No one is immune to the effects of coronavirus disease 2019 (COVID-19). Although the United States has >4 million confirmed cases and >144 000 deaths at the time of this writing,1 COVID-19’s effects on individuals and communities extend far beyond hospitalizations and mortality. Pandemics disturb individual and community well-being through direct effects of the illness and through emotional isolation, economic loss, work and school closure, and inadequate distribution of needed resources, among others.2 Previous research highlights consequences of pandemic mitigation efforts (such as quarantine) on stress, depression, fear, anger, boredom, stigma, and other negative states.3 Adults already report worse psychological well-being now as compared to before COVID-19.4 Because data suggest that children might less frequently transmit5 or become severely ill from the virus,6,7 the unique consequences that COVID-19 exerts on children risk being overlooked. Data on child and family well-being during COVID-19 are sparse, yet recent reports of increased family violence are ominous.8 Given the body of knowledge of the damaging effects of toxic stress and adverse childhood experiences on developing brains and lifelong health,9 a clearer representation of how the pandemic is affecting children and families is urgently needed.
Addressing this critical issue in this month’s Pediatrics, Patrick et al10 report findings from a cross-sectional survey inquiring how COVID-19 has affected the physical and emotional health of US parents and children. By leveraging an existing panel, the research team rapidly deployed a novel online survey to parents (N = 1011) of children aged <18 years, generating nationally representative estimates of changes in well-being between March and June. Patrick et al10 observed that more than one-quarter of parents reported worse mental health and that 14% reported worse behavioral health in their children. Results were most striking for single parents and parents of the youngest children, of whom approximately one-third reported worse mental health. Nearly 1 in 4 lost regular child care, and modest changes in food insecurity and employer-sponsored insurance coverage were observed.
These findings are foreboding even if some expected higher rates of worsening well-being. The effects of stress during crises are cumulative, and we should expect well-being outcomes to worsen with time. Consequences of isolation and quarantine are perpetuated by longer duration, financial loss, and preexisting mental health challenges, and they can persist beyond the quarantine period.3 Data from the severe acute respiratory syndrome coronavirus 1 epidemic in 2003 suggest that members of the general public impacted by the epidemic (ie, quarantined) had psychiatric symptoms months after the epidemic’s control.11 Additionally, common survey limitations, including cross-sectional rather than longitudinal data collection, social desirability bias, or unintended selection bias due to COVID-19 itself, could skew the results toward more neutral findings.
Families’ experiences of the pandemic are not uniform. Baseline physical and mental health, local and state policy decisions,12 race and/or ethnicity,13,14 economic stability,15 individual and community resources,13 immigration status,16 and geography17 all influence the relationship between COVID-19 and well-being. In the study by Patrick et al,10 although some parents reported worse child physical health, even more reported better physical health. Exploring what drove some parents to report improvements in child and/or parent mental or physical health could inspire novel interventions to bolster resilience during the pandemic. Longitudinal analyses may reveal COVID-19’s dynamic relationship with well-being. Future studies quantifying variation in well-being metrics within communities and over time could reveal best- and worst-case scenarios for children and families, expose critical inequities, and help uncover novel risk and protective factors to guide policy.
The pandemic has wide-reaching ramifications, and responses must account for its impact on children and families. With their findings, Patrick et al10 reiterate the need for clinicians to address these concepts during routine encounters. Researchers can build on this study by expanding the conceptualization of well-being to integrate resilience, positive social connection, purpose, autonomy, etc18 in observational and interventional studies. Policy makers should address several immediate challenges on the horizon facing families. Although the Families First Coronavirus Response Act19 and the Coronavirus Aid, Relief, and Economic Securities Act20 may have temporized well-being consequences, unemployment subsidies and eviction moratoria expire at the end of July, eroding safeguards against homelessness, hunger, and poverty.21–23 Schools are unlikely to open for most children next year, despite providing vital access to food for >30 million children24 as well as health and therapeutic services.25 Online school may be more challenging for children with special health care needs.26 Limited child care will strain working parents, especially mothers. Racial and/or ethnic disparities in COVID-19 infection and consequences27,28 are inexcusable and should be addressed directly. A full recovery from COVID-19 will require care for the well-being of our populations. The study by Patrick et al10 is a valuable step toward that recovery.
Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.
FUNDING: No external funding.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2020-016824.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.