Relationships Among Parenting Stress and Well-Being, COVID-19 Information Management, and Children's COVID-19 Fear : Journal of Developmental & Behavioral Pediatrics

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Original Article

Relationships Among Parenting Stress and Well-Being, COVID-19 Information Management, and Children's COVID-19 Fear

Boone, Dianna M. PhD*; Stromberg, Sarah PhD*; Fritz, Alyssa PhD*; Rodriguez, Juventino Hernandez PhD; Gregus, Samantha PhD§; Faith, Melissa A. PhD, ABPP*,†

Author Information
Journal of Developmental & Behavioral Pediatrics 43(9):p e581-e589, December 2022. | DOI: 10.1097/DBP.0000000000001116
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Abstract

The COVID-19 pandemic has disrupted the lives of children and their families throughout the world.1 National and local governing agencies have enacted numerous restricting ordinances and recommendations, including quarantine and social distancing, to limit virus spread.1 Restrictions related to the COVID-19 pandemic have dramatically changed children's daily routines (e.g., reduced physical activity, increased screen time, and irregular sleeping schedules).2 In addition, children and families are inundated with media descriptions of COVID-19 threat and severity.2 Nearly constant media exposure, combined with social isolation and changes in usual routine, can contribute to youth experiencing negative psychosocial outcomes, including increased anxiety and depression.3 Children are also experiencing greater anxiety associated with a fear of contracting COVID-19.3 During the COVID-19 pandemic, children experiencing concern regarding their own health and the health of their family members is a normative response.4 For most children, fear of COVID-19 is an adaptive response that motivates children to engage in precautionary measures to protect themselves from the virus (e.g., frequently washing hands and social distancing). However, some children may be more likely to experience greater than normative COVID-19 fear, including recurring uncontrollable thoughts about contracting the virus.4 Children may also have pre-existing anxiety, depression, or behavioral concerns predating the COVID-19 pandemic, which may also contribute to children's COVID-19 fear.4 Children's illness fear is important to examine because previous studies examining children's psychological outcomes related to the severe acute respiratory syndrome (SARS) outbreak have found an increase in the presence of posttraumatic stress disorder symptoms in youth after quarantining for an extended period of time.5

Studies have demonstrated clear positive associations between parents' overall functioning and children's functioning during stressful events.6,7 In accordance with Social Cognitive Theory and the concept of social referencing, children may react to the COVID-19 pandemic similarly to how they observe their parents reacting to the pandemic.6 Parents are experiencing multiple stressors during the COVID-19 pandemic, including shifting to working from home, a lack of usual supports, increased child care responsibilities, potential job and insurance loss, financial strain, and protecting themselves and their children from contracting COVID-19.7 A lack of usual support, in combination with parents and children experiencing increased social isolation, may be related to parents experiencing increased parenting stress and decreased overall emotional well-being.7,8 For the purposes of this study, parenting stress refers to “a set of processes that lead to aversive psychological and physiological reactions arising from attempts to adapt to the demands of parenthood.”9 It is possible that caregivers who are facing high parenting stress levels and decreased emotional well-being may be more likely to parent their children differently during the COVID-19 pandemic, although few studies have evaluated these potential links.

Prime et al.8 developed a theoretical model to explain how COVID-19 disruptions may affect parenting behaviors. Specifically, major changes in parents' routines and stressors (e.g., financial difficulties, increased child care responsibilities, and social isolation) may be correlated with parents' reduced overall well-being and increased perceived stress specifically related to parenting. For example, some parents experiencing COVID-19–related stressors may not manage child behavior problems using the discipline strategies they previously used. Illustratively, a parent who is experiencing significant role strain related to managing their child's education while working from home may be less likely to limit their child's access to electronic devices for an extended period of time. Prime et al.8 posited that parents who experience greater parenting stress9 may be likely to engage in fewer positive parent-child interactions and greater negative interactions, which may be related to worsening child adjustment over time.

Currently, no studies have yet evaluated to what extent parenting stress is related to how parents manage their children's COVID-19 knowledge. For the purpose of this study, greater management of children's COVID-19 knowledge refers to parents making efforts to manage their children's access to COVID-19 information (e.g., identifying information sources and clarifying misinformation). Studies have documented that providing open, accurate, and developmentally appropriate COVID-19 information to children is essential to children's optimal psychosocial adjustment during the pandemic.10 It is possible that when parents are stressed or experience role strain, they may engage in greater management of their children's COVID-19 knowledge to protect their child from becoming stressed. This hypothesis is supported by recent studies demonstrating that parents may use controlling parenting behaviors to reduce their own fear and anxiety regarding a stressor.11,12 For instance, Wissemann et al.12 conducted a longitudinal study found parents' COVID-19 fear predicted greater controlling parenting behaviors at time 2. These studies suggest that although some parents may think they are reducing their children's COVID-19 anxiety by managing children's COVID-19 knowledge, they might inadvertently be more likely to exacerbate children's fear of contracting the virus. Previous investigators have developed the evidence-based theory of uncertainty management,13 which explains that individuals seek information for the purpose of learning or discovering evidence that confirms or disconfirms their current beliefs.13 Based on Uncertainty Management Theory, individuals may choose certain information sources based on their beliefs of the source's efficacy and familiarity.13 Specifically, parents may either withhold potentially distressing information about a diagnosis or provide unsolicited information13 to their children. In addition, individuals may engage in avoidance behaviors (e.g., discrediting certain information and selective attention).13 Brashers et al. 13 postulated that as individuals increasingly obtain health-related information to reduce their uncertainty, they may also experience greater illness anxiety. Based on Uncertainty Management Theory,13 it is possible that parents may be reducing their own uncertainty and anxiety by managing their child's COVID-19 knowledge, and the current study examines this potential link. This hypothesis aligns with previous studies documenting that parents who are experiencing greater stress and fear may be more likely to use controlling parenting practices.11,12 Additional information is needed examining how parents manage their children's COVID-19 knowledge and how managing their knowledge is related to both parenting stress and children's COVID-19 fear.

The purpose of this study was to evaluate whether the association between parenting stress and children's COVID-19 fear could be explained by parents' COVID-19 information management and emotional well-being in response to COVID-19. Prime (2020)8 highlights the interconnections between social disruptions, family relationships, economic stressors, and variabilities in family's vulnerabilities/resiliencies. This builds on long-standing research on the association between negative parent-child interactions and poor child outcomes.12,14,15 Consistent with Prime's8 theoretical model, we hypothesized a potential relation between parenting stress and children's COVID-19 fear explained by parents' emotional well-being and management of their children's COVID-19 knowledge. Specifically, we hypothesized that parents' lower emotional well-being would be associated with greater parenting stress, management of children's COVID-19 knowledge (e.g., greater clarifying COVID-19 misinformation and checking information sources), and children's illness fear. We also hypothesized that parents' greater management of their children's COVID-19 knowledge would be associated with greater parenting stress and reduced emotional well-being.

METHOD

Participants were recruited through Amazon Mechanical Turk (MTurk), an internet survey recruitment tool. The study was posted on MTurk as an online survey and was made available only to parents within the United States, based on screening questions MTurk users completed when they originally registered for an MTurk account. Additional eligibility criteria, determined by screening questions, included speaking English and having at least one 7- to 17-year-old child living in the home. The age range of 7 to 17 years was chosen because our study was part of a larger study that examined constructs (e.g., peer interactions and academic concerns) that would affect school-age children. The larger study also attempted to link parent responses to children's responses, and children's self-reports were not validated below age 7 years. We chose the upper age limit because we wanted to maintain focus on children who were under the age of majority. Participants first reviewed informed consent, then provided demographic information about themselves and their child, and finally completed questionnaires about themselves and a child living in their home. We asked parents who had more than one 7- to 17-year-old child in their home to select the child who had the most recent birthday for responding to questionnaires. Parents received debriefing information after participating, including parent and family COVID-19 educational materials. A total of 720 participants began the study; 125 (17.36%) were disqualified for not passing the validation check (see Procedures). The final sample consisted of 595 caregivers of children during the COVID-19 pandemic: 40.0% men, 69.2% non-Latinx White, 12.1% Black, 10.1% Latinx, 6.6% Asian, and <2% other. Most participants were married (72.9%), reported working full time (69.2%), reported working full time (79.2%), reported working part time (11.4%), were earning less than $70,000/yr (54.1%), and were speaking English at home (85.7%). Caregivers reported on their child's demographics. Children had an average age of 11.4 years. Children were 67.9% non-Latinx White, 11.6% Black, 11.6% Latinx, 5.7% Asian, and <2% others. For the purposes of the current study, chronic illness was defined as a physical condition and excluded developmental and/or psychological comorbidities. However, we did also assess for developmental and/or behavioral/psychological disorders (e.g., autism and ADHD). In our sample, per parents' report, 1 child was diagnosed with ADHD, and 3 children were diagnosed with autism. Of the children, 8.7% had a chronic illness (4.9% had asthma). Most children were in elementary school (49.4%) and receiving school online only (53.6%) at the time of the survey. Please see Tables 1 and 2 for detailed demographic information.

Table 1. - Demographic Characteristics of Caregivers
Variable Value
Parent gender, N (%)
 Female 352 (59.2)
 Male 238 (40.00)
Parent ethnicity, N (%)
 Non-Latinx White 412 (69.2)
 Black 72 (12.1)
 Latinx 60 (10.1)
 Asian 39 (6.6)
 Other (Native American, Alaskan Native, Native Hawaiian, or Pacific Islander) 9 (1.5)
 Missing 3 (0.5)
Parent relationship status
 Married 434 (72.9)
 In a relationship, but not married 74 (12.4)
 Single because widowed or divorced 48 (8.1)
 Single (not widowed or divorced) 37 (6.2)
 Missing 2 (0.3)
Parent education, N (%)
 Less than high school degree 2 (0.3)
 High school graduate (high school diploma or GED) 35 (5.9)
 Some college but no degree 94 (15.8)
 Associate degree in college (2 yrs) 94 (15.8)
 Master's degree 114 (19.2)
 Bachelor's degree in college (4 yrs) 239 (40.2)
 Professional degree (JD, MD) 9 (1.5)
 Doctoral degree 7 (1.2)
 Missing 1 (0.2)
Parent employment status
 Working (full time) 412 (69.2)
 Working (part time) 68 (11.4)
 Not working (unemployed) 52 (8.7)
 Not working (temporary layoff/furloughed from a job) 49 (8.2)
 Not working (retired or disabled) 13 (2.2)
 Missing 1 (0.2)
Relationship to the child, N (%)
 Mother 333 (56.0)
 Father 228 (38.3)
 Grandparent 18 (3.0)
 Other 14 (2.5)
 Missing 1 (0.2)
Income level, N (%)
 Less than $10,000 57 (9.6)
 $10,000 to $19,999 22 (3.7)
 $20,000 to $29,999 44 (7.4)
 $30,000 to $39,999 34 (5.7)
 $40,000 to $49,999 52 (8.7)
 $50,000 to $59,999 43 (7.2)
 $60,000 to $69,999 51 (8.6)
 $70,000 to $79,999 55 (9.2)
 $80,000 to $89,999 38 (6.4)
 $90,000 to $99,999 44 (7.4)
 $100,000 to $149,999 91 (15.3)
 $150,000 or more 42 (7.1)
 Missing 22 (3.7)
GED, graduate equivalency degree.

Table 2. - Demographic Characteristics of Youth
Variable Value
Age, mean (SD) 11.4 (3.64)
Gender, N (%)
 Male 322 (54.10)
 Female 271 (45.50)
 Missing 2 (0.3)
Children's ethnicity
 Non-Latinx White 404 (67.9)
 Black 69 (11.6)
 Latinx 69 (11.6)
 Asian 34 (5.7)
 Other (Native American, Alaskan Native, Native Hawaiian, or Pacific Islander) 9 (1.5)
 Missing 10 (1.7)
Child's grade level
 Elementary 294 (49.5)
 Middle 136 (22.8)
 High school 163 (27.4)
 Missing 2 (0.3)
Children's chronic illness
 Yes 50 (8.7)
 No 543 (91.2)
 Missing 2 (0.03)
Children's chronic illness type
 Asthma or pulmonary condition 32 (5.4)
 Neurological disorder 2 (0.3)
 Type 1 diabetes 2 (0.3)
 Chronic pain 2 (0.3)
 Cardiac condition 1 (0.02)
 Bleeding disorder 1 (0.02)
 Sickle cell disease 1 (0.02)
 Other chronic illness type 9 (1.5)
Children's developmental/behavioral disorder type
 ADHD 1 (0.02)
 Autism 3 (0.01)
Method of school delivery
 Online only 319 (53.6)
 Both online and in-person 160 (26.9)
 Only workbooks 71 (11.9)
 In-person only 10 (1.7)
 Other 23 (3.9)
 Missing 12 (2.0)
ADHD, attention deficit hyperactivity disorder.

Measures

Fear of Illness and Virus Evaluation

The fear of illness and virus evaluation (FIVE) is a parent-report measure assessing children's virus-related fears.16 All items range from 1 (not at all) to 4 (all the time) and are summed. In the first domain, scales include virus-related fears (9 items; scores range from 9 to 36), fears related to social distancing (10 items; scores range from 10 to 40), and impairment related to virus fears (2 items; scores range from 2 to 8). Items in these domains include “My child is afraid they may get a bad illness or virus” and “My child is afraid they will be stuck at home because of a bad illness or virus.” A second domain assesses children's virus safety behaviors (e.g., washing hands and wearing a mask; 14 items; scores range from 14 to 56). This domain includes items such as “My child wears a mask over their face or protective gear (e.g., gloves or things to cover clothes).” Higher scores indicate greater virus safety behaviors. An overall composite score is also calculated using all subscales with the exception of the children's virus safety behavior subscales. Higher scores indicate greater COVID-19 fear. For the purposes of this study, only the overall composite score was used, which indicated the extent of COVID-19 fear. Researchers developed the FIVE during the COVID-19 pandemic, so robust psychometric evaluation remains ongoing. However, Scharmer et al. 17 used the FIVE when examining COVID-19 fear in relation to youths' disordered eating behaviors (M age = 19.7 years) and found the FIVE to have strong internal consistency (α = 0.94). In this study, internal consistency for child fear of illness (i.e., COVID-19 fear) was excellent (α = 0.92).

Epidemic/Pandemic Impacts Inventory

The Epidemic/Pandemic Impacts Inventory (EPII) is a 92-item measure that assesses how COVID-19 affects various domains in parents' lives.18 Assessed domains include, but are not limited to, education, physical health, home life, employment, and emotional well-being.18 We only examined the parent emotional well-being subscale (8 items) for this study. Sample questions from this subscale include “Have you experienced an increase in mental health problems or symptoms (e.g., mood, anxiety, and stress)?” and “Have you experienced an increase in sleep problems or poor sleep quality?” Each item has a response set of “Yes, Me” = 1, “Yes, Person in Home” = 2, “Yes, this affected me and a person in my home” = 3, and “Not Applicable” = 0. Because we were interested in parent-level impacts, we coded items that affected the parent alone (“Yes, Me” = 1) and items that did not happen to parents = 0 and then summed and reverse-coded scores, with higher scores indicating better parent emotional well-being. Although recent studies have used the EPII,19 only investigators from 1 study who used a modified version of the EPII reported internal consistency (α = 0.87) using a sample of predominantly African-American adult teachers.20 Internal consistency based on our sample was adequate (α = 0.75).

Parents' Management of Their Children's COVID-19 Knowledge

We used 2 items to assess parents' management of their child's COVID-19 knowledge. This subscale was taken from a 13-item measure, Parent's Coping Strategies for Children, which assesses the degree to which parents use expert-recommended coping strategies to help their child cope with the COVID-19 pandemic. We selected these coping strategies based on National Child Traumatic Stress Network (NCTSN)21 and CDC recommendations.22 To assess parents' knowledge management, parents rated the extent to which they (1) identified trusted sources of information related to COVID-19 for their children and (2) clarified children's misinformation related to COVID-19 using a 4-point scale (1 = Never to 4 = Almost Always). We used a composite score of these 2 items to capture parents' management of children's COVID-19 knowledge. For this composite score, the scores ranged from 2 to 8. Greater management of children's COVID-19 knowledge refers to parents making efforts to managing their children's access to COVID-19 information (e.g., identifying information sources and clarifying misinformation). Internal consistency for the current sample was questionable (α = 0.60).

Parental Stress Scale

The parental stress scale (PSS) is a well-validated 18-item questionnaire assessing parents' stress associated with raising children.23 Parents were asked to rate the extent they agree with statements such as “I feel overwhelmed by the responsibility of being a parent” and “It is difficult to balance different responsibilities because of my children.” Participants rate their agreement on a 5-point Likert-type scale ranging from strongly disagree to strongly agree. Total possible scores range from 18 to 90, with higher sum scores indicating greater parental stress. Internal consistency for the current sample was excellent (α = 0.90).

All study measures are available from the corresponding author on request.

Procedure

All procedures and measures were approved by the principal investigator's institutional review board. Data were collected as part of a larger study examining children's and parents' functioning during the COVID-19 pandemic. Data collection occurred on May 7 to 11, 2020, in 4 groupings. Postings varied in time (i.e., morning, afternoon, evening, or weekend) to allow a greater variety among eligible participants. All responses were completed by the end of May 2020. Consistent with recommendations for data collected through MTurk recruitment,24 our study used instructional manipulation check (IMC) items to identify invalid response sets.25 There were 18 total IMC challenge questions throughout the survey (i.e., 1–2 IMC items per measure). As part of informed consent, we told participants they had to answer all challenge questions correctly to receive compensation. Only participants who correctly completed 16 or more of the 18 challenge questions received $3.50 for survey completion and were included in data analyses. Data from 125 participants were excluded for answering 15 or fewer challenge questions correctly.

Data Analytic Plan

We conducted preliminary analyses to examine outliers and to assess for normality, linearity, and heteroscedasticity. We conducted bivariate Pearson correlations to preliminarily examine associations among children's COVID-19 fear and parents' parenting stress, emotional well-being, and management of their child's COVID-19 knowledge. Table 3 summarizes correlation analyses. Although we would typically examine longitudinal data to examine our proposed model, we examined cross-sectional data because we aimed to understand how these parenting variables are related to children's COVID-19 fear closer to when quarantine restrictions officially began. Regarding potential child-related covariates, we considered child age, child grade, child gender, and presence of youth chronic illness for inclusion as covariates in our analyses. Based on bivariate correlations, Spearman's rho calculations for binary variables, and one-way analysis of variance (ANOVA), neither child age (r = −0.002, p = 0.959), child grade (F [12, 564] = 1.396, p = 0.163), child gender (ρ = 0.062, p = 0.138), nor presence of a child's chronic illness (ρ = −0.076, p = 0.068) were significantly associated with our planned outcome variable (i.e., children's COVID-19 fear) and therefore not included as covariates in our analyses. In addition, we examined caregiver-related potential covariates, including caregiver gender, caregiver education level, caregiver relationship to child, and number of adults and children in the home. Caregiver gender (ρ = 0.020, p = 0.629), caregiver education level (F [7, 569] = 1.112, p = 0.354), parent ethnicity (F [5, 572] = 1.276, p = 0.273), caregiver relationship (F [4, 573] = 0.400, p = 0.808), and number of children (r = −0.006, p = 0.880) or adults (r = 0.032, p = 0.443) were not significantly related to children's COVID-19 fear and were not included in our analyses.

Table 3. - Pearson Correlations, Means, and SDs Among Variables
Variable 1 2 3 4 5 Mean SD Range of Scores
1. Parents' COVID-19 knowledge management 5.96 1.62 2–8
2. Parents' emotional well-being −0.11 2.28 1.52 1–8
3. Parents' parenting stress −0.18 a −0.29 a 36.19 11.42 1–16
4. Children's illness fear 0.20 a −0.22 a 0.27 a 37.41 12.43 21–82
aCorrelation is significant at the 0.01 level (2-tailed).

Table 3 summarizes descriptive statistics for each study variable. We used Hayes' PROCESS macro to examine the indirect effects of our proposed model examining the association between parenting stress and children's COVID-19 fear explained by parents' emotional well-being and management of their children's COVID-19 knowledge. Hayes' PROCESS macro uses bootstrapped confidence intervals (CIs) to estimate indirect effects among variables. According to Hayes,26 bootstrapping is a statistical method used for cross-sectional data that involves drawing repeated samples from the data with replacement to gain multiple estimates of the indirect effect. Using this method, 5000 bootstrapped samples were generated. Advantages to using this statistical approach are that it does not make the often erroneous assumption of normality for the direct effects, and multiple mediators and moderators can be tested simultaneously. In addition, type II error is reduced because fewer inferential tests are required. Bootstrapping bases significant results on finding that the 95% CI does not contain 0. We used Hayes' model 6 to examine the hypothesized model. We determined effect sizes by using Fairchild et al.'s27 recommendation of using R2 when conducting mediation analyses.

RESULTS

Direct Effects

We tested a model investigating the associations between parenting stress and children's COVID-19 fear explained by parenting stress and parents' management of their children's COVID-19 knowledge. As presented in Figure 1, our model explained 14% of the variance in children's COVID-19 fear. Path coefficients revealed a significant link between parenting stress and parent emotional well-being (a1 = −0.024, p = 0.001), with a small effect size (R2 = 0.08). Parent emotional well-being was significantly associated with parental management of children's COVID-19 knowledge, with a small effect size (R2 = 0.05), after controlling for parenting stress (d1 = −0.276, p = 0.010). Parenting stress was significantly related to parental management of children's COVID-19 knowledge, with a small effect size (R2 = 0.05), after controlling for parent emotional well-being (a2 = −0.030, p = 0.001). Parental management of children's COVID-19 knowledge was significantly associated with children's COVID-19 fear (b2 = 1.92, p < 0.001), with a medium effect size (R2 = 0.14), after controlling for parent emotional well-being and parenting stress. Parent emotional well-being was not significantly related to children's COVID-19 fear (b1 = −0.139, p = 0.09). Parenting stress was also significantly positively related to children's COVID-19 fear (c1 = 0.296, p < 0.001), with a medium effect size (R2 = 0.14).

F1
Figure 1.:
Depicting the association between parenting stress and children's COVID-19 fear explained by parents' emotional well-being and management of children's COVID-19 knowledge. Note: Serial mediation indirect path: parenting stress → emotional well-being → management of COVID-19 knowledge → COVID-19 fear (95% CI = 0.002, 0.027). CI, confidence interval.

Indirect Effects

The bootstrapped confidence interval (CI) (0.002, 0.027) for the specific indirect effect (0.013) of the serial mediation revealed that parent emotional well-being and management of children's COVID-19 knowledge serially mediated the relation between parenting stress and children's COVID-19 fear. Our results suggest that greater parenting stress was associated with decreased parental emotional well-being, which was subsequently linked with greater parental management of children's COVID-19 knowledge and greater children's COVID-19 fear.

DISCUSSION

The COVID-19 pandemic has changed parents' and children's daily lives worldwide.1 Many parents are spending increased time with their children during quarantine, but research is needed to identify parenting behaviors associated with children's illness fear during the COVID-19 pandemic. This study's purpose was to evaluate links between parenting stress and children's COVID-19 fear, including the potential mediating roles of the degree to which parents manage children's COVID-19 knowledge and parents' emotional well-being.

We found that the combined effect of parents' emotional well-being and parents' management of children's COVID-19 knowledge significantly mediated the positive relation between parenting stress and children's COVID-19 fear. Our model explained 15% of the variance in children's COVID-19 fear. There are multiple explanations for our findings based on evidence-based theories, including Prime et al.'s8 framework, Social Cognitive Theory,6 and the Pediatric Stress Model.28 Consistent with Prime et al.,8 our findings support that parents' combined parenting stress and poorer emotional well-being may be related to parents managing their children's virus-related knowledge, which may be linked with children's illness fear. In accordance with Prime et al.,8 it is possible that parents who experienced more stress may have more difficulty coping with their child's COVID-19 fears. Research examining Social Cognitive Theory has found evidence supporting social referencing, which occurs when one's perception of another person's response to an event is used to form one's own appraisal of the same event.6 Specifically, studies have found that children display a fear response toward a novel stimulus after witnessing their mothers exhibit a fear response.29 In the context of the COVID-19 pandemic, our findings suggest that children who observe their parent experiencing increased parenting stress in combination with their parent managing their COVID-19 knowledge during the pandemic may develop increased COVID-19 fear because they reference their parents' emotional well-being. However, we are unable to ascertain the specific direction of this relation given our study's cross-directional design. For example, it is possible that children with greater COVID-19 fear solicit different parent responses, or children's fears may contribute to parents' increased stress or reduced emotional well-being. In addition, our findings may be explained by the Pediatric Medical Traumatic Stress Model,28 which suggests that parents' posttraumatic stress symptoms increase the risk of their children developing posttraumatic stress symptoms.

In our study, parents' poorer emotional well-being was significantly linked with greater parenting stress and children's illness fear. Parents may be experiencing multiple stressors during the pandemic (e.g., increased child care responsibilities, social isolation, and financial difficulties).7 Consistent with findings from Mikolajczak et al.,30 if parents who have high parenting stress are not able to spend as much quality time with their children (e.g., because of role strain during a pandemic), decreased quality time with children could also be related to parents' emotional well-being. Another recent study found that parents' COVID-19–related stressors and disruptions in parents' and children's usual routines appeared to be linked with fewer positive child-parent interactions, which was associated with parents' poorer emotional well-being.31 Of course, it is also possible that parents with lower emotional well-being are perceived as having higher concurrent stress, as our study used a nonexperimental design and therefore cannot draw causal implications. Our findings, although requiring replication, may indicate a need for empirically evaluated interventions targeting parents' emotional well-being and stress because these constructs may be related to parent and child quality of life through the pandemic.

In addition to parents' emotional well-being, parents' management of children's COVID-19 knowledge was significantly linked with greater parenting stress and parent-reported children's COVID-19 fear. Parenting stress was negatively related to parents' management of their children's COVID-19 knowledge. Parents who were experiencing decreased parenting stress may have been more likely to have energy and perceived bandwidth to ensure their child had complete and accurate information about COVID-19. However, it is also possible that by managing their child's COVID-19 knowledge, parents may have been more likely to increase their parenting self-efficacy, and experience decreased parenting stress. Surprisingly, parents' management of their children's COVID-19 knowledge was linked with children's greater fear. Many studies have documented that children experience less fear after receiving developmentally appropriate information about COVID-19.31 However, although we are not able to conclude the directionality, we may have found this association because parents may be engaging in greater management of their child's COVID-19 knowledge in response to their child's fearfulness. In addition, our finding may have occurred because parents may be providing children COVID-19 information when their child may not be requesting COVID-19 information, which may be associated with greater fear. Although we did not measure children's anxiety before the COVID-19 pandemic, it is possible that children who were previously anxious before the pandemic may be responding to COVID-19 information with heightened fear. In addition to parenting stress, parents' anxiety may also be related to the extent parents manage their children's knowledge. Consistent with our finding that parents' management of COVID-19 knowledge predicted children's COVID-19 fear, other studies outside the realm of COVID-19 have previously concluded that parental worry about their child's safety is linked with children's greater fear level.31 Additional research is needed to further elucidate the mechanisms through which parenting stress and management of children's COVID-19 knowledge are related to children's virus-related fear.

There were some limitations in our study. For example, we conducted mediation analyses using cross-sectional data, and researchers recommend using longitudinal data to conduct mediation analyses.32–34 Data were obtained using a cross-sectional design, which may lead to statistical bias33,34; therefore, we cannot determine specific directionality among variable relationships, and our findings should be interpreted as correlational. Although our findings were clinically significant, we found small effect sizes. The 2 items we used to assess parents' knowledge management may also be subjective and potentially biased by the caregiver's personal experiences; however, parents' subjective beliefs regarding their management of their children's COVID-19 knowledge are valuable information to understand. In addition, the internal consistency of our measure assessing parents' management of their children's COVID-19 knowledge was questionable (α = 0.60). Participants' responses were obtained using single-informant self-report data, which may not provide a fully accurate picture of symptoms. Single-informant and/or single method designs may also lead to informant bias and increase the risk of type 1 error. In addition, we used parents' report to examine children's COVID-19 fear, and studies have indicated that youths' self-report data are more accurate when assessing youths' internalizing symptoms.35 We obtained data from a large online convenience sample, and it is possible that we might have obtained different results if we recruited participants using other recruiting methods. Similarly, 44.6% of parents reported earning more than $70,000; it is possible that we might have obtained a more diverse sample if we did not use an online convenience sample. The majority of our sample also consisted of parents who are married (72.9%) and work full time (69.2%). Of parents, 11.4% reported working part time. Studies have indicated that parents who are single and work part time may experience increased parenting stress and lower emotional well-being.30 Future studies should examine how parents' sociodemographic characteristics are related to parents' parenting stress, emotional well-being, and management of their children's COVID-19 knowledge. In addition, changes in parent-child relationship variables (e.g., parent-child relationship quality), which we did not assess in this study, may be more closely related to parenting stress than parent mental health factors such as emotional well-being. We also did not assess whether children needed additional school supports or other developmental supports.

Despite our study's limitations, our study has many strengths. We used a large sample during the COVID-19 pandemic. Our study also used verification questions25 to exclude participants who might have introduced error by not carefully reading questions or by randomly answering. Our statistical methodology and strong statistical power allowed us to examine the combined effect of parent emotional well-being and parents' management of children's COVID-19 knowledge. The current study's results also fill literature gaps regarding how parenting practices affect children's illness fears during the COVID-19 pandemic.

Implications for Future Research and Practice

Our findings may also inform the development of community-focused or school-focused interventions aimed at improving parents' emotional well-being during the pandemic. It is essential for community-focused or school-focused interventions to be developed given the increase in children experiencing mental health difficulties3,8 and increased wait times for outpatient psychological services.36 Our results demonstrate the importance of pediatric health care providers to routinely assess how parents and children are coping during the COVID-19 pandemic. If parents are experiencing elevated stress or poor emotional well-being, parents may benefit from learning evidence-based coping interventions (e.g., relaxation interventions and cognitive restructuring) to reduce parenting stress and improve emotional well-being. Previous studies have also indicated that mindfulness interventions have been beneficial in reducing parents' parenting stress.37 Specifically, mindfulness interventions have been effective in group38 and community39 settings. Once parents' parenting stress and well-being are improved, parents may be better able to evaluate their need to manage their children's COVID-19 knowledge. Because our study demonstrated a positive association between parents' management of COVID-19 knowledge and children's fear, parents may also benefit from psychoeducation regarding how managing their children's knowledge may be related to greater fear in their children. Future studies should longitudinally evaluate the extent to which parents' COVID-19 communication and parents' emotional well-being change over time. Because our model explained a small amount of variance in children's COVID-19 fear, future studies should examine additional factors consistent with Prime et al.'s8 model that may contribute to children's COVID-19 fear, including parents' anxiety, parents' depression, and specific types of parent-child interactions among parent and child. Future studies should also use observational methods to code COVID-19 related parent-child interactions to further evaluate associations between parents' COVID-19 communication and children's COVID-19 fear.

In conclusion, few studies have examined links between parenting behaviors and children's COVID-19 psychosocial adjustment. The current study contributes to existing literature by examining links between parenting stress and children's virus-related fear explained by parents' emotional wellbeing and management of their children's COVID-19 knowledge. Parenting behaviors such as parents' management of their children's COVID-19 knowledge and parent emotional well-being may have a significant impact on children's COVID-19 fear during the pandemic. Additional research should examine how other parenting practices and beliefs (e.g., parents' COVID-19 anxiety, parents' beliefs about COVID) are related to children's illness fear. Future studies are needed to evaluate whether interventions targeting parenting stress, parent emotional well-being, and/or parents' management of children's COVID-19 information could decrease children's COVID-19 fears.

ACKNOWLEDGMENTS

The authors thank the parents who contributed to our research.

REFERENCES

1. World Health Organization (WHO). Impact of COVID-19 on people's livelihoods, their health and our food systems. Available at: https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people's-livelihoods-their-health-and-our-food-systems. Accessed June 22, 2021.
2. Xiang M, Zhang Z, Kuwahara K. Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected. Prog Cardiovasc Dis. 2020;63:531–532.
3. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954.
4. Haig-Ferguson A, Cooper K, Cartwright E, et al. Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic. Behav Cogn Psychother. 2021;49:129–143.
5. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7:105–110.
6. Feinman S. Social referencing and conformity. In: Social Referencing and the Social Construction of Reality in Infancy. New York, NY: Springer US; 1992:229–267.
7. Patrick SW, Henkhaus LE, Zickafoose JS, et al. Well-being of parents and children during the COVID-19 pandemic: a national survey. Pediatrics. 2020;146:e2020016824.
8. Prime H, Wade M, Browne DT. Risk and resilience in family well-being during the COVID-19 pandemic. Am Psychol. 2020;75:631–643.
9. Deater-Deckard K. Parenting Stress. New Haven, CT: Yale University Press; 2008.
10. Dalton L, Rapa E, Stein A. Protecting the psychological health of children through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4:346–347.
11. Robichaud JM, Roy M, Ranger F, Mageau GA. The impact of environmental threats on controlling parenting and children's motivation. J Fam Psychol. 2020;34:804–813.
12. Wissemann K, Mathes B, Meyer A, Schmidt NB. COVID-related fear maintains controlling parenting behaviors during the pandemic. Cogn Behav Ther. 2021;50:305–319.
13. Brashers DE. Communication and uncertainty management. J Commun. 2001;51:477–497.
14. Patterson GR, Dision TJ, Bank L. Family interaction: a process model of deviancy training. Aggress Behav. 1984;10:253–267.
15. Kochanska G, Boldt LJ, Goffin KC. Early relational experience: a foundation for the unfolding dynamics of parent-child socialization. Child Dev Perspect. 2019;13:41–47.
16. Ehrenreich-May J. Fear of illness and virus evaluation (FIVE). Available at: https://adaa.org/sites/default/files/UofMiamiFear%20of%20Illness%20and%20Virus%20Evaluation%20(FIVE)%20scales%20for%20Child-%2C%20Parent-%20and%20Adult-Report.pdf. Accessed June 22, 2021.
17. Scharmer C, Martinez K, Gorrell S, et al. Eating disorder pathology and compulsive exercise during the COVID-19 public health emergency: examining risk associated with COVID-19 anxiety and intolerance of uncertainty. Int J Eat Disord. 2020;53:2049–2054.
18. Grasso D, Briggs-Gowan MJ, Carter A, et al. A Person-Centered Approach to Profiling COVID-Related Experiences in the United States: Preliminary Findings from the Epidemic-Pandemic Impacts Inventory (EPII). West Hartford, CT: PsyArXiv; 2020.
19. Carosella KA, Wiglesworth A, Silamongkol T, et al. Non-suicidal self-injury in the context of COVID-19: the importance of psychosocial factors for female adolescents. J Affective Disord Rep. 2021;4:100137.
20. Baker CN, Peele H, Daniels M, et al. The experience of COVID-19 and its impact on teachers’ mental health, coping, and teaching. School Psych Rev. 2021;1–14.
21. Griffin D. Supporting Children During Coronavirus (COVID19). Nctsn.org. 2020. Available at: https://www.nctsn.org/resources/supporting-children-during-coronavirus-covid19. Accessed June 22, 2021.
22. Centers for Disease Control and Prevention (CDC). COVID-19 and Your Health. cdc.gov. 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. Accessed June 22, 2021.
23. Berry JO, Jones WH. The Parental Stress Scale: initial psychometric evidence. J Soc Pers Relat. 1995;12:463–472.
24. Paolacci G, Chandler J. Inside the Turk: understanding mechanical Turk as a participant pool. Curr Dir Psychol Sci. 2014;23:184–188.
25. Oppenheimer DM, Meyvis T, Davidenko N. Instructional manipulation checks: detecting satisficing to increase statistical power. J Exp Soc Psychol. 2009;45:867–872.
26. Hayes AF, Scharkow M. The relative trustworthiness of inferential tests of the indirect effect in statistical mediation analysis: does method really matter? Psychol Sci. 2013;24:1918–1927.
27. Fairchild AJ, Mackinnon DP, Taborga MP, Taylor AB. R2 effect-size measures for mediation analysis. Behav Res Methods. 2009;41:486–498.
28. Kazak AE, Kassam-Adams N, Schneider S, et al. An integrative model of pediatric medical traumatic stress. J Pediatr Psychol. 2006;31:343–355.
29. Mumme DL, Fernald A, Herrera C. Infants' responses to facial and vocal emotional signals in a social referencing paradigm. Child Dev. 1996;67:3219–3237.
30. Mikolajczak M, Raes ME, Avalosse H, et al. Exhausted parents: sociodemographic, child-related, parent-related, parenting and family-functioning correlates of parental burnout. J Child Fam Stud. 2018;27:602–614.
31. Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents' stress and children's psychological problems in families facing the COVID-19 outbreak in Italy. Front Psychol. 2020;11:1713.
32. Maxwell SE, Cole DA, Mitchell MA. Bias in cross-sectional analyses of longitudinal mediation: partial and complete mediation under an autoregressive model. Multivariate Behav Res. 2011;46:816–841.
33. Mitchell MA, Maxwell SE. A comparison of the cross-sectional and sequential designs when assessing longitudinal mediation. Multivariate Behav Res. 2013;48:301–339.
34. O'Laughlin KD, Martin MJ, Ferrer E. Cross-sectional analysis of longitudinal mediation processes. Multivariate Behav Res. 2018;53:375–402.
35. van de Looij-Jansen PM, Jansen W, de Wilde EJ, et al. Discrepancies between parent-child reports of internalizing problems among preadolescent children: relationships with gender, ethnic background, and future internalizing problems. J Early Adolesc. 2011;31:443–462.
36. Bojdani E, Rajagopalan A, Chen A, et al. COVID-19 Pandemic: impact on psychiatric care in the United States. Psychiatry Res. 2020;289:113069.
37. Burgdorf V, Szabo M, Abbott MJ. The effect of mindfulness interventions for parents on parenting stress and youth psychological outcomes: a systematic review and meta-analysis. Front Psychol. 2019;10:1336.
38. Neece CL, Green SA, Baker BL. Parenting stress and child behavior problems: a transactional relationship across time. Am J Intellect Dev Disabil. 2012;117:48–66.
39. Potharst ES, Baartmans JMD, Bogels SM. Mindful parenting training in a clinical versus non-clinical setting: an explorative study. Mindfulness. 2021;12:504–518.
Keywords:

parenting stress; illness fear; knowledge management; parental emotional well-being

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