When the Bough Breaks: A systematic review and meta‐analysis of mental health symptoms in mothers of young children during the COVID‐19 pandemic

Abstract

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: 1) the prevalence of depression and anxiety in parents of young children (< age 5) during the COVID-19 pandemic, and 2) sociodemographic (e.g., parent age, minority status) and methodological moderators (e.g., study quality) that explain heterogeneity among studies. A systematic search was conducted across four databases from January 1 st , 2020 to March 3 rd , 2021. A total of 18 non-overlapping studies (9,101 participants), all focused on maternal mental health, met inclusion criteria.Random-effect meta-analyses were conducted. Pooled prevalence estimates for clinically significant depression and anxiety symptoms for mothers of young children during the COVID-19 pandemic were 27.4% (95% CI: 21.5-34.3) and 43.5% (95% CI:27.5-60.9), respectively.Prevalence of clinically elevated depression and anxiety symptoms were higher in Europe and North America and among older mothers. Clinically elevated depressive symptoms were lower in studies with a higher percentage of racial and ethnic minority individuals. In comparison, clinically elevated anxiety symptoms were higher among studies of low study quality and in samples with highly educated mothers. Policies and resources targeting improvements in maternal mental health are essential. P r e -p r i n t Key Findings• Pooled prevalence rates of clinically elevated depression and anxiety symptoms of mothers of young children (under age 5 years) during the COVID-19 pandemic were 27.4% and 43.5%, respectively, indicating an increase from pre-pandemic estimates.• Estimates for depression symptoms were higher among studies from Europe and North America, with a higher proportion of older mothers and a lower proportion of racial and ethnic minority participants.• Estimates of anxiety symptoms were higher among low-quality studies, studies conducted in Europe and North America, studies with older mothers, and studies of highly educated mothers.P r e -p r i n t Statement of RelevanceAs a result of the COVID-19 pandemic, mothers have faced significant challenges, including loss of social support and childcare, loss of employment, and increased financial strain.Consequently, mental health difficulties in mothers have increased nearly two-fold for depression and three-fold for anxiety from pre-pandemic estimates. Given that infant mental health is inextricably linked to the mental well-being of the caregiver, policies that decrease familial stress, increase social and financial resources, and support the mental health of mothers during and after the COVID-19 pandemic are needed.

Towards a dimensional model of risk and protective factors influencing children’s early cognitive, social and emotional development during the COVID-19 pandemic

“…The mental health of parents with young children appears to have been particularly affected by the pandemic (Racine et al, 2022); indeed, having young children was identified as a risk factor for distress during the pandemic (Pierce et al, 2020). Although the triggers of mental distress for parents during the pandemic are diverse, and vary from family to family, commonly reported factors include fears of infection, financial and job insecurity, the demands of balancing work and childcare, disruptions to self-care routines, and low levels of social support (Calvano et al, 2021;Davidson et al, 2021;Racine et al, 2022;Russell et al, 2020).…”

“…The mental health of parents with young children appears to have been particularly affected by the pandemic (Racine et al, 2022); indeed, having young children was identified as a risk factor for distress during the pandemic (Pierce et al, 2020). Although the triggers of mental distress for parents during the pandemic are diverse, and vary from family to family, commonly reported factors include fears of infection, financial and job insecurity, the demands of balancing work and childcare, disruptions to self-care routines, and low levels of social support (Calvano et al, 2021;Davidson et al, 2021;Racine et al, 2022;Russell et al, 2020). It is well documented that parental mental health difficulties are a risk factor for early childhood difficulties with self-regulation and related executive functions, as well as difficulties with coping with negative emotions or stressful situations, which may either manifest as a tendency to be self-critical and anxious (i.e., internalizing difficulties) or a tendency to 'act out' in disruptive or aggressive ways (i.e., externalizing behavioural problems) (Carneiro et al, 2016;Power et al, 2021;Rigato et al, 2022;Ross et al, 2020;Stein et al, 2014;Sweeney & MacBeth, 2016).…”

The longitudinal effects of stress and fear on psychiatric symptoms in mothers during the COVID-19 pandemic

“…The lives of mothers have been notably disrupted by lack of childcare, supervising at-home learning, and caregiving of family members at risk of COVID-19 complications (Frank et al 2021 ; MCGoron et al 2021 ). In a meta-analysis of 18 studies of 8981 mothers of children under 5 years old during the first year of the pandemic, 26.9% (95% CI: 21.3–33.4) experienced clinically significant depressive symptoms and 41.9% (95% CI: 26.7–58.8) experienced anxious symptoms (Racine et al 2022 ). Several studies show large declines in mental health after the pandemic onset.…”

“…Few large studies have focused on mental health of mothers during the pandemic, and those that do are mostly cross-sectional or have a brief length of follow-up. Although there have been many longitudinal COVID-19 mental health studies (COVID-Minds Network 2021 ; Unnarsdóttir et al 2021 ), few focus on maternal mental health; all take place in Canada, Denmark, and the UK; and none specifically assess PPD history (Dickerson et al 2022 ; Ladekarl et al 2021 ; Overbeck et al 2022 ; Racine et al 2022 ; Saleem et al 2022 ; Zhang et al 2022 ). Only one Danish cohort examines symptom trajectories at multiple timepoints throughout the pandemic, and they found no differences (Overbeck et al 2022 ).…”

Mothers’ Domestic Responsibilities and Well-Being During the COVID-19 Lockdown: The Moderating Role of Gender Essentialist Beliefs About Parenthood

“…With schools and daycare centers closed, established daily routines disappeared and parents had to find new ways to combine childcare (including homeschooling), housework, and paid work (Global Gender Gap Index & World Economic Forum, 2021 ; Power, 2020 ). Thus, not surprisingly, research shows negative effects of the pandemic on families with young children (Gassman-Pines et al, 2020 ; Janssen et al, 2020 ; Patrick et al, 2020 ) versus older adults (Sterina et al, 2022 ) and on the well-being of parents (e.g., Cameron et al, 2020 ; Cusinato et al, 2020 ; Etheridge & Spantig, 2020 ; Harth & Mitte, 2020 ; Huebener et al, 2021 ; Racine et al, 2022 ).…”