Parenting-Related Exhaustion During the Italian COVID-19 Lockdown

Daniela Marchetti, PHD; Lilybeth Fontanesi, PHD; Cristina Mazza, PSYD; Serena Di Giandomenico, PSYD; Paolo Roma, PHD; Maria Cristina Verrocchio, PSYD

Disclosures

J Pediatr Psychol. 2020;45(10):1114-1123. 

In This Article

Discussion

To our knowledge, the present research was the first cross-sectional study to address parenting-related exhaustion in a large community sample of parents of children aged 0–13 during the COVID-19 lockdown. More than 80% of our sample reported high levels of psychological distress, and nearly one in five (17%) reported significant parenting-related exhaustion. Although no comparison data are available on this epidemic, we feel that the present findings are of clinical significance, suggesting that there is a high psychological burden of social isolation.

Of interest, and consistent with previous results showing gender differences in vulnerability to stress (e.g., Taylor et al., 2000), mothers showed significantly higher psychological distress than fathers; this calls for particular psychosocial attention to be paid to women. In general, the wide prevalence of high psychological distress found in the present study might be explained by the prolonged social isolation, combined with parents' feelings of general helplessness and increased care demands from their children. Such distressing factors may be particularly heightened for single parents with more than one child or parents with a special needs child. The higher psychological distress shown by mothers may also indicate that women are experiencing an additional source of stress when attempting to balance their traditional primary caregiving responsibilities with professional demands.

The main symptom of parental burnout syndrome is parenting-related exhaustion, which consists of overwhelming exhaustion related to the parental role that can lead to the belief that parenting requires too great an investment and consequently reduce the amount of time that parents spend with their children (Mikolajczak et al., 2018; Roskam et al., 2018). Parenting is a complex and stressful activity (e.g., Crnic & Low, 2002), and the unusual and prolonged engagement in parenting that is required during the COVID-19 lockdown could partially explain parents' feelings of being emotionally drained and insufficiently prepared to meet parental demands. Although more than half of our participants (64%) did not report significant levels of emotional exhaustion relating to parenting, previous research has reported that only 1.3–8.8% of parents in the general population show an alarming rate of parental burnout, of which emotional exhaustion is a specific feature (Roskam et al., 2017).

The present results also revealed a high-risk group for parenting-related exhaustion, characterized by the following factors: motherhood, being single, having younger children, having a special needs child, and having a large number of children. This finding is in line with previous studies that have highlighted risk factors for parenting stress, relating to sociodemographic characteristics (e.g., having a large number of children), child features (e.g., having a child with a disability or sleep problems), and family functioning (e.g., lacking parental support from a partner) (Mikolajczak et al., 2018). It could be argued that the present finding that mothers were at greater risk of suffering from parenting-related exhaustion was due to the female over-representation in our sample. However, because the Italian culture still holds that women should be the primary caregiver to their children, responsible for maintaining the household, and also involved in professional work, mothers may have suffered more than fathers due to the pressures of working from home, managing children's home schooling, and managing the family, more generally; for this reason, they may have felt more personally involved in the survey topic.

Furthermore, parents with higher psychological distress, lower parental resilience, and lower perceived social connections were at greater risk of experiencing higher parenting-related exhaustion. Parental resilience, which refers to the process of managing stress and functioning well in the face of stressors, challenges, and adversity, is a key element of a well-functioning family system (Gavidia-Payne et al., 2015; Kiplinger & Browne, 2014). Previous studies have shown that parental health and supportive social connections are linked to positive parental mood, parental satisfaction, well-being, a sense of competence, and lower psychological distress (e.g., Lee et al., 2001). In other words, parental resilience and social connections seem to decrease the risk of experiencing parenting-related exhaustion.

Surprisingly, experiences related to COVID-19 did not have a direct and significant impact on emotional exhaustion in our sample. However, this finding is consistent with that of a recent study conducted with 854 Italian parents of children aged 2–14 years, which found that living in an at-risk contagion zone or being in closer contact with the virus had no significant effect on the well-being of parents and children (Spinelli et al., 2020). Thus, pre-existing conditions and psychological variables may have a greater impact on the risk for developing parenting-related exhaustion than specific COVID-19 experiences. However, further studies should examine this issue in depth.

The present findings have significant implications. First, parenting-related exhaustion may represent a threat to children's well-being. Highly psychologically distressed parents could be less available, accessible, and responsive to their children's needs, and this might increase the likelihood that their children will develop maladaptive behavior. Furthermore, the study provides additional support for the call for preventive activities and well-being programs to support parents during the COVID-19 pandemic.

Mental health professionals and social workers should be alerted to the effects of lockdown and isolation on parenting and, consequently, children's well-being. As geographical location (i.e., living in the most highly infected areas) did not emerge as a risk factor, the psychological condition of parents was found to be most significant, over and above specific COVID-19 variables (e.g., infected loved ones, losses).

The mental health literature provides robust evidence that interventions can mitigate negative outcomes in the aftermath of a disaster (e.g., Magruder et al., 2016). Governments and healthcare authorities should adopt appropriate measures to respond to this risk factor, such as an assessment of families' needs and psychological interventions to mitigate emotional exhaustion and psychological distress among at-risk families. For example, during the early phase of this global health crisis, information and tips for parents on how to explain the risks of COVID-19 to their children and how to manage daily life at home (including social distancing and home schooling) could be very useful. In this regard, the open access online parenting resources provided by the WHO and other institutional agencies are good initiatives. These resources, based on robust evidence from randomized controlled trials, provide tips for parents to build positive relationships and manage parenting stress (Cluver et al., 2020).

Research on interventions following mass disasters suggests that "psychological first aid" is a meaningful first step in ensuring basic care and support (Fox et al., 2012). Effective longer-term interventions may include mental health services within primary care settings (North & Pfefferbaum, 2013) and family-based and trauma-informed training programs for mental health professionals and school personnel (Cohen, 2002; Klingman & Cohen, 2004). Families with pre-existing mental needs should be supported by the continuous delivery of their regular psychotherapeutic and psychiatric treatment (e.g., via telepsychiatry and online-delivered care) through all phases of the pandemic, and screening via helplines could be used to identify the most severe cases (Fegert et al., 2020). The efficacy of telehealth family-based interventions in enhancing parental well-being, parenting behavior, and child mental health, including in high-risk populations, has been confirmed (Harris et al., 2020; MacDonell & Prinz, 2017). Of note, telemental health services are not widely available to socially disadvantaged populations, due to their lack of access to technology (Golberstein et al., 2020). Thus, in preparation for a possible future crisis, such modalities should be expanded to reach these populations by reducing inequities in access to care. Furthermore, the clear coordination of child protection and mental health services could be helpful for families at risk of violence. Finally, mental health professionals and services should be equipped with information on the available interventions, methods to assess and treat conditions of particular risk, and toolkits to communicate essential psychosocial care principles and psychological first aid (Fontanesi et al., 2020).

In interpreting the present findings, balanced consideration should be given to the study's limitations and strengths. At the time of the investigation, no data on the effects of the COVID-19 epidemic were available. Thus, we used a cross-sectional online survey to recruit as wide and representative a sample of the Italian population as possible, in order to capture a timely picture of the national situation. The strengths of our study (i.e., its contribution to the literature, its large sample size, and its use of validated psychological assessment measures) should be considered in light of its limitations, which include: the use of only parent self-report measures, the inability to detect the direction of causality, due to the cross-sectional study design; the potential for social desirability bias; the inconsistent availability of Internet connectivity in the general public; respondents' particular motivations to participate in the online assessment; and the low number of fathers enrolled. With respect to this latter limitation, the gender imbalance in the present study has been consistently demonstrated, reported, and addressed in previous research (Saleh & Bista, 2017; Slauson-Blevins & Johnson, 2016; Yetter & Capaccioli, 2010). Further longitudinal research in different countries affected by the COVID-19 pandemic is needed.

In conclusion, the present findings highlight how the COVID-19 crisis has contributed to heightening parents' emotional fatigue, especially amongst parents with pre-existing conditions of vulnerability. The results also raise serious concerns about the need for specific social and psychological support programs for parents and families, both during and after the pandemic, over and above national economic interventions to help families.

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