Families Matter: A Cross-Sectional Study of Parent and Child Mental Health During COVID-19 (Preprint)

Journal Article


Background: The pandemic has disrupted all aspects of children’s lives and has increased children’s exposure to adversity and traumas known to increase the risk of mental health challenges. Recent studies have reported increased rates of mental health challenges in youth during the pandemic, yet few studies have examined the impact of the pandemic on the mental health of toddlers, preschoolers, and elementary school-age children. The pandemic has also adversely impacted caregiver mental health and other indirect factors, including economic instability, known to increase children’s risk for impairing mental health challenges.


Objective: This study aimed to characterize the social-emotional challenges of children ages 2 to 12 years old during the pandemic and identify modifiable child, caregiver, and family-related risk factors that contribute to risk and are additional targets for intervention.


Methods: Caregivers (N = 676) of children ages 2-12 completed an online survey in early fall 2021 using standardized screening tools to assess child social-emotional challenges and caregiver anxiety and depression. We used a new 16 scale to assess the impact of the pandemic at the child, caregiver, and family levels. We used hierarchical linear regression and logistic regression to explore the relationship between children’s mental health and caregivers’ mental health. We used path analysis to explore direct and indirect effects of the impact of pandemic stress on child emotional and peer challenges, mediated by caregiver anxiety and depression.


Results: Eighty-seven percent of the children were ages 2-8 years old (n=588) with 13% (n=88) between 9-12 years old. Caregivers endorsed significant child emotional and peer challenges with 80% (n = 536) of children at risk for clinically-significant emotional challenges and 57% (n = 388) at risk for clinically-significant peer social challenges. Emotional challenges increased with age (r = .20, P <.001). 50% (n=330) of caregivers screened positive for generalized anxiety and 24% (n=160) screened positive for depression. Cumulative COVID-19 impact was directly associated with increased child emotional challenges (r=.29, P<.001), peer challenges (r=.29, P<.001), caregiver anxiety (r = .32, P<.001), and caregiver depression (r = .42, P<.001). Caregiver anxiety accounted for 31% of the total effect of COVID-19 impact on child emotional challenges and 18% of the total effect on peer challenges.


Conclusions: The results of our study show that the COVID-19 pandemic is having direct and indirect adverse impacts on the social-emotional health of children ages 2 to 12 years old with impacts on very young children similar to impacts for older children. Only with an integrated, family-focused approach that includes young children will we be able to mitigate the current pediatric mental health crisis.



Full Text

Duke Authors

Cited Authors

  • Friis, E; Erwin, SR; Daniel, J; Egger, R; Egger, H

Digital Object Identifier (DOI)

  • 10.2196/preprints.35953