This study aimed to examine the clinical, financial and social impacts of the COVID-19 pandemic and their associations with maternal and child mental health, in a unique cohort of Australian mothers recruited for their experience of adversity. In this cohort, only one mother and her child had experienced a COVID-19 infection. In contrast, high proportions of mothers reported negative financial and social impacts including job and income loss, worries about becoming infected, stress related to changes in contact with family and friends, and difficulties managing usual duties in addition to children’s at-home learning. Many mothers also reported positive social impacts such as their family finding good ways of coping and supporting others in the community. Of these, both financial impacts and greater family stress were associated with poorer maternal and child mental health, while greater family resilience was associated with better mental health.
These results align with other data on Australian families. An intergenerational cohort surveyed between May to September 2020 found that 24% of parents had experienced job or income loss,[17] and a nationally-representative poll of Australian families in June 2020 reported a rate of 28%.[6] These are similar to the 27% of women reporting job and income loss in the current study. Like other studies from both Australian [6, 37, 38] and international cohorts [7, 28, 29], we found that financial impacts of the COVID-19 pandemic and public health restrictions were associated with poorer parent and child mental health. For example, the Born in Bradford study of families living in an economically deprived city of the UK found more than one third of families experienced financial insecurity during the COVID-19 pandemic, and this was associated with parent anxiety and depression.[7] Our findings extend on the existing literature by demonstrating the relationship for Australian families experiencing adversity. Notably, families in the current cohort were already less likely to be in paid employment (53%) or have poorer mental health (20–30% with high mental health symptoms, see Bryson et al [39]) before the pandemic. As such, the relative impacts of the public health restrictions are arguably greater for these families and likely to exacerbate existing health disparities.
Our findings highlight the critical importance of financial stability for families during crises such as the COVID-19 pandemic. Amongst families already at risk of financial hardship, rates of job and income loss were high. These findings were in the context of the Australian Governments’ Job Keeper and Job Seeker policies (Fig. 1), which mitigated some of the financial impacts for families. These social policy changes represent some of the largest (albeit temporary) in Australia’s history. The JobKeeper and JobSeeker supplements were so significant that, by September 2020, overall levels of poverty and housing stress were substantially lower than they had been pre-COVID-19.[15] However, the current study and wider Australian evidence show that many families were still financially impacted,[6, 17] and those families have fared poorly with regard to their mental health and wellbeing.[38, 40] The Jobseeker supplement has since been reduced and subsequently ceased entirely, leaving families at heightened risk of worsening economic positions and subsequent poorer mental health.
We further found that families reported high rates of stress related to changes in family interactions and worries about infection which were associated with poorer parent and child mental health, in line with previous studies.[5, 7, 28, 29] Previous findings include studies of families in the UK [7] Canada [29] and the US [30], where lockdown measures were put in place but COVID-19 infection rates were also high. Even with very low rates of infection in Australia, we identified similar findings in which an overall measure of family stress had the strongest associations with poorer maternal and child mental health. The most common of these experiences was maternal report that their child’s online/at-home schooling made it difficult to do their usual paid work and/or domestic duties. Other Australian surveys found similar results; for example, parents who participated in the nationwide COVID-19 Pandemic Adjustment Survey in April 2020 reported that managing their child’s at-home schooling was a significant challenge during the pandemic and related restrictions.[40] These findings are particularly pertinent to the large proportion of families in the current study living in Victoria, where at home-schooling was prolonged and access to at-school learning was limited for much of the 2020 school year (see Fig. 1).
Promisingly, many families also reported experiences of family resilience. Mothers in the current study reported that their families found good ways of coping and had provided support to other people in the community; a total rating of these experiences of family resilience was associated with better mental health, particularly for children. Two nationwide surveys of Australian families reported similar findings. Both the National Child Health Poll and the COVID-19 Pandemic Adjustment Survey found parents reported experiences of strengthened family relationships, constructive communication, spending more positive time together and feeling more connected with their children.[6, 40]
The strengths of this study are the unique, prospective cohort of mothers with young children, who were recruited during pregnancy for their experience of adversity. Even in the year prior to the COVID-19 pandemic, 5 to 6 years after recruitment, high proportions of this cohort were not in paid employment, reported low income and poor mental health. As this study was embedded in an established longitudinal study, we were able to quickly harness the opportunity to assess families’ experiences during the height of the first lockdown and throughout the first 10 months of COVID-19 in Australia. We also had comprehensive pre-pandemic data to draw on, to account for family circumstances and mental health before the pandemic had emerged.
The study also has limitations. Despite the advantages of using an existing cohort, it was not designed a priori for assessing the impacts of the COVID-19 pandemic. We also relied on maternal report for the family experiences and maternal and child mental health outcomes. These measures were necessarily maternal report, as mothers can provide valuable information about their families’ experiences of the COVID-19 pandemic, as well as their young child’s mental health. Maternal mental health is also an important determinant of child outcomes. [41, 42] However, mothers who experienced the pandemic as stressful, or those with poorer mental health, may be more likely to report more negative experiences and rate their child’s mental health poorly.[41] To address this, analyses took account of self-reported maternal mental health data collected prior to substantial COVID-19 occurrence in Australia. Comparison between the models which did not (Model 1) and did (Model 2) account for prior maternal mental health showed that the findings and interpretation of results were not substantively changed, suggesting that the associations between COVID-19 impacts and mental health outcomes were somewhat independent from mothers’ prior mental health.
Australian families clearly found the challenges of lockdown and the related changes in work-family life stressful, with flow-on effects for both parent and child mental health. Closure of schools and transitioning to at-home learning appears to be a key contributor to this. Studies from past instances of school closures suggest these actions disproportionately impact families experiencing adversity, by removing access to additional services provided at schools while increasing stress on primary caregivers.[43] As Australia (and countries globally) emerge from lockdown and the pandemic, the disproportionate burden on women and children already living in adversity will need to be addressed with similarly disproportionate service system and economic policy responses. Promisingly, findings of this and existing studies show that family resilience such as finding ways of coping together and supporting others were associated with better mental health; this suggests that there are opportunities to build positive community support into the recovery processes. Future research would benefit from examining the pre-pandemic factors which might be associated with family resilience, to identify opportunities for supporting families both in recovering from the pandemic and in redressing inequities in parent and child mental health.