The interplay between mothers’ and children behavioral and psychological factors during COVID-19 : an Italian study

A review by Elise FERRER et Laure QUENAULT

Summary 

It may surprise you, but in 2020 a highly contagious virus spread around the world. Italy was the first country to implement a lockdown in early March. And the consequences of this decision have been numerous: closure of schools, travel restrictions, teleworking, social distancing… In families, the whole daily organisation has been turned upside down. Parents have had to try, sometimes with difficulty, to maintain a balance between teleworking, daily life and homeschooling. The children have been deprived of all links with their peers. Lifestyle habits were also completely disrupted: less outdoor activities and exposure to light, impacts on sleep, diet, boredom… This situation may have caused psychological distress.

Faced with this unprecedented event, the aim of this study is to better understand the consequences of confinement on behavioral and psychological factors and thus to enable a better response from institutions to families.  The authors wanted to explore the consequences of confinement on the mental health of children and mothers. To do so, they drew on studies conducted in 2004, 2012 and 2016 on the impact of quarantine (for SARS and MERS viruses) on mental health. These studies reported a high prevalence of psychological and behavioral symptoms. 

Methodology

To conduct their research, the authors recruited 245 mothers of children between the ages of 2 and 5 through an online advertisement. The mothers were either working as before lockdown, not working, stopped working since lockdown or teleworking. On the one hand, the authors wanted to assess the changes in behavioral habits during the COVID-19 lockdown. Thus, they measured sleep quality of mothers and children through the Pittsburgh Sleep Quality Index (PSQI) and Sleep Disturbance Scale for Children (SDSC), and time perception via the Italian adapted version of the Subjective Time Questionnaire (STQ). On the other hand, they evaluated psychological well-being by examining children’s inhibition and emotional control through the Inhibitory Self-Control Index (ISCI). Using the Strengths and Difficulties Questionnaire – Parent version (SDQ-P) they measured the children’s strengths and issues as they were perceived by their parents and finally, to assess emotional regulation, participants completed the Difficulties in Emotion Regulation (DERS).

Results & Discussion

Regarding sleep timing, the results were quite noticeable. The breakdown of daily routines led to mothers and children going to bed later and waking up later (about an hour) than before lockdown. Also, regardless of the mothers’ working situations, results highlight a declining sleep quality among the mothers. As expected, there’s a positive correlation between the mothers’ and children’s sleep changes, as the mothers’ follow their children’s sleep patterns.

As regards children’s psychological well-being, this study points out an increase in self-control and inhibition difficulties, inattention and hyperactivity issues and emotional symptoms (stomachaches, tearfulness, having a lump in your throat…) regardless of the mothers’ working situation. Further analysis indicates that the children’s emotional issues derive from their mothers’ and their own sleep quality but also from the lack of outdoor activities allowing them to evacuate their energy. Finally, the mothers’ psychological well-being was strongly affected by their sleep quality, their growing fear of COVID-19, increased time pressure and emotional symptoms. 

Our critical evaluation

However, due to the study’s limitations, these conclusions still require scrutiny. First of all, the authors openly criticise their sample. On the one hand, they admit its size is quite small and point out that it « could have decreased [the] statistical power [of their study] ». On the other hand, they admit to some biases coming from the recruitment process. Some of the mothers were recruited by word of mouth because their children all went to the same kindergartens but most of them were « seeking information on research-related websites and social media groups ». In other words, we can’t really say that the sample is representative of all Italian mothers of 2 to 5 years-old children during the pandemic and that the conclusions can apply to all.

Furthermore, there is no consideration for the impact of the relationship to the father (or secondary care-giver). The authors chose to focus on the relationship to the mother even though research (see Boiteau et al., 2019¹) proved that the relationship to the father is equally important in a child’s development. Moreover, the authors decided to only use online questionnaires. This choice might have impacted the reliability of the final results. As tiredness sets in, it gets harder to regulate your emotions and evaluate things properly. We can ask ourselves if mothers in a state of weariness could effectively assess their feelings. Perhaps including interviews could have given a more objective view of the mothers’ issues (even though it would have not been easy in this context).

This article brings interesting recommendations for future studies on the matter. It also suggests taking more into account mothers’ emotional regulation when designing psychological support programs for emergency scenarios such as the COVID-19 lockdowns. 

Conclusion

Although it does not give practical recommendations, this article brings important reflections. We learn that parents and children present emotional “perturbations”, low mood and irritability when put in quarantine. We are also reminded of how much sleep quality and outdoor activities are important for mental health. And finally, articles of this kind give us perspectives and insight on what to look for during a health crisis. In a world where teleworking tends to be generalized, behavioral and psychological indicators of well-being need to be addressed and cared for.

Key words

• Smart working/Teleworking : Télétravail
• Interplay : Interagir/interaction
• House-holding : Ménage
• Welfare : Bien-être 
• Consistent : Cohérent
• Acquaintance : Connaissance (une personne)

Ressources

The article reference :

Di Giorgio, E., Di Riso, D., Mioni, G., & Cellini, N. (2020). The interplay between mothers’ and children behavioral and psychological factors during COVID-19 : an Italian study. European Child & Adolescent Psychiatry, 30(9), 1401‑1412. https://doi.org/10.1007/s00787-020-01631-3

¹ Boiteau, C., Apter, G., & Devouche, E. (2019). À l’aube de la paternité… Une revue du vécu des pères pendant la période périnatale. Devenir, 31(3), 249-264. https://doi.org/10.3917/dev.193.0249