Background: The pace at which the present pandemic and future public health crises involving viral infections are eradicated heavily depends on the availability and routine implementation of vaccines. This process is further affected by a willingness to vaccinate, embedded in the phenomenon of vaccine hesitancy. The World Health Organization has listed vaccine hesitancy among the greatest threats to global health, calling for research to identify the factors associated with this phenomenon.Methods: The present cross-sectional study seeks to investigate the psychological, contextual, and sociodemographic factors associated with vaccination hesitancy in a large sample of the adult population. 4,571 Norwegian adults were recruited through an online survey between January 23 to February 2, 2021. Subgroup analyzes and multiple logistic regression was utilized to identify the covariates of vaccine hesitancy.Results: Several subgroups hesitant toward vaccination were identified, including males, rural residents, and parents with children below 18 years of age. No differences were found between natives and non-natives, across education or age groups. Individuals preferring unmonitored media platforms (e.g., information from peers, social media, online forums, and blogs) more frequently reported hesitance toward vaccination than those relying on information obtainment from source-verified platforms. Perceived risk of vaccination, belief in the superiority of natural immunity, fear concerning significant others being infected by the virus, and trust in health officials' dissemination of vaccine-related information were identified as key variables related to vaccine hesitancy.Conclusion: Given the heterogeneous range of variables associated with vaccine hesitancy, additional strategies to eradicate vaccination fears are called for aside from campaigns targeting the spread of false information. Responding to affective reactions in addition to involving other community leaders besides government and health officials present promising approaches that may aid in combating vaccination hesitation.

Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk-and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2868; 79.5% mothers) with >1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents towards children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger towards their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents towards children explains 41% of the variation in parental stress. These findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID-19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso-and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted. K E Y W O R D S anxiety, COVID-19, depression, parental stress, risk-and protective factors 1 | INTRODUCTION When the coronavirus disease of 2019 (COVID-19) pandemic struck globally in 2020, everyday family life changed dramatically as the pandemic and measures to combat it wreaked havoc on millions of parents and families. The rapid onset of the pandemic quickly and radically changed many otherwise stable features of family life and functionality and imposed additional burdens and demands on parents. Hence, major concerns regarding the potentially deleterious effects of these increased family demands and

Background In these unpredictable times of the global coronavirus disease 2019 (COVID-19) pandemic, parents worldwide are affected by the stress and strain caused by the physical distancing protocols that have been put in place. Objective In a two‐wave longitudinal survey, we investigated the levels of parental stress and symptoms of anxiety and depression in a sample of parents at two time points; during the implementation of the strictest physical distancing protocols following the onset of the COVID-19 pandemic (T1, N = 2,868) and three months after the discontinuation of the protocols (T2, N = 1,489). Further, we investigated the relationships between parental stress and anxiety and depression relative to relationship quality and anger toward their children at the two aforementioned time points, including subgroups based on age, parental role, cultural background, relationship status, education level, number of children, employment status and pre-existing psychiatric diagnosis. Methods and findings Parents were asked to fill out a set of validated questionnaires on the two measurement points. Parental stress significantly decreased from T1 to T2, indicating that the cumulative stress that parents experienced during the implementation of the distancing protocols declined when the protocols were phased out. The decrease of perceived parental stress was accompanied by a significant decrease in the symptoms of both depression and anxiety among the participating parents. Symptoms meeting the clinical cut-offs for depression (23.0%) and generalized anxiety disorder (23.3%) were reported among participating parents at T1, compared to 16.8% and 13.8% at T2, respectively. The reduction in depression and anger toward their child(ren) from T1 to T2 was associated with a reduction of parental stress. Relationship quality and anger toward their child(ren) at T1 further predicted a change in the level of parental stress from T1 to T2. Conclusions The study underlines the negative psychological impacts of the implementation of the distancing protocols on parents’ health and well-being. Uncovering the nature of how these constructs are associated with parents and families facing a social crisis such as the ongoing pandemic may contribute to the design of relevant interventions to reduce parental distress and strengthen parental coping and resilience.

Background:The prevalent co-occurrence between parental stress and depression has been previously established prior to and during the COVID-19 pandemic outbreak. However, no studies to date have identified the connections through which these symptom domains interact with each other to emerge into a complex and detrimental mental health state, along with the plausible mechanistic variables that may play key roles in maintaining parental stress and depression. The aim of this research is to uncover these interactions in a period where parents experience heighted demands and stress because of the strict social distancing protocols.Methods: Network analysis is utilized to examine parental stress and depressive symptoms during the COVID-19 pandemic in a large cross-sectional study (N = 2868) of parents. Two graphical Gaussian graphical network models were estimated, one in which only parental stress and depression symptoms were included, and another in which several mechanistic variables were added.Results: Expected influence and bridge expected influence revealed that feeling worthless was the most influential node in the symptoms network and bridged the two psychological states. Among the mechanistic variables, worry and rumination was specifically relevant in the depressive cluster of symptoms, and self-criticism was connected to both constructs. Conclusion:The study display that the co-occurrence of parental stress and depression have specific pathways, were manifested through feelings of worthlessness, and have specific patterns of connection to important mechanisms of psychopathology. The results are of utility when aiming to avoid the constellation of co-occurring parental stress and depressive symptoms during the pandemic.

Objective: The main aim of the study was to examine levels of parental stress and symptoms of depression and anxiety in the general parental population (N = 2868) during the strict government-initiated physical distancing protocols following the onset of the COVID-19 pandemic. We further investigated specific predictors of parental distress, including burnout, anger aimed at children, worry, lack of social support, lower perceived self-efficacy, and difficulty to work from home.Method: In this cross-sectional, epidemiological study, we disseminate an online survey that was administered two weeks after the government-initiated physical distancing protocols were established. Data were collected from March 31 to April 7. Results: Female parents compared to male parents and parents living with more than one child per parent or child(ren) with special needs compared to those living with one or fewer children per parent reported higher levels of parental stress. Burnout and social support were further associated with parental stress. Specifically, nearly one-fourth of the parents reported that they have felt burned out or in the proximity of feeling burned out more than half the days during the social distancing interventions. Also, 29% of the parents reported that they were angrier at their child(ren) than usual during the physical distancing period.Parents with a pre-existing psychiatric diagnosis had significantly higher parental stress compared to individuals with no psychiatric diagnosis. The reported prevalence of depression and anxiety symptoms above standardized cutoff levels among the 2868 parents was 25.4% for depression and 24.1% for anxiety, with the highest prevalence score on both symptoms of anxiety (37.6%) and depression (38.5%) for the youngest parents (age group 21–30 years). Furthermore, the parents who were home with their children and predominantly followed distancing protocol by socially distancing from public activity and peers (i.e., at least 10 out of 14 days) had significantly higher symptoms of depression (29%) and anxiety (27%), compared to parents who did not isolate in the same manner (i.e., depression 13% and anxiety 15%). Conclusions: The present study reveals that home confinement during the restricted lockdown period is related to markedly high levels of parental stress, in addition to symptoms of depression and anxiety in parents. Given the detrimental effects of depression, anxiety, and parental stress on the quality of life, morbidity rates, as well as adverse child outcomes and the potential risk of child abuse and neglect, these results suggest that appropriate action should be taken to impede further development of these symptoms, as well as developing interventions aimed at vulnerable subgroups and other relevant factors associated with increased parental stress. Keywords: COVID-19 lockdown, parental stress, depression, anxiety