Effects of Coronavirus Disease 2019 (COVID-19) on Family Functioning

Over a year and a half after the first clinical manifestations of coronavirus disease 2019 (COVID‐19) were reported in Whuan, China,Bloom J.D. Chan Y.A. Baric R.S. Bjorkman P.J. Cobey S. Deverman B.E. et al.Investigate the origins of COVID-19., the magnitude of the pandemic across the globe and its related clinical and social effects are still unclearAlzueta E. Perrin P. Baker F.C. Caffarra S. Ramos-Usuga D. Yuksel D. et al.How the COVID-19 pandemic has changed our lives: A study of psychological correlates across 59 countries.. The pandemic has affected lives and sparked concerns about everything from health to job security. In high-Gross Domestic Product (GDP) countries, despite trillions in coronavirus aid released by governments, many families still struggle to pay for basic necessities like food and rent, and these difficulties worsened during the pandemic,. The general social uncertainty caused by the pandemic seems to have also affected family resilience, weakening the ability of individuals to confront challenges, survive difficulties, and thrive in adversities as a groupKillgore W.D.S. Taylor E.C. Cloonan S.A. Dailey N.S. Psychological resilience during the COVID-19 lockdown.,Pettoello-Mantovani M. Pop T.L. Mestrovic J. Ferrara P. Giardino I. Carrasco-Sanz A. Nigri L. et al.Fostering Resilience in Children: The Essential Role of Healthcare Professionals and Families..To reduce community spread of the virus, many countries adopted unprecedented confining measures, including the restriction of populations in their homes and reduction of interpersonal contacts. Confinement, quarantine measures of suspected COVID-19 cases, and social distancing were prolonged and their effectiveness were debated at social, scientific, and political levelsKorean Society of Infectious Diseases
A Debate on Public Health Responses to COVID-19: Focused Protection versus Sustained Suppression.. However, although their prevention value in limiting viral spread is generally recognized, it is also widely accepted that social isolation measures have upended family livesAlzueta E. Perrin P. Baker F.C. Caffarra S. Ramos-Usuga D. Yuksel D. et al.How the COVID-19 pandemic has changed our lives: A study of psychological correlates across 59 countries.. Particularly, they have affected family functioning and parenting, which are significantly associated with the physical and psychosocial functioning of children and adolescentsLunkenheimer E.S. Olson S.L. Hollenstein T. Sameroff A.J. Winter C. Dyadic flexibility and positive affect in parent-child coregulation and the development of child behavior problems..

This commentary, authored by the working group on social pediatrics of the European Paediatric Association/Union of National European Paediatric Societies and Associations, briefly discusses the effects of the confinement measure taken to combat the COVID-19 pandemic on family functioning. Our aim is to raise awareness of pediatricians, social work professionals, and policy makers, as knowledge on the effects of social restrictions on family functioning may contribute to the efforts of national health systems to be effectively prepared to handle the social effects of future public health crises. Adopting a more mindful and coordinated approach may help to overcome divergences across countries, particularly in complex socio-political realities.

Family functioning: a social and structural asset of global family environmentPhysical and psychosocial performance of children and adolescents challenged by adversities are significantly related to a number of family factors, including family functioning and parenting, which are typically embedded within the context of a familyLunkenheimer E.S. Olson S.L. Hollenstein T. Sameroff A.J. Winter C. Dyadic flexibility and positive affect in parent-child coregulation and the development of child behavior problems.. Specific variables, which characterize parent-child relations in each family, may also play a role in maintaining a balanced physical and psychosocial functioning in children struggling with external events affecting their families. Parent–child dyadic rigidity, together with the presence or absence and the magnitude of variables such as unstable family income, broken home, family mobility, mental health of parents, number of children in the family, single parent family, and parental past, may accelerate a deterioration of intra-family relationsLunkenheimer E.S. Olson S.L. Hollenstein T. Sameroff A.J. Winter C. Dyadic flexibility and positive affect in parent-child coregulation and the development of child behavior problems.. In contrast, parent–child interaction processes of dyadic positive affect and flexibility may help to prevent possible negative impacts on children’s daily life and contribute to an effective parent–child co-regulation10,11,12.Family functioning is a multidimensional concept that refers to the dynamics and quality of family members’ relationships. This is based on the organization and level of conflict and cohesion internal to families and in large part on their adaptability and communication skills. In general, a family environment characterized by cohesion, clear communication ability, well-defined roles and good emotional balance and regulation, describes a positive family functioning11.12. Inadequate or defective family functioning refers to families showing disorganization characterized by unclear family roles, high levels of inner conflict situations, and poor affective and behavioral controlPalermo T.M. Chambers C.T. Parent and family factors in pediatric chronic pain and disability: An integrative approach.,Lewandowski A.S. Palermo T.M. Stinson J. Handley S. Chambers C.T. Systematic review of family functioning in families of children and adolescents with chronic pain.. Family structure also play an important role in achieving balanced family functioningFamily Instability and Child Well-Being..Family functioning is widely used as an evaluation criteria for parents, caregivers, and familiesBeardslee W.R. Gladstone T.R.G. Wright E.J. Cooper A.B. A Family-Based Approach to the Prevention of Depressive Symptoms in children at risk: Evidence of Parental and Child Change.. A variety of measures are available to asses functioning in families challenged by negative events and to evaluate family factors useful to identify families most at risk for poor family functioning. It is important to properly assess family functioning in order for caregivers to provide informed support, tailor interventions, and evaluate outcomes for individuals and the entire familyBeardslee W.R. Gladstone T.R.G. Wright E.J. Cooper A.B. A Family-Based Approach to the Prevention of Depressive Symptoms in children at risk: Evidence of Parental and Child Change.,Beardslee W.R. Hoke L. Wheelock I. Rothberg P. van de Velde P. Swatling S. Initial findings on preventive intervention for families with parental affective disorders., and ultimately, to develop programs and interventions that aim to improve family relationships and the overall functioning of the family. Five major theoretical models commonly used to asses family functioning are reported in the Table 1 (available at www.jpeds.com), which can be suitably selected and adopted as an assessment tool depending on the family context in which they are used.Effects of COVID-19 pandemic on family functioningA variety of natural, economic, and public health crisis have affected families throughout the world, causing distress to family members, including mental health problems, inter-parental conflict, and relational instability, which generated an increase of rough and abusive parentingPettoello-Mantovani M. Namazova-Baranova L. Ehrich J. Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.,Hoey H. Mestrovic J. Vural M. Baranova L.N. Somekh E. Pettoello-Mantovani M. Children facing natural, economic and public health crisis in Europe: The risks of a predictable unpredictability.. During the COVID-19 pandemic, families have suffered severe financial and psychological hardship, which were particularly problematic in complex socio-political contextsMcIntosh E.D. Janda J. Ehrich J.H. Pettoello-Mantovani M. Somekh E. Vaccine Hesitancy and Refusal. characterized by important socio-economic diversities, such as in Europe, which make difficult to establish coherent and consistent decision processes. In addition to the usual consequences of a public health crisis, including job instability and financial disruptions, families have experienced stress caused by social isolation, confinement within the household, rupture in the nature of school settings, concern for the future, and the need to make unprecedented health-related decisions for family members in a context of uncertaintyFerrara P. Corsello G. Ianniello F. Sbordone A. Ehrich J. Giardino I. et al.Internet Addiction: Starting the Debate on Health and Well-Being of Children Overexposed to Digital Media..Understanding the influence of the pandemic on family functioning is therefore essential in order to plan effective support interventions and preventive measures, and to allocate adequate resources to properly assist families during and after the pandemic. Recent studies in Europe and the US have provided evidence for a significant increase in overall mental distress in people tested before and during the pandemicPierce M. Hope H. Ford T. Hatch S. Hotopf M. John A. et al.Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population., and showed a consistent deterioration in parent and child mental and behavioral health during the first months of the pandemicFeinberg M.E. Mogle J A. Lee J.K. Tornello S.L. Hostetler M.L. Cifelli J.A. et al.Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning.,Jiao W.Y. Wang L.N. Liu J. Fang S.F. Jiao F.Y. Pettoello-Mantovani M. Somekh E. Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic.. In particular, increase in parent depression and children’s internalizing and externalizing problems from before the pandemic were significant findings, which normally are infrequently observed in developmental and family studiesFeinberg M.E. Mogle J A. Lee J.K. Tornello S.L. Hostetler M.L. Cifelli J.A. et al.Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning.,Jiao W.Y. Wang L.N. Liu J. Fang S.F. Jiao F.Y. Pettoello-Mantovani M. Somekh E. Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic.. During the pandemic, these 2 factors increased 2-fold and were more likely to score in the clinical rangeFeinberg M.E. Mogle J A. Lee J.K. Tornello S.L. Hostetler M.L. Cifelli J.A. et al.Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning..Preliminary reports on the social consequences of COVID-19 suggest that mental health problems and family conflicts generated by the pandemic may negatively impact family functioning, including the ability to develop resiliencePettoello-Mantovani M. Pop T.L. Mestrovic J. Ferrara P. Giardino I. Carrasco-Sanz A. Nigri L. et al.Fostering Resilience in Children: The Essential Role of Healthcare Professionals and Families.,Killgore W.D.S. Taylor E.C. Cloonan S.A. Dailey N.S. Psychological resilience during the COVID-19 lockdown.. The ongoing COVID-19 pandemic offers an important opportunity to further investigate the implications of deterioration in parent and child psychological well-being during extraordinary public health events. They may in fact amplify intra-family conflicts and compromise the capability of parents to implement and sustain protective health behaviors of family members, including social distancing, hand-washing, mask-wearing, and preventive plans recommended by public health authoritiesWilliams J. Namazova-Baranova L. Weber M. Vural M. Mestrovic J. Carrasco-Sanz A. et al.The Importance of Continuing Breastfeeding during Coronavirus Disease-2019: In Support of the World Health Organization Statement on Breastfeeding during the Pandemic.. The assessment of family functioning during a pandemic, as in the case of COVID-19, seems important to maintain an adequate dynamic and quality of family members’ relationships.ConclusionsIt is currently unclear whether and to what extent family instabilities due to the COVID-19 pandemic may recover during the months following the end of this public health emergency and for how long the negative effects of this event persist and will affect parent and child well-being. However, experience from past crises, suggests the strategic importance to establish or potentiate preventive measures based on the promotion of individual and family resilience before a crisisPettoello-Mantovani M. Pop T.L. Mestrovic J. Ferrara P. Giardino I. Carrasco-Sanz A. Nigri L. et al.Fostering Resilience in Children: The Essential Role of Healthcare Professionals and Families.,Hoey H. Mestrovic J. Vural M. Baranova L.N. Somekh E. Pettoello-Mantovani M. Children facing natural, economic and public health crisis in Europe: The risks of a predictable unpredictability. and to plan for providing support to families after the onset of a crisisFerrara P. Guadagno C. Sbordone A. Amato M. Spina G. Perrone G. et al.Child Abuse and Neglect and its Psycho-Physical and Social Consequences: A Review of the Literature.. Family support plans should include the promotion of coping skills, family relationship quality, and attitude managementFerrara P. Caporale O. Cutrona C. Sbordone A. Amato M. Spina G. et al.Femicide and murdered women's children: which future for these children orphans of a living parent?.. Assisting families in recovering from pandemic periods and from crises in general would require a multidimensional and interdisciplinary approach including schools, pediatricians, social work professionals, mental health clinicians, counselors, family service agencies, and sport organizations,

Bennet T. Developing Individualized Family Support Plans. Brookline Books; Lumen Editions, 1999

.References

Undiagnosed pneumonia.China (Hubei): Request for information. ProMED post (2019); https://promedmail.org/promed-post/?id=6864153

Bloom J.D. Chan Y.A. Baric R.S. Bjorkman P.J. Cobey S. Deverman B.E. et al.

Investigate the origins of COVID-19.

Science. 372: 694

World Health Organization (WHO) Coronavirus disease (COVID-19) outbreak. Coronavirus disease (COVID-19) outbreak. www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen (Accessed, 03 June, 2021)

Alzueta E. Perrin P. Baker F.C. Caffarra S. Ramos-Usuga D. Yuksel D. et al.

How the COVID-19 pandemic has changed our lives: A study of psychological correlates across 59 countries.

Journal of Clinical Psychology. 77: 556-570

Jenco M. Study: COVID-19 pandemic exacerbated hardships for low-income, minority families. American Academy of Pediatrics News. (Accessed, 03 June, 2021) https://www.aappublications.org/news/2020/06/03/covid19hardships060320

AAFF) Karpman M, Gonzalez D, Kenney MG. Parents Are Struggling to Provide for Their Families during the Pandemic. Urban Institute. .(Accessed, 03 June, 2021) https://www.urban.org/sites/default/files/publication/102254/parents-are-struggling-to-provide-for-their-families-during-the-pandemic_2.pdf

Killgore W.D.S. Taylor E.C. Cloonan S.A. Dailey N.S.

Psychological resilience during the COVID-19 lockdown.

Psychiatry Res. 291: 113216https://doi.org/10.1016/j.psychres.2020.113216Pettoello-Mantovani M. Pop T.L. Mestrovic J. Ferrara P. Giardino I. Carrasco-Sanz A. Nigri L. et al.

Fostering Resilience in Children: The Essential Role of Healthcare Professionals and Families.

J Pediatr. 205: 298-299.e1Song J.Y. Peck K.R. Korean Society of Infectious Diseases

A Debate on Public Health Responses to COVID-19: Focused Protection versus Sustained Suppression.

J Korean Med Sci. 35: e433Lunkenheimer E.S. Olson S.L. Hollenstein T. Sameroff A.J. Winter C.

Dyadic flexibility and positive affect in parent-child coregulation and the development of child behavior problems.

Dev Psychopathol. 23: 577-591Palermo T.M. Chambers C.T.

Parent and family factors in pediatric chronic pain and disability: An integrative approach.

Pain. 119: 1-4Lewandowski A.S. Palermo T.M. Stinson J. Handley S. Chambers C.T.

Systematic review of family functioning in families of children and adolescents with chronic pain.

J Pain. 11: 1027-1038

Family Instability and Child Well-Being.

Am Sociol Rev. 72: 181-204Beardslee W.R. Gladstone T.R.G. Wright E.J. Cooper A.B.

A Family-Based Approach to the Prevention of Depressive Symptoms in children at risk: Evidence of Parental and Child Change.

Pediatrics. 112: 119-131Beardslee W.R. Hoke L. Wheelock I. Rothberg P. van de Velde P. Swatling S.

Initial findings on preventive intervention for families with parental affective disorders.

Am J Psychiatry. 149: 1335-1340Pettoello-Mantovani M. Namazova-Baranova L. Ehrich J.

Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.

Ital J Pediatr. 42: 18Hoey H. Mestrovic J. Vural M. Baranova L.N. Somekh E. Pettoello-Mantovani M.

Children facing natural, economic and public health crisis in Europe: The risks of a predictable unpredictability.

Turk Pediatri Ars. 55: 4-9McIntosh E.D. Janda J. Ehrich J.H. Pettoello-Mantovani M. Somekh E.

Vaccine Hesitancy and Refusal.

J Pediatr. 175: 248-249.e1Ferrara P. Corsello G. Ianniello F. Sbordone A. Ehrich J. Giardino I. et al.

Internet Addiction: Starting the Debate on Health and Well-Being of Children Overexposed to Digital Media.

J Pediatr. 191: 280-281.e1Pierce M. Hope H. Ford T. Hatch S. Hotopf M. John A. et al.

Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population.

The Lancet Psychiatry. 7: 883-892Feinberg M.E. Mogle J A. Lee J.K. Tornello S.L. Hostetler M.L. Cifelli J.A. et al.

Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning.

Fam Process. https://doi.org/10.1111/famp.12649Jiao W.Y. Wang L.N. Liu J. Fang S.F. Jiao F.Y. Pettoello-Mantovani M. Somekh E.

Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic.

J Pediatr. 221: 264-266.e1Killgore W.D.S. Taylor E.C. Cloonan S.A. Dailey N.S.

Psychological resilience during the COVID-19 lockdown.

Psychiatry Res. 291: 113216Williams J. Namazova-Baranova L. Weber M. Vural M. Mestrovic J. Carrasco-Sanz A. et al.

The Importance of Continuing Breastfeeding during Coronavirus Disease-2019: In Support of the World Health Organization Statement on Breastfeeding during the Pandemic.

J Pediatr. 223: 234-236Ferrara P. Guadagno C. Sbordone A. Amato M. Spina G. Perrone G. et al.

Child Abuse and Neglect and its Psycho-Physical and Social Consequences: A Review of the Literature.

Curr Pediatr Rev. 12: 301-310Ferrara P. Caporale O. Cutrona C. Sbordone A. Amato M. Spina G. et al.

Femicide and murdered women's children: which future for these children orphans of a living parent?.

Ital J Pediatr. 41: 68

Massachusetts Department of Mental Health. Chapter 171. Report and Annual Individual and Family Support Plan. https://archives.lib.state.ma.us/handle/2452/839255 .(Accessed, 28 June 2021)

Bennet T. Developing Individualized Family Support Plans. Brookline Books; Lumen Editions, 1999

Article InfoPublication History

Accepted: June 30, 2021

Received: June 30, 2021

Publication stageIn Press Accepted ManuscriptFootnotes

The authors declare no conflicts of interest.

Identification

DOI: https://doi.org/10.1016/j.jpeds.2021.06.082

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© 2021 Elsevier Inc. All rights reserved.

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