Olsavsky, A. L., Ralph, J., Benhayoun, A., Hill, K. N., Guttoo, P., Akard, T. F., Gerhardt, C., & Skeens, M. A. (2024). COVID-19 impact, resilience, and child quality of life: A dyadic analysis. Journal of Family Psychology, 38(4), 523–535. https://doi.org/10.1037/fam0001218
Key Points
- The COVID-19 pandemic significantly impacted child quality of life (QoL) and resilience in U.S. families.
- Both child and caregiver perceptions of COVID-19 impact were associated with later child QoL and resilience.
- Child resilience mediated the relationship between COVID-19 impact and child QoL.
- Factors like income, gender, and ethnicity significantly affected child QoL and resilience outcomes.
- The research provides insights into family interdependence during crisis, but has limitations in sample diversity and generalizability.
- Understanding these dynamics is crucial for developing targeted interventions to support child well-being during and after societal adversities.
Rationale
The COVID-19 pandemic caused significant disruptions to children’s and caregivers’ mental and physical well-being, including quality of life (QoL) (Nobari et al., 2021; Ravens-Sieberer et al., 2023).
While research has established that caregivers and children experienced stress and poorer well-being due to the pandemic (Adams et al., 2021), little is known about the interdependent associations between caregiver and child COVID-19 experiences and well-being, particularly in U.S. samples.
Understanding these dynamics is crucial for developing effective interventions.
Previous studies have shown that caregivers’ mental states are linked to child well-being during the pandemic (Ueda et al., 2022), and that resilience may serve as a protective factor (Montirosso et al., 2021).
However, most research on child QoL during the pandemic has been conducted outside the U.S. (Nobari et al., 2021), limiting our understanding of how U.S. children were affected.
This study aimed to address these gaps by examining how caregiver and child perceptions of early COVID-19 impact were associated with later resilience and child QoL in U.S. families.
By utilizing a family systems perspective and dyadic data analysis, the research provides insights into the complex interrelationships among family members’ experiences and well-being during a major societal crisis.
Method
The study employed a longitudinal design with two time points, using online surveys to collect data from caregiver-child dyads.
Procedure
Families were recruited remotely via Facebook advertisements from May to July 2020 (Time 1). Caregivers completed measures first, followed by their oldest willing child.
Follow-up surveys were sent from November 2020 to January 2021 (Time 2) to participants who agreed to future research.
Sample
The final sample included 231 caregiver-child dyads. Children (54.5% male) were aged 8-17 years (M = 11.87, SD = 2.66). Most children (92.2%) and caregivers (92.6%) identified as White.
Caregivers were primarily female (94.8%) and biological parents (93.9%). Most families resided in the Midwestern United States (46.8%).
Measures
- COVID-19 Impact: Measured using the COVID-19 Exposure and Impact Scale (CEFIS; Kazak et al., 2021).
- Child Quality of Life: Assessed using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL; Varni et al., 2003).
- Resilience: Measured with the Connor–Davidson Resilience Scale 10 (CD-RISC 10; Campbell-Sills & Stein, 2007).
- Family Relationships: Assessed using the Patient-Reported Outcomes Measurement Information System Short Form Family Relationship Scale.
Statistical measures
Data were analyzed using descriptive statistics, correlations, and advanced dyadic data analysis techniques, including Actor-Partner Interdependence Models (APIMs) and Actor-Partner Interdependence Mediation Models (APIMeMs).
Results
Hypothesis 1: Greater caregiver and child perceived T1 COVID-19 impact would be associated with worse caregiver proxy- and child self-reported T2 child QoL (actor and partner effects).
Results: Supported. Lower actor (b = −3.57, p = .002) and partner (b = −2.78, p = .02) COVID-19 impact were significantly associated with greater child QoL.
Hypothesis 2: Greater caregiver- and child-reported T1 COVID-19 impact would be associated with lower caregiver and child T2 resilience (actor and partner effects).
Results: Partially supported. There was a significant actor effect (b = −2.02, p = .003) such that lower self-reported COVID-19 impact was associated with greater resilience for both caregivers and children. No significant partner effects were found.
Hypothesis 3: Greater caregiver- and child-reported T1 COVID-19 impact would be associated with lower caregiver and child T2 resilience, which would then be associated with lower T2 child QoL (actor and partner indirect effects).
Results: Partially supported. Two significant indirect effects were found:
- Lower T1 child COVID-19 impact → Higher T2 child resilience → Higher T2 child-reported child QoL
- Lower T1 child COVID-19 impact → Higher T2 child resilience → Higher T2 caregiver proxy-reported child QoL
Insight
This study provides novel insights into the well-being of U.S. children and their caregivers during the COVID-19 pandemic.
The findings underscore the interdependence of caregiver and child experiences, highlighting the importance of considering family systems in understanding and addressing child well-being during crises.
Key findings include:
- Both child and caregiver perceptions of COVID-19 impact were associated with later child QoL, demonstrating the importance of considering multiple family members’ perspectives.
- Child resilience played a mediating role between COVID-19 impact and child QoL, suggesting that fostering resilience in children may be an important point of intervention.
- Sociodemographic factors, such as income and gender, were significantly associated with child QoL outcomes, highlighting the need to consider these factors in interventions.
These findings extend previous research by:
- Providing insights into U.S. children’s QoL during the pandemic, addressing a gap in the literature.
- Using dyadic data analysis to examine interdependent effects within families, offering a more nuanced understanding of family dynamics during crisis.
- Identifying child resilience as a potential mechanism through which COVID-19 impact affects child QoL.
Future research could:
- Examine these relationships in more diverse samples to improve generalizability.
- Investigate the long-term effects of the pandemic on child QoL and resilience.
- Develop and test interventions aimed at fostering child resilience within the family context.
Strengths
- Longitudinal design, allowing for examination of relationships over time.
- Use of dyadic data analysis techniques (APIMs and APIMeMs) to capture interdependence within families.
- Inclusion of both child and caregiver reports of child QoL.
- Assessment of multiple factors (COVID-19 impact, resilience, QoL) to provide a comprehensive picture of family well-being.
Limitations
- The sample was primarily White and of middle to upper socioeconomic status, limiting generalizability to more diverse populations.
- Nearly all caregivers were women, preventing examination of potential differences based on caregiver gender.
- Data were collected via Facebook advertisements, which may have introduced selection bias.
- The study focused on two time points during the first year of the pandemic, limiting understanding of longer-term effects.
- The moderator and dependent variable in the APIMeM were measured concurrently, potentially obscuring additional indirect effects.
These limitations suggest caution in generalizing results to low-income or minoritized groups and underscore the need for further research with more diverse samples and over longer time periods.
Implications
The findings have significant implications for understanding and supporting child well-being during and after societal crises:
- Clinical Practice: Interventions aimed at improving child QoL should consider the family system, addressing both child and caregiver perceptions and experiences. Fostering resilience in children may be a particularly effective strategy.
- Policy: Efforts to support families during crises should consider sociodemographic factors, such as income and gender, which were found to significantly affect outcomes.
- Research: The study highlights the importance of using dyadic approaches to understand family dynamics during crises. Future research should build on this by examining these relationships in more diverse samples and over longer periods.
- Education: The findings underscore the need for training mental health professionals in family systems approaches and resilience-building strategies for children.
- Public Health: The study suggests that public health messaging and interventions during crises should target both caregivers and children, recognizing their interdependent experiences.
Variables that influence the results include sociodemographic factors (e.g., income, gender, ethnicity), family relationship quality, and individual perceptions of COVID-19 impact. These variables should be considered in the development and implementation of interventions.
References
Primary reference
Olsavsky, A. L., Ralph, J., Benhayoun, A., Hill, K. N., Guttoo, P., Akard, T. F., Gerhardt, C., & Skeens, M. A. (2024). COVID-19 impact, resilience, and child quality of life: A dyadic analysis. Journal of Family Psychology, 38(4), 523–535. https://doi.org/10.1037/fam0001218
Other references
Adams, E. L., Smith, D., Caccavale, L. J., & Bean, M. K. (2021). Parents are stressed! Patterns of parent stress across COVID-19. Frontiers in Psychiatry, 12, Article 626456. https://doi.org/10.3389/fpsyt.2021.626456
Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20(6), 1019-1028. https://doi.org/10.1002/jts.20271
Kazak, A. E., Alderfer, M., Enlow, P. T., Lewis, A. M., Vega, G., Barakat, L., Kassam-Adams, N., Pai, A., Canter, K. S., Hildenbrand, A. K., McDonnell, G. A., Price, J., Schultz, C., Sood, E., & Phan, T. L. (2021). COVID-19 Exposure and Family Impact Scales: Factor structure and initial psychometrics. Journal of Pediatric Psychology, 46(5), 504-513. https://doi.org/10.1093/jpepsy/jsab026
Montirosso, R., Mascheroni, E., Guida, E., Piazza, C., Sali, M. E., Molteni, M., & Reni, G. (2021). Stress symptoms and resilience factors in children with neurodevelopmental disabilities and their parents during the COVID-19 pandemic. Health Psychology, 40(7), 428-438. https://doi.org/10.1037/hea0000966
Nobari, H., Fashi, M., Eskandari, A., Villafaina, S., Murillo-Garcia, Á., & Pérez-Gómez, J. (2021). Effect of COVID-19 on health-related quality of life in adolescents and children: A systematic review. International Journal of Environmental Research and Public Health, 18(9), Article 4563. https://doi.org/10.3390/ijerph18094563
Ravens-Sieberer, U., Kaman, A., Erhart, M., Otto, C., Devine, J., Löffler, C., Hurrelmann, K., Bullinger, M., Barkmann, C., Siegel, N. A., Hurrelmann, K., Bullinger, M., Barkmann, C., Siegel, N. A., & Hölling, H. (2023). Quality of life and mental health in children and adolescents during the first year of the COVID-19 pandemic: Results of a two-wave nationwide population-based study. European Child & Adolescent Psychiatry, 32, 575-588. https://doi.org/10.1007/s00787-021-01889-1
Ueda, R., Okada, T., Kita, Y., Ukezono, M., Takada, M., Ozawa, Y., Inoue, H., Shioda, M., Kono, Y., Kono, C., Nakamura, Y., Amemiya, K., Ito, A., Sugiura, N., Matsuoka, Y., Kaiga, C., Shiraki, Y., Kubota, M., & Ozawa, H. (2022). Quality of life of children with neurodevelopmental disorders and their parents during the COVID-19 pandemic: A 1-year follow-up study. Scientific Reports, 12(1), Article 4298. https://doi.org/10.1038/s41598-022-08273-2
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