRI maintained the original four subscales that measured daily living routines (5 items; e.g., “I wake up at about the same time on weekdays”), household responsibilities (4 items; e.g., “I clean up food mess after snack”), discipline routines (6 items; e.g., “I help decide and prepare for family fun or events”) and homework routines (4 items; e.g., “I complete homework”), and scores were averaged across all items to derive a total score that captured children’s overall levels of regular daily routines. The full version of modified CRI used in the current study can be found in the Appendix. The modified CRI appears to be a valid and reliable measure during the COVID-19 pandemic (Liu et al., 2021; Ren, He et al., 2021 ). Children were instructed to report how much these items described their daily lives on a five-point Likert scale ranging from 1 (almost never) to 5 (always), with higher scores representing more routinized lives endorsed by children during the quarantine period. The Cronbach’s α was 0.92 for the total score in the current sample.

Analytic strategy

Data analyses were first conducted using SPSS v23.0. After descriptive analyses, Multivariate Analysis of Variance (MANOVA) was performed, followed by Pearson correlation analyses. The main analyses were then conducted using Mplus version 8.3 (Muthén & Muthén, 1998–2017). We established the latent moderated structural equations (LMS) to examine potential moderation effects. To construct latent variables, the five items measuring maternal panic over COVID-19 were included as indicators, while the subscales of child depressive symptoms and child daily routines were included as indicators correspondingly. First, a measurement model was established to clarify the latent constructs (i.e., maternal panic over COVID-19, child depressive symptoms and child daily routines) and ensure the fitness of the model before estimating the structural models. Model fit was estimated based on Comparative Fit Index (CFI), Tucker Lewis index (TLI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR), with CFI and TLI values > 0.90 and RMSEA and SRMR values < 0.08 indicating good fit (Hatcher, 2005).

The structural models were then examined in two steps. We first established the structural model without the interaction term, which was therefore referred to as Model 0. Next, the latent interaction term was included in the model, which constituted Model 1. Since the model fit indices (e.g., CFI, TLI, RMSEA and SRMR) were not available for LMS models, a two-step method was adopted to examine the model fit. First, model fit indices were obtained for Model 0. Second, the relative fit of Model 0 and Model 1 was compared with the log-likelihood ratio test, which helped to determine whether the more parsimonious Model 0 (which excluded the interaction term) represented a significant loss in model fit compared to the more complex Model 1 (which included the interaction term). If the log-likelihood ratio test was significant, then Model 0 showed a significant loss in model fit relative to Model 1, and it could be concluded that Model 1 was a well-fit model (Maslowsky et al., 2015). Child gender and grade were dummy coded and included in the structural models as covariates, and data were standardized prior to model estimation.

Results

Preliminary analyses

Descriptive statistics for all study variables are presented in Table 2. To explore potential gender and grade differences, we first conducted MANOVA with dummy-coded child gender (0 = boys, 1 = girls) and grade (0 = primary school, 1 = middle school) entered as independent variables, and maternal panic over COVID-19, child daily routines, and depressive symptoms entered as dependent variables. The results revealed significant main effects of Gender, Wilks’ λ = 0.99, F (3, 1583) = 4.65, p < .01, partial η2 = 0.01, and Grade, Wilks’ λ = 0.94, F (3, 1583) = 31.53, p < .001, partial η2 = 0.06, but not the Gender x Grade interaction effect, Wilks’ λ = 1.00, F (3, 1583) = 1.69, p = .168, partial η2 = 0.003.

Table 2.

Descriptive Statistics and correlations among study variables

Variables M (SD) 1 2
1. Maternal Panic over COVID-19 2.94 (0.77)
2. Child Depressive Symptoms 1.54 (0.48) 0.22***
3. Child Daily Routines 3.84 (0.70) − 0.17*** − 0.46***
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Note. * p < .05. ** p < .01, ***p < .001

Follow-up univariate analyses revealed that for the gender effect, girls endorsed higher levels of daily routines than boys, F (1, 1585) = 6.14, p < .05, partial η2 = 0.004. For grade differences, mothers of middle school students reported higher levels of panic over COVID-19 than mothers of primary school students (F (1, 1585) = 15.96, p < .001, partial η2 = 0.01). In addition, middle school students reported higher levels of depressive symptoms compared to primary school students (F(1, 1585) = 77.12, p < .001, partial η2 = 0.05), whereas primary school students reported higher levels of daily routines (F(1, 1585) = 51.45, p < .001, partial η2 = 0.03). As MANOVA revealed significant main effects of both child gender and grade, these two variables were included as covariates in subsequent moderation analyses.

Pearson correlations among study variables are also presented in Table 2. Consistent with Hypothesis 1, maternal panic over COVID-19 was positively correlated with child depressive symptoms and negatively correlated with daily routines endorsed by children during the pandemic period. In addition, daily routines were negatively correlated with depressive symptoms.

Moderating Effect of child daily routines

Prior to estimating the structural models, the measurement model was first verified with maternal panic over COVID-19, child depressive symptoms and child daily routines constructed as latent variables. The model fit the data well, χ2 = 368.27, df = 61, RMSEA = 0.06, CFI = 0.96, TLI = 0.95, SRMR = 0.06.

To assess Hypothesis 2, we continue to construct LMS models, and the model fit indices and standardized regression coefficients were presented in Table 3. First, we established Model 0 without the latent interaction term, and it fit the data well, χ2 = 506.11, df = 85, RMSEA = 0.06, CFI = 0.95, TLI = 0.93, SRMR = 0.06. In Model 0, both maternal panic over COVID-19 (β = 0.13, p < .001) and child daily routines (β = − 0.37, p < .001) significantly predicted child depressive symptoms. Next, we established Model 1 that included the latent interaction term. The log-likelihood ratio test suggested a difference value of D = 20.92, df = 1, p < .001 (based on the chi-square distribution). Therefore, Model 0 showed a significant loss in model fit compared to Model 1 that included the interaction. After controlling child gender and grade, the interaction effect of maternal panic over COVID-19 and child daily routines was significant, indicating that the association between maternal panic over COVID-19 and child depressive symptoms was significantly moderated by child endorsement of daily routines during the pandemic period (β = − 0.14, p < .01). Subtracting the total variance of child depressive symptoms explained in Model 0 (R2 = 0.20) from that in Model 1 (R2 = 0.23) yielded an additional 3% of variance explained by the interaction of maternal panic over COVID-19 and child daily routines.

Table 3.

Model Fitness Indices and Standardized Regression Coefficients of LMS

Model 0 Model 1
Model Fitness Indices
c2 506.11
df 85
Log(L) -25134.49 -25124.03
CFI 0.95
TLI 0.93
RMSEA 0.06
SRMR 0.06
AIC 50358.97 50340.05
BIC 50600.66 50587.11
Standardized Regression Coefficients
Maternal Panic → Depressive symptoms 0.13*** 0.16***
Child Routines → Depressive symptoms -0.37*** -0.36***
Panic x Routines → Depressive symptoms -0.14**
Child Gender → Depressive symptoms 0.08*** 0.08***
Child Grade → Depressive symptoms 0.13*** 0.13***
Maternal Panic with Child Routines -0.23*** -0.23***
R 2 0.20*** 0.23***
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Note. Gender and grade were dummy coded: for gender, 0 = boys, 1 = girls; for grade, 0 = primary school, 1 = middle school. * p < .05. ** p < .01, ***p < .001

We then probed the interaction at ± 1 SD of the mean of daily routines to further examine the moderation effect. As displayed in Fig. 1, at lower levels of maintenance of daily routines, maternal panic over COVID-19 was strongly associated with child depressive symptoms (b = 0.96, p < .001), but such association was attenuated and became insignificant when children maintained higher levels of daily routines (b = 0.05, p > .05), corroborating our expectations of the positive effects of daily routines on the association between maternal panic over COVID-19 and their children’s depressive symptoms.

Fig. 1.

Fig. 1

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Interaction of Maternal Panic Over COVID-19 and Child Daily Routines Predicting Children’s Depressive Symptoms

Note. Low daily routines = -1 SD of the mean of daily routines, high daily routines = + 1 SD of the mean of daily routines. Unstandardized regression coefficients reported

Discussion

The sudden outbreak of COVID-19 around the world caused substantial changes in family life. The interrupted routines, together with the perception of threat to be infected, led to parental panic reactions to the pandemic, which could be transmitted via family systems and associated with child psychological distress. The current study examined the relation between maternal panic over COVID-19 and children’s depressive symptoms during the stay-at-home period among Chinese families, with a focus on the potentially beneficial role of establishing child daily routines. Among the results, a positive association was found between maternal panic over COVID-19 and child depressive symptoms, but this relation was also significantly attenuated (i.e., buffering effect) among children who endorsed more regular daily routines.

Gender and grade effects

Overall, girls endorsed higher levels of daily routines during the quarantine period than boys. This was consistent with previous research results indicating that boys are less routinized in all four aspects of daily activities (Liu et al., 2021). Such gender differences suggest that boys may be more negatively affected by the sudden interruption of regular school lives, and it may be more difficult for them to adjust to the new quarantined lives at home.

As for grade differences, middle school students reported more depressive symptoms and fewer daily routines than primary school symptoms. These findings also corroborated previous studies conducted during the pandemic, indicating that psychological distress such as depression, anxiety, and stress gradually increase from primary school to middle school (Ren, He et al., 2021; Tang et al., 2021). Moreover, there is some evidence to suggest that adolescents might be the most vulnerable age group for experiencing heightened internalizing problems during the pandemic, with adolescents found to report greater depressive symptoms than both younger children and middle-aged adults, perhaps due to more active search of COVID-19-related information via social media (Huang & Zhao, 2020; Qiu et al., 2020).

Our results also indicated that mothers of middle school students reported elevated levels of panic over COVID-19 compared to mothers of primary school students. Mothers of middle school students tended to be older than their primary school counterparts, and may have experienced heightened family pressure during the pandemic. For example, they may suffer more from quarantine-related financial loss, since they have to raise their children as well as supporting elderly parents in the family, and they may be more concerned about their children’s schoolwork in the face of senior high school enrollment. The elevated panic over COVID-19 among middle-aged parents also calls for further attention to this particular cohort of people in terms of their psychological distress during the COVID-19 pandemic.

Maternal panic over COVID-19 and child depressive symptoms

As expected, our results revealed that maternal panic over COVID-19 was positively related to child depressive symptoms during the quarantine period. This finding is consistent with family systems theory, corroborating the effects of parental emotional responses to the COVID-19 pandemic on child psychological adjustment within a family unit. Similarly, ecological system theory (Bronfenbrenner, 1986) suggests that the family is one of the microsystems that exerts direct impact on children’s developmental outcomes, and personal characteristics of family members (such as parental employment status and support) could have non-negligible influence on children. Previous studies have indicated that family stress and chaos increased with the quarantine measures due to the outbreak of the pandemic, leading to disorganization and instability within the family systems and resulted in family dysfunction (Browne et al., 2021; Cassinat et al., 2021). When parents feel stressed during the pandemic, they may change their parenting practices, including paying less attention to children’s cues of distress, providing less parental support, and increasing child neglect or abuse (Brown et al., 2020).

Moreover, the way in which parents communicate with their children about the life-threatening illness may also be altered. Previous research has suggested that when parents try to minimize child distress, they tend to talk to children only about the factual aspects of the disease and avoid sharing their emotions, which can lead to children feeling uncertain and anxious about their parents’ emotional status (Dalton et al., 2019). In turn, children may also learn to avoid sharing their thoughts and feelings with parents, contributing to the child eventually being left to deal with their negative affect all by themselves (Dalton et al., 2019; Dalton et al., 2020). In support of this notion, a recent study of Chinese children suggested that parental fear induction practices were related to increased preventive practices endorsed by their children, yet at the cost of heightened depressive symptoms of children after quarantine (Ren, Cheah et al., 2021). Taken together, these finding suggest that when mothers are faced with the heightened stressors of the pandemic (e.g., unknown duration of quarantine, threat of infection, increased family financial pressure), there may be changes in their parenting behaviors that contribute to increased parent-child conflict and reduced parental support, that in turn, may be associated with elevated children’s depressive symptoms. Alternatively, as emotional spillover effects may occur among family members (Browne et al., 2021), adolescents could also feel their parents’ panic over the pandemic and consequently pay more attention to information related to the pandemic, which may increase their own panic and fear towards COVID-19 and make them become more anxious and depressed.

Moderating role of child daily routines

Our results further indicated that child daily routines significantly moderated the positive association between maternal panic over COVID-19 and child depressive symptoms. This novel finding adds to the extant literature suggesting that maintaining regular routines can benefit child and adolescent psychological well-being during the stay-at-home period of COVID-19 pandemic (Liu et al., 2021; Ren, He et al., 2021). As previously discussed, the panic and fear of COVID-19 may be transmitted from mothers to their children within the family systems, so that children may become panic and fearful towards the pandemic and exhibit more psychological distress. Research has suggested that fear of COVID-19 consists of four interrelated aspects: (1) fear of the body, which concerns the need to protect one’s own health; (2) fear of significant others, which concerns the fear of being infected by or infecting loved ones; (3) the fear of knowing that excessive searching for relevant information may increase our own anxiety and depression; and (4) the fear of passively waiting and taking no actions (Schimmenti et al., 2020).

There are several ways that daily routines may be particularly helpful in alleviating these fears. First, the endorsement of daily routines has been consistently shown to make family lives more predictable and controllable (Sytsma et al., 2001). Therefore, when children establish regular daily activities (such as fixed periods for homework and social media), they may avoid unnecessary online searching or being overwhelmed by information about the pandemic, which may offer cognitive relief from fearful feelings. Also, adherence to routinized behaviors such as hygiene practices helps to prevent children from the threat of infection. As well, taking responsibilities for household work may decrease related family conflict and improve the quality of parent-child relationship.

Finally, our results suggested that children who maintained higher levels of daily routines consistently showed below-average levels of depressive symptoms regardless of the levels of parental negative emotions. Such results highlight the direct positive relation between daily routines and children’s psychological well-being during the pandemic, and parents may help their children to establish regular and consistent family routines in order to better adjust to the changing and stressful quarantine situations.

Limitations and future research directions

The current study revealed a significant relation between maternal’ panic over COVID-19 and child psychological maladjustment, with additional evidence that a routinized life acted as a protective factor against this detrimental association. Nevertheless, results should be interpreted with caution in light of some limitations. First, the cross-sectional design of the current study prevents us from drawing causal conclusions pertaining to relations between study variables. For example, we postulated that the endorsement of daily routines served to attenuate the association between maternal COVID-19 panic and child depression. However, it is possible that the combination of parental panic and child depression contributed to a disruption in child daily routines. Future research should utilize longitudinal designs to ascertain the underlying nature of the relation between parental reactions towards the pandemic, daily routines, and child adjustment.

Second, as mentioned before, data for the current study were collected in April of 2020. This represented the latter stage of the school closure period in Zhengzhou, Henan Province, which were in effect from February to May of 2020. In other words, we collected data near the end of the quarantine period, and students had already been engaged in online classes for two months. Therefore, it is possible that, by this time, parents and adolescents may have adapted to the stay-at-home status to some extent. It is not clear if similar findings would have emerged if data were collected during the initial stages of quarantine, when sudden changes may have resulted in heightened stress and chaos in family lives. Therefore, the results of the current study may be more applicable to circumstances when quarantine measures have become more normalized rather than the initial phase of such health crises. In this regard, future research may attempt to examine the buffering effect of daily routines in family contexts at the early stage of the quarantine period so as to further understand the positive role of routinized lives along the spectrum of global pandemic development.

Finally, the reciprocal effects between parents’ and children’s adjustment have received increased attention, suggesting that it is important to explore both parent-driven effects and child-driven effects (Barbot et al., 2014). Therefore, the association between parental pandemic-related reactions and child adjustment could also be child-driven, such that the psychological distress or decrease in academic grades exhibited by children may make their mothers worried and anxious about the prolonged duration of quarantine. Therefore, future research may take both parent-driven and child-driven effects into consideration to further understand the parent-child interactions within family systems during the pandemic.

Conclusions and implications

Results from the current study revealed a positive association between maternal panic over COVID-19 and children’s depressive symptoms during the stay-at-home period of the pandemic, and highlighted the protective role of daily routines in alleviating the association between parental panic and children’s psychological distress. Such results have potentially important practical implications for clinicians, parents as well as children. For example, as mothers’ negative emotional reactions towards the COVID-19 may permeate through family systems to affect their children’s psychological adjustment adversely, they may pay more attention to their emotional expressions at home and reduce panic or anxious emotions towards the pandemic through self-regulation or seeking for professional help when necessary. Moreover, parents and children are encouraged to maintain routinized lives and reduce chaos and conflict in families, especially during quarantine period of public health crises like the current COVID-19 pandemic. These efforts, though relatively easy to achieve, may indeed help to establish more predictable yet less stressful family environments, which may mitigate the negative emotions expressed by family members towards the pandemic and protect children’s psychological well-being.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 (21.7KB, docx)

Acknowledgements

This research was supported by grants from the Research Project of Shanghai Science and Technology Commission (20dz2260300), the Research Funds for Shanghai Health Commission for Academic Leader Training (GWV-10.2-XD30) and the Research Funds for Changning District Health Committee of Medical Specialty (20192002).

Authors’ contributions

M. Y. developed the hypotheses, performed the statistical analyses, interpreted the results, and wrote the first draft of the manuscript; X. B. helped to revise the manuscript, and interpret the results; J. L. helped to develop the hypotheses, revise the manuscript, and interpret the results; H. Z. conceived of the present study and helped to revise the manuscript; R. C. helped to revise the manuscript and interpret the results. B. S. helped to revise the manuscript. All authors read and approved the final manuscript.

Data Availability

The data of the current study are available from the corresponding author on reasonable request.

Declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Written assent was obtained from all participating children and their parents.

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Footnotes

Publisher’s Note

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Contributor Information

Junsheng Liu, Email: jasonliu@yeah.net.

Hong Zhen, Email: zhhmm2@163.com.

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Supplementary Materials

Supplementary Material 1 (21.7KB, docx)

Data Availability Statement

The data of the current study are available from the corresponding author on reasonable request.

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