Flattening the Other Curve, Part 2
Key Findings
At the outset of the COVID-19 pandemic, households with young children saw an immediate increase in anxiety, depression, stress, and loneliness for both children and their caregivers. In this post we report that since April 6, when our weekly nationally representative survey began, caregiver well-being appears to be improving in our overall sample.
However, for specific subgroups of households we did not see this positive trend.
Instead, caregivers in some subgroups appear to be experiencing ongoing difficulties in well-being.
Throughout the COVID-19 pandemic, public health experts have stressed the importance of “flattening the curve” in order to slow infection rates and avoid overwhelming the health care system. While many measures were at least temporarily effective in slowing the virus’s spread (i.e., social distancing, sheltering-in-place, closing businesses and schools), experts have also raised concerns about the effects on emotional and psychological well-being of the ongoing pandemic and related disruptions in areas such as daily routines, work, health care, and finances.
In early April, we reported findings on this topic from our first survey. Specifically, we identified large increases in both caregiver stress and children’s emotional and behavioral difficulties, compared with pre-pandemic levels.
Two weeks after the initial survey, we noted that although reports of adult and young children’s well-being had begun to improve for middle and upper income households, well-being within lower income households was continuing to diminish as the weeks passed.
Consistent with other reports in the media, these findings indicated that the challenges presented by the current pandemic are exposing and even increasing the inequities that exist within households with fewer resources to buffer the stress of the pandemic.
The pandemic has exposed and even increased the inequities within households with fewer resources.
With the RAPID survey, we can tease apart some of the potential areas of inequity and explore how the pandemic appears to be negatively affecting well-being within households facing different types of challenges.
Last week, we reported on how children’s emotional difficulties and behavior problems have changed across the first ten weeks of the RAPID survey. This week we focus on the well-being of parents and other caregivers, who play a key role in buffering young children from the negative effects of the pandemic.
Specifically, we look at how caregivers’ well-being has changed across the ten weeks of the RAPID survey.
Our analyses show that when looking at all families in the survey together, there are promising signs of improvement — caregiver reports of anxiety, depression, loneliness, and stress are going down overall.
However, when looking at specific subgroups, the picture is different, and there is substantial variability across households. Some households are showing more difficulties in well-being across time, and some households in which the trends in well-being were initially positive are now showing a reversal.
These trends require action from policy makers, early childhood educators, and mental health practitioners that takes into account variation in family circumstances.
Trends in caregiver’s well-being across all families in the survey
We found that for the overall sample, caregivers’ ratings of anxiety, depression, loneliness, and stress all have gone down over the past 10 weeks.
Notably, these analyses do not explain why caregivers have reported fewer difficulties over time.
It is possible that many households with young children have successfully settled in to their new routine and adapted to significant changes in work, finances, childcare, and social interactions.
In addition, since these trends for caregivers mirror the patterns that we reported last week for children’s well-being, it is possible that caregiver’s and children’s well-being is closely tied together. Caregivers may feel better as they see their children’s mental health improve over time, and vice versa.
Importantly, well-being is not improving for all caregivers.
Despite these overall positive trends, we saw different patterns emerge for caregivers within specific subgroups of households with young children. In order to examine these different patterns of caregiver well-being in specific subgroups, we compared the average weekly scores for specific subgroups on caregiver anxiety, depression, stress, and loneliness to the average weekly scores for the overall sample.
There were three subgroups in which caregivers’ well-being did not show the same pattern as the overall sample:
Lower income households.
Households with three or more children.
African American households.
Lower income households
In lower income households, caregivers are experiencing more depression and anxiety.¹
Lower income caregivers have had higher levels of depression than the overall sample across the entire span of the survey. In addition, although levels of anxiety were diminishing initially in these households, in recent weeks it is now increasing significantly relative to the rest of the sample.
Households with three or more children
In households with three or more children, caregivers’ are experiencing more depression and stress.
Caregiver depression and stress has been higher from the start of the survey for households with 3 or more children compared to the overall sample.
During the early weeks of our survey, like the overall sample, caregivers in these households were reporting decreasing depression and stress. But since, depression in this group is on the rise and the gap between this group and the rest of the sample has widened over time.
Households with 3 or more children also report ongoing elevated levels of caregiver stress across the span of the survey and the gap between this group of households and the overall sample is widening over time.
African American households
In African American households, caregivers have reported increasing anxiety and stress in recent weeks.
During the early weeks of the survey, both anxiety and stress were decreasing for African American caregivers at a rate that was similar to that in the overall sample. But in recent weeks these trends have reversed, and we are now seeing the opposite trend of increasing depression and stress among African American caregivers.
It is also noteworthy that, in African American households, anxiety and stress have actually been consistently lower than for the overall sample. This finding is counterintuitive in light of reports that communities of color have been disproportionately affected by the pandemic, especially in terms of mortality rates and economic impact.
Moreover, if the current trends continue, African American caregivers’ anxiety and stress will soon be higher than the overall sample.
Households in which a child has a disability
Among households in which a child has a disability, caregivers reported decreases in anxiety, depression, and loneliness across the initial period of the survey.
Caregivers in these households still report feeling more anxiety, depression, and loneliness than caregivers in the overall sample, and the reports of decreasing problems have levelled off in recent weeks.
Accounting for subgroup differences in caregiver well-being
We cannot discern from our data analyses why caregiver well-being, difficulties have remained or are increasing for some subgroups.
We did examine the available data to see if these problematic trends could be accounted for by factors such as job loss and related income difficulties, lack of paid sick leave, food insecurity, or inadequate health care. None of these variables explained the increases in or higher levels of anxiety, depression, stress or loneliness observed in the aforementioned subgroups.
However, as discussed in last week’s post, life may be growing increasingly challenging for some households as the pandemic continues into summer.
For example, stress related to childcare may be peaking for caregivers now that the academic school year has ended, workplaces are reopening, and child care options for summer remain limited. This may be especially true in households with fewer financial resources or more children.
In addition, for all families — but African American families in particular — the increasing focus on society’s continued systemic racism and discrimination may be contributing to the recent increase in stress and anxiety.
Concerns about children’s safety due to race-related violence and limited opportunities due to institutionalized racism in schools and workplaces are certainly not new to African American caregivers. These concerns may be heightened when combined with new concerns about children’s and other family member’s health (due to inequities in both virus exposure and treatment during the pandemic).
The potential compound effects of the pandemic and systemic racism on African American families should be acknowledged and addressed directly by policy-makers and mental health professionals in their pandemic response efforts.
What are the implications of these trends in caregiver well-being?
Overall, if we consider all families included in the RAPID survey of households with young children, caregiver mental health appears to be improving. After the initial spike in mental health concerns reported at the start of the pandemic, caregivers are experiencing improvement in anxiety, depression, loneliness, and stress during recent weeks.
Consideration of the unique obstacles faced by caregivers from different households should be a focus of policymakers so that barriers to access and other structural inequities can be appropriately addressed. Specifically, we recommend the following:
Recommendations
Recommendations for policymakers
Increase funding for and access to services that support family health and mental health. These resources need to be focused on and made immediately available to the subgroups showing the greatest levels of need. Notably, these are subgroups in which there have historically been gaps in access, which have only increased during the pandemic.
Pass legislation that provides financial supports for lower-income households in order to cover the costs of basic needs, including housing, food, and childcare, which is a major source of stress in these families.
Provide funding to address social determinants of health, including racial disparities being observed in COVID outcomes.
Increase support to households in which a young child has a disability, via enhanced funding and innovative approaches for providing services.
Additional recommendations
Communities should focus on activities, in the context of re-opening, that maximize regaining or establishing new social supports, which help to buffer against stress, loneliness, anxiety, and depression, and which also minimize isolation. With the possibility of the reinstatement of shelter in place measures, policy makers and communities should be better prepared with prevention strategies to reduce caregiver stress.
Public agencies at federal, state, and community levels must develop capacity to maintain real-time data and information on social service and mental health options for families, and increase efforts to make it easier for families to find and locate available, high quality services.
Suggestions for further reading
“The Next Pandemic: Mental Health,” EdSurge.
“Racial inequalities in COVID-19 — the impact on black communities,” Medical News Today
“Black Families Were Hit Hard by the Pandemic. The Effects on Children May Be Lasting,” New York Times
“Her life was turned upside down by coronavirus. Then the signs of anxiety and depression kicked in,” CNN
“Flattening the mental health curve is the next big coronavirus challenge,” The Conversation
“Coping with Stress,” Centers for Disease Control and Prevention
“Facing mental health fallout from the coronavirus pandemic,” World Health Organization
About the project
When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.
The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.
This week’s analyses are based on responses collected from 5173 caregivers between the dates of April 06, 2020 and June 25, 2020. These caregivers represent a range of voices: 12.47% are African American, 18.77% are LatinX, and 12.51% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.
We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.
Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.
Suggested citation
Center for Translational Neuroscience (2020, June 30). Flattening The Other Curve, Part 2: Trends for Parental Well-Being Are Improving Overall, but Not for Everyone. Medium. https://medium.com/rapid-ec-project/flattening-the-other-curve-part-2-5661a2d36a82
¹ For the purposes of this project, we have defined “lower income households” as those at or below 150% of the federal poverty guidelines for household size. (return)