Geography Is Not Destiny…or Is It?
Key facts
In this week’s post, we show that for caregivers of young children, well-being is tied to the coronavirus infection rates in the state where they live.
Specifically:
As rates of infection climb, so do caregiver reports of emotional distress.
As rates level off and decline, well-being improves.
We examined these patterns in two clusters of states that have shown very different infection rates patters over the last several months: (1) New York and New Jersey, and (2) Texas, Florida, and Arizona.
In the early weeks of the pandemic (April 6 to April 22), New York and New Jersey had some of the highest infection rates in the country and caregivers in those states felt higher levels of emotional distress. At this time, in Texas, Florida, and Arizona, infection rates were low as was caregiver emotional distress.
More recently (June 1 to July 13), infection rates in New York and New Jersey have declined and caregivers in those states have reported decreasing levels of emotional distress. In stark contrast, infection rates in Texas, Florida, and Arizona, have increased considerably and caregiver emotional distress showed a corresponding increase.
These findings cannot be explained by differences in financial or material hardship among caregivers. Rather, we find that it is the infection rates where families live that are affecting caregiver well-being.
Policy makers must take action to control and contain the virus using strategies driven by evidence. This will not only save lives, but it will also impact the future of America’s young children and those who care for them.
Background
As debate continues over how to manage the coronavirus pandemic, national infection rates and deaths continue to climb at an alarming rate.
On a state-by-state basis, however, circumstances vary greatly. Infection rates in states that were among the hardest hit early on have levelled off and been declining for some time. Other states that initially had low infection and death rates have seen dramatic increases in the spread of the virus in recent weeks.
These trends are not random.
The earliest-hit states employed evidence-based public health strategies such as social distancing, testing, and contact tracing, and residents of those states largely cooperated with those measures. As a result, these states have managed to control and contain the virus.
States that have ignored public health policies and gambled with economic recovery and reopening are now paying the price in human suffering.
Over the last several weeks, we have found:
Caregivers and their children are struggling emotionally.
Caregivers are worried about meeting their families’ basic needs.
Family conflict has increased.
Any one of these stressors is difficult to manage when trying to support young children, make a living, and run a household. Taken together, they are affecting the emotional lives of those caring for young children.
This week, we document that trends in infection rates—independent of material and financial hardships, are also affecting caregivers’ emotional stress.
We’ve selected two clusters of states (New York and New Jersey vs. Florida, Texas and Arizona) that have shown very different trends in infection rates. Our data show that across the weeks we have been conducting the RAPID survey (beginning April 6), where there are higher rates of infection, caregivers have more emotional difficulties.
This is true of overall well-being, and across more specific measures such as depression, anxiety, stress, and loneliness.
Caregiver ratings of these various aspects of emotional distress change for better or worse over time as infection rates in their state decrease and increase.
Caregivers are significantly affected by the infection rates where they live, independent of personal hardships such as job and income loss, loss of childcare, family conflict and pandemic-related inequities.
In prior posts we have focused largely on social policy issues.
This week’s analyses of RAPID survey data emphasize the essential importance of public health policy for households with young children.
Our analysis shows that elected officials at national, state, and local levels must implement effective public health measures to control and contain the coronavirus. These policies decrease infection and mortality rates and they improve caregiver wellbeing and child development.
Methods
To examine how changes infection rates in different states across the country are affecting caregiver wellbeing, we focused on two clusters of states:
New York and New Jersey where infection rates were higher during the early weeks of the pandemic and have dropped considerably since, and
Texas, Florida, and Arizona where infection rates were low early on, and are high and also continuing to increase in recent weeks
We used publicly available data to develop infection rate curves for these two groups of states. Specifically, we computed the sum of infection rates across weeks for each of the two groups of states. We then compared the trends in well-being during early weeks of the pandemic and during the most recent weeks of the pandemic.
Each week of the pandemic, caregivers in our RAPID-EC survey of households with children under the age of 5 reported their feelings of anxiety, depression, loneliness, and stress. We used these self-ratings to create a total composite score for caregiver emotional distress. We then examined how these wellbeing scores related to changes in infection rates in the states where the caregivers live.
Our analyses controlled for material hardship. That is, we analyzed whether mental health was better or worse than would be expected given someone’s particular financial position.
These controls allowed us to determine that higher infection rates have an additional negative effect on wellbeing, over and above any increases in material or financial hardship.
When infection rates are high and on the rise, caregiver well-being suffers
The figure below shows how caregiver well-being has changed over the course of the pandemic in New York and New Jersey (shown in yellow) and in Texas, Florida, and Arizona (shown in green).
We looked closely at two significant points in time:
Early in the pandemic: 3 weeks into our survey (April 6 to April 22) when infection rates were high in New York and New Jersey and low in Texas, Florida, and Arizona; and
Later in the pandemic: 7 weeks into our survey (June 1 to July 13) when infection rates were low in New York and New Jersey and high and increasing higher in Texas, Florida, and Arizona.
We find that living in a state with high and increasing rates of infection negatively affects caregiver wellbeing.
Likewise, caregivers living in states where there is less infection show better overall wellbeing.
We also separately examined each component of caregiver well-being (anxiety, depression, stress, and loneliness) during both the early and later phases of the pandemic.
Early in the pandemic, we found that caregivers reported more depression and more anxiety when infection rates in their state were higher. Later in the pandemic we found that when infection rates in their state were higher, caregivers reported significantly more distress in all four areas: depression, anxiety, stress, and loneliness.
These patterns cannot be explained by financial or material hardship
We know from last week’s post that financial and material hardship during the pandemic have had a negative impact on caregiver well-being. Could differences in financial resources in New York and New Jersey compared with Texas, Florida, and Arizona be causing the differences that we observed in trajectories of caregiver well-being?
The answer is no.
The above findings cannot be explained by state-level differences in financial or material hardship. Even though individual families who experience more financial difficulty and material hardship are worse off in terms of both caregiver and child wellbeing, the additional impact of state-wide infection rates on caregiver well-being is not a result of financial differences across regions.
Implications
Our data show that caregivers feel worse where there are higher infection rates in their state and that this is not due to fewer financial resources.
While we do not have data to explain what is driving these associations, one potential explanation may be that higher rates of infection in a caregiver’s surrounding community causes the caregiver to feel more worry and stress about the future.
Will my family get sick?
Will I get sick and not be able to take care of my children?
Will our state shut down again?
Will I lose my job?
It is possible that having higher infection rates in one’s immediate surroundings increases personal feelings of imminent and substantial threat.
Given that a number of government relief efforts (detailed in last week’s post) are set to expire at the end of July, worry about the future will likely only increase among caregivers — particularly in places where infection rates are high.
This week’s findings have particularly worrisome implications given the impact that caregiver well-being has on the emotional health of children, as we explored in last week’s post. In states with high infection rates, caregivers experience more emotional distress. Our data suggest that this will have immediate, negative consequences for their young children.
Children in states with higher infection rates may be suffering emotionally as a direct result of their parents’ heightened emotional distress.
Recommendations
These findings show that policy makers at the national, state, and local levels need to follow the public health recommendations and implement measures to control and contain the virus. This includes social distancing, mask wearing, testing, and contact tracing.
Policy makers must consider the negative consequences for caregivers and families living in high-infection areas and take action to alleviate the emotional distress that these families are experiencing.
If steps are not taken to protect caregivers and their children from emotional suffering, these patterns will only grow worse as the pandemic continues. These may create a new public health crisis associated with emotional distress and mental health difficulties that will require resources from already-strapped communities.
Additional readings
“The coronavirus pandemic is pushing America into a mental health crisis,” Washington Post
“A Mental Health Pandemic: The Second Wave of COVID-19,” Psychiatric Times
“Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality,” Child and Adolescent Psychiatry and Mental Health
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.
These analyses are based on responses collected from 6250 caregivers between the dates of April 06, 2020 and July 23, 2020. These caregivers represent a range of voices: 8.86% are Black/African American, 21.14% are LatinX, and 26.02% 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, July 30). Geography Is Not Destiny…or Is It?: Caregiver Distress Tracks with State Infection Rates. Medium. https://medium.com/rapid-ec-project/geography-is-not-destiny-or-is-it-aa2d6023c177