Harmful Impacts of the COVID-19 Pandemic on Parents and Carers

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In this podcast, we are joined by Dr. Hope Christie, a teaching fellow at the Center for Research on Children and Families at the Department of Psychology at the University of Edinburgh.

Hope is the first author of the paper, ‘Examining harmful impacts of the COVID-19 pandemic and school closures on parents and carers in the United Kingdom: A rapid review’ (doi.org/10.1002/jcv2.12095), recently published in JCPP Advances, and this paper will be the focus of today’s conversation.

To set the scene, Hope discusses what prompted her interest in parental mental health, before turning to explore why parents appear to have suffered disproportionately compared to non-parents during national lockdown restrictions, and shares insight into why the pandemic was so hard for so many parents.

Turning to her paper, Hope provides an overview of the research and the methodology used.
Hope then turns to comment on some of the key findings, in particular why kinship carers may have struggled more; as well as elaborates on her finding that parents with children aged 10 or younger reported high levels of stress when restrictions were highest, whereas parents with older children reported more depressive symptoms

With the ongoing impact of the COVID-19 pandemic and many parents still suffering disproportionately, Hope considers how this continues to manifest and discusses how she hopes the concerns raised in her paper will be addressed and how might parents at the greatest risk be best supported, both now and in the event of a future lockdown.

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Dr. Hope Christie
Dr. Hope Christie

I am currently a teaching fellow in the Department of Clinical Psychology. My area of expertise is looking at parents who have experienced a trauma and have developed post traumatic stress disorder (PTSD) as a result of this experience. My interests are around understanding how PTSD and parent mental health can affect the parent (as an individual), as well as their parenting behaviours and the wider family dynamic. I have mixed methodology experience utilising a number of different methods during my PhD and post-doctoral work, which includes: Quantitative data collection and analysis; Interviews and focus groups; Observational data; and Photovoice. My research also works across different countries and contexts, having previously worked with trauma exposed parents in both the United Kingdom and South Africa. (Bio and image from The University of Edinburgh)

Transcript

[00:00:01.280] Jo Carlowe: Hello, welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today I’m interviewing Dr. Hope Christie, a teaching fellow at the Center for Research on Children and Families at the Department of Psychology at the University of Edinburgh.

Hope is the first author of the paper, ‘Examining harmful impacts of the COVID-19 pandemic and school closures on parents and carers in the United Kingdom: A rapid review’, recently published in JCPP Advances. This paper will be the focus of today’s conversation. JCPP Advances is one of the three journals produced by the Association for Child and Adolescent Mental Health. ACAMH also produces the Journal of Child Psychology and Psychiatry and the CAMH.

If you’re a fan of our In Conversation series, please subscribe on your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Hope, thank you very much for joining me. Can you start by saying a little about who you are and what you do?

[00:01:16.963] Dr. Hope Christie: First of all, thank you very much for having me. So, as you said in your intro, I’m based at the University of Edinburgh in the Department of Clinical Psychology. I am a teaching fellow there at the moment. My background does primarily work in– with parents who have experienced a trauma and who have post-traumatic stress disorder as a result of that, so really understanding more about how their trauma and PTSD might affect them, their mental health, their parents, and their family dynamic.

[00:01:48.680] Jo Carlowe: What prompted your interest in particularly in parental mental health?

[00:01:52.880] Dr. Hope Christie: I did my PhD in Bath with Professor Sarah Halligan, who’s also a co-author on the review that we’re going to talk about. Her interest is primarily in child and adolescent mental health and recovery after trauma. When I started to do my PhD with her, she was wonderful in just saying go and read as much as you can about this area and come back to me when you found a topic that you’re interested in and that’s how we’ll pursue your PhD.

What I found when– I was reading a lot– I did a lot of reading. And what I found was that when talking about parents’ mental health, there’s a distinct focus on the impact that has on the child. There’s very little that actually asks what is the impact on the parent? How are they coping with their own mental health while also trying to juggle being a parent at the same time?

There wasn’t very much information around that. I was particularly interested as I’m sure a lot of your listeners who are parents– also, it’s one of the hardest jobs you’ll ever do. And that’s generally not even when you’ve got mental health difficulties thrown into the mix as well. So, I was really interested to tease that apart a little bit more and see, again, in terms of support, where the support was set for parents, not just “Well, let’s support you so your child also doesn’t feel the effects of that.” So, yeah, that’s where my interest came from.

[00:03:18.350] Jo Carlowe: And parents do appear to have suffered disproportionately compared to non-parents during national lockdown restrictions. Why was the pandemic so hard for so many parents?

[00:03:31.100] Dr. Hope Christie: Oh, let me count the reasons. I wouldn’t want to say it upfront now. Lockdown was hard for everybody for a number of different reasons. But I think parents did suffer disproportionately because they just had to take on so much additional stress. They already do a million and one things for their family and for their children on a daily basis anyway and when lockdown happened, a lot of the support structures that parents had in place disappeared.

So that might be support structures in terms of additional family members that might have helped out with childcare responsibilities or other things of that nature. It might have been after school clubs that might have been respite care if their child required that. It might have been additional physio, speech and language, whatever it may have been– all of that disappeared. And as well– do you know some parents that we spoke to on another project, which I’ll mention as we go through, said that school was a respite time for them as well.

That was the only time they got a little bit of a breather. And then– but that disappeared. And then parents then have to take on the job of being a teacher. And depending on the developmental stage of the child, that has quite substantial consequences if the children are– young people, I should say, are sitting high school exams and their parents are in there stressing about whether they’re getting the right level of education and whether this is going to have a knock-on impact.

So– do you know there is just a massive amount of stress and additional worries that came with that. And that’s just to do with their child on top of. Do you know they’re are also trying to balance work while everyone’s still in the same space. They’re trying to keep their child calm about what’s going on while also trying to work out what’s going on themselves. A lot of parents we’ve seen through the review actually ended up taking reduction hours or quitting their job altogether so that they could manage more childcare. So that then brings about earning capacity changes and changes in income, not on top of, if we think more specific cases in terms of mental health difficulties that might have gotten worse or also those families that were perhaps living in a domestic abuse situation at that time– yeah, I think a number of reasons why parents may have suffered disproportionately to non-parents during the pandemic.

[00:05:50.377] Jo Carlowe: And, of course, you address many of these issues in the review. So, this is your paper– ‘Examining harmful impacts of the COVID-19 pandemic and school closures on parents and carers in the United Kingdom: A rapid review’–recently published in JCPP Advances. Hope, can you give us an overview of the paper. What did you look at?

[00:06:11.080] Dr. Hope Christie: So, I should also say that the paper was actually commissioned by SAGE, the Scientific Advisory Group for Emergencies in the Department of Education. So originally it was produced as a larger report looking at the impact of lots of different stages of preschool children, primary school, high school, going on to future work, and parents and carers. So, there was big group of us that worked on these different reviews at that time. So, the overview of the paper is that we were asked to look at a rapid review of the evidence that existed in the UK at that time.

This was both from what we termed “emerging evidence” and “existing evidence.” So existing being published papers that might have scientific articles peer-reviewed articles that had already come out and emerging evidence was more around charity reports or other grey literature that we had come across as well during that review process. So, we were really just focused on anything that had been published in the UK at that time during the pandemic, looking at evidence of impacts of– our specific focus was parents and carers in the UK.

We reviewed the literature and then began to tease out what the main impacts where to parents. We were looking at– the language that was used was “harms” to parents in the UK and that covered a broad-brush list of things, whether it was physical, mental, harms to earning capacity, there was quite a few other ones in there as well. So, we were interested in looking at the harms to parents and carers. The larger report also covered potential suggestions for alleviating or dealing with those harms, which didn’t quite make it into the review in JCPPA.

[00:07:52.150] Jo Carlowe: Right, great. Did you want to say anything more about the methodology used?

[00:07:57.020] Dr. Hope Christie: So, we worked with a team of people who helped with the review. We searched a lot of academic and non-academic databases to find as many pieces of evidence that we could at that time. So, the searches were conducted between, if I’m correct, the 21st and the 28th of April 2021. And we were looking, we looked at very broad terms, so we made sure we didn’t miss anything. So, we were– used terms like parents, and carers, COVID-19, and UK.

And we did additional searches to make sure we didn’t miss anything off reports of charity websites and anything. So, we really wanted to make sure that we covered everything when we carried out that search strategy. So, as a result, we started off with a large amount of papers, just under 500, and we managed to work on our way through what was relevant and what wasn’t relevant. And when I say not relevant, it was generally really if the study hadn’t been conducted in the UK, if the sample didn’t involve parents and carers, or if it didn’t cover any harm and whatever the harm may be, then that was excluded. But we ended up with 32 papers in total. And within that, we covered quite a few areas of harm to parents and carers in the UK.

[00:09:13.335] Jo Carlowe: Let’s look at some of the key findings. And I’ll probably dig a bit deeper into some of them, but can you give an overview? What were the things that stood out?

[00:09:21.048] Dr. Hope Christie: Yeah, of course. So, the main key findings of the research where, again, as I said earlier, on lockdown was extremely hard for everyone, but especially for parents. And we found that actually there were some parents that suffered disproportionately more than other parents. And those ones were parents from single parent households. Any parents that were perhaps on a low socioeconomic status band. And ethnic minorities groups. Or kinship carers as well, so people that perhaps weren’t the biological mother or father but were maybe grandparents, or aunties and uncles tended to also suffer a little bit more than parents in general.

So, we found that the parents did really suffer during the pandemic. And actually, to be honest, are still experiencing that fallout now, despite the fact we’re returning to normal. So, we found parents suffered mental health difficulties, earning incapacity changes, so changes to their income, at that time and also threats to physical harm in terms of if they were perhaps in an abusive relationship. So that government freeze at the time of stay home, stay safe didn’t really apply to families perhaps that had an abusive partner in the household at that time. We also found a lot of services were unable to provide assistance during that time, which also increased the demand on parents even more.

And parents really became their child’s de facto teacher. So, home schooling brought around a whole new host of problems that were stressful for parents, not only in making sure that their child was continuing to home school, but, again, when we looked at maybe single parent households or low socioeconomic households that maybe there was only one device that was split between every family member in the household, so, therefore, home schooling was even more challenging.

There might have been challenges with access to the internet, which meant children weren’t able to do the online schooling that they were supposed to be doing because they didn’t have access to the internet. And also, just as an addition, do you know a lot of children in low socioeconomic status households perhaps qualified for free school meals, which now they weren’t getting because they weren’t going to school, which, again, another level of stress for the parents. So that was the main findings that we had from the review.

[00:11:32.380] Jo Carlowe: I was curious about what you said about kinship carers suffering disproportionately. Any thoughts about why they struggled more?

[00:11:39.833] Dr. Hope Christie: From the charity report– there wasn’t very many charity reports around kinship carers. But from the ones that we found and included in the review, it was the– most often it was grandparents that were looking after children and believe they suffered disproportionately more because they’re just a bit older and finding it hard to deal with a younger child in the household. There was some other charity reports that alluded to the child-to-carer violence in terms of maybe children being really– or young people being very stressed out by the situation that they found themselves in and then were acting out quite physically in that way and grandparents or kinship carers were bearing the brunt of that as well at the time.

[00:12:23.350] Jo Carlowe: There was something that I found really interesting in the paper. You found that parents with children aged 10 or younger reported high levels of stress when restrictions were highest, whereas parents with older children reported more depressive symptoms. Can you elaborate? What do you make of that?

[00:12:39.130] Dr. Hope Christie: It was a really interesting finding. So I suspect or maybe this is just me pulling from work that I– other work that I’ve done, not so much from the review findings, but I think with a child under the age of 10, they’re maybe not quite as aware of what’s going on, for example, so the stress is maybe coming from trying to keep a normal routine, trying to make sure that the child is entertained sufficiently for periods of time, while also maybe managing your work at the same time or trying to do other things.

And a lot of the time they’re not the only child in the household, so you’ve got a lot of other competing needs in the house. But, yeah, children under 10– we would maybe see maybe increases the level of stress for that reason. Also, a lot of parents didn’t have access to green spaces or didn’t have a garden, for example. So, again, keeping a child under the age of 10 inside the four walls day in and day out could– yeah, could send anyone–

[00:13:38.800] Jo Carlowe: –off the walls.

[00:13:39.130] Dr. Hope Christie: –stress levels through the roof. Yeah, exactly. Whereas, I think, depressive symptoms more in parents with older children was– we’ve seen this on another project that we were working on– that was that parents had quite a high level of self-blame or self-guilt with their older children because they maybe felt that their educational needs weren’t being met or they were really worried on the fact that their child was missing out on some key events– maybe prom, or away days for school, or key socializing events that they weren’t getting to access now, and they were missing their friends.

And maybe your older children are able to vocalize that a little bit more, so I think there’s maybe an acute awareness there from parents, not that I’m saying that they had any right to. They don’t need to blame themselves for anything because they were just doing their absolute best. But what we found from parents in another project was that they were blaming themselves and feeling really guilty that their child had missed out on these things and perhaps that was manifesting itself more in depressive symptoms.

[00:14:42.543] Jo Carlowe: You state in the paper that the findings highlight considerable cause for concern for the consequences of children. Can you elaborate on this?

[00:14:51.760] Dr. Hope Christie: Education and social development would be the main worry and concern. And I know that when we did the larger report for the Department of Education that was their– their key area of interest was making sure that they– children were able to catch up. And I think that they will catch up. I can understand why it’s worrying, but it should hopefully be a bit of comfort for parents to know that their child will catch up.

But I can totally understand in older children who are perhaps in transitioning now on from high school. They don’t get to repeat that year again and they have to now move on into the world of work. So, they’ve missed out on perhaps key phases where they would maybe gain life experience, or mature and things, and that can be a cause for concern. Again, for children as well that are coming from a lower socioeconomic status background, they will have missed a lot more schooling than perhaps– pardon the phrase– but well-off peer, for example.

If they’ve not had access to the same levels of a tablet time, or device time, and have not had access to internet, then they will be significantly more behind their peers when they go back, which is a concern as well. And, obviously, there will be knock-on effects in terms of looking at how parents are coping and how that might then translate into an intergenerational effect on children and their well-being.

So if parents are still feeling really, really stressed or– that might have a bit of an intergenerational transmission effect on onto children. And I know from, again, other work that we’ve done, parents had done a fantastic job at shielding their child from a lot of stress. So when we did work with both the parent and the child, the child had such a positive view of their lockdown experience and saying, like, “I still had all my medication, and I still got to speak to my friends and things”, and mum’s in the background saying, like, “Well, yeah, you had your medication because I made sure to go and get it.”

[00:16:50.953] Jo Carlowe: I want to pick up on the knock-on effect because you mentioned it earlier when we talked about parents suffering disproportionately. You made the comment that many still are, that there is some ongoing impact, perhaps we can just return to that. How does that still manifest now then, even though we think it’s all over.

[00:17:10.401] Dr. Hope Christie: I think parents are always going to worry about their children and are always going to worry about how they grow, and develop, and things. And I think that will be at the back of a lot of parent’s mind, that two-year gap almost that children have maybe missed out on– as I say, educational markers or key life events that they maybe haven’t had access to. And I was more referring to a study that myself and colleagues from Edinburgh have conducted with parents with children who have special educational needs, who their mental health scores are still quite low and not really improving.

And I think it is just this prolonged knock-on effect that, even though the stress of lockdown has disappeared because we’re not in lockdown anymore, the residual aftereffects of that stress still remain and a lot of what is, again, around respite care not really returning to full capacity or perhaps children during COVID aging out of respite care. So, for example, I’ve had some parents whose children were maybe 18 when lockdown hit but now have aged out of receiving any level of respite care and other stresses around that. So, obviously, lockdown has been lifted, which is a huge relief, but I think there are still things that do remain to be causing quite a lot of stress for parents.

[00:18:27.590] Jo Carlowe: How do you hope the concerns raised will be addressed and how might parents at the greatest risk be best supported, both now and in the event of a future lockdown?

[00:18:39.350] Dr. Hope Christie: [LAUGHS] That’s quite a big question. That’s a difficult one to answer. I think– because I wouldn’t ever want to with this answer– and send you that any one group or organization didn’t do their absolute best during lockdown, obviously it was such an unprecedented thing and all of us were just kind of scrambling through it day by day and trying to– but I think– hopefully now we have gone through– I mean, touch wood we never go through one again, but should be hopefully enough lessons have been learned so if it’s possible– I mean, this is ideal world situations obviously, nobody got the funding for this– but if it’s possible to know those probably more vulnerable or lower socioeconomic status children be sent home with their own tablet or their own device so they can do things, children perhaps– in households where there is no internet, they’re be given a little dongle or something so they are able or given work that’s pre-loaded onto something so that they can still keep in touch.

I think we are probably more aware of restrictions and regulations now in terms of keeping distance from each other and things. So, if it could be the case that maybe respite care and other services are able to still function during something like that and still offer places to those most vulnerable families who are really at their breaking point or even surpassed that. It would be good.

I know, again, in terms of parents that had children with additional medical needs getting access to the correct care as and when in terms of overnight care, making sure that all the correct medical equipment was available for them and for their children so that there was no question that their child would be adequately cared for, either in a hospital or in their home. It’s– I think it is a really difficult one, I think, for parents own mental well-being because I think it’s the oxygen mask in the plane scenario of looking after yourself before you look after others.

And I think parents are always– “I’ll look after my child first and I always am secondary to that”– which I completely understand, but, obviously, if they’re burning the candle at both ends and really severely just running on empty, then they’re not going to be able to be the most available and there for their child and what their child needs. So I think if there’s an option– I don’t even know what it would look like– but if there’s an option to be able to support parents more adequately in terms of making sure mentally they’re doing OK– and I think more messages probably would be helpful and easing their anxiety around school catch-up or you are doing your best, so– it’s never going to alleviate people not blaming themselves but probably more positive messages around that might also be helpful.

[00:21:21.690] Jo Carlowe: What about policymakers? What message do you hope they take from your review?

[00:21:27.093] Dr. Hope Christie: A big question because, I think, it’s hard, as I say. We really did the review as part of the Department of Education. And I know that their interests are primarily aligned with children’s education and not so much with parents, but, again, I feel like just the same message is that there just needs to be more support available for parents and more tailored, effective support that I think– we’ve seen that a lot with parents with children with special educational needs.

Support that’s available for mainstream children or typically developed children does not fit for children with special educational needs. They need their own tailored support. And, unfortunately, that’s the kind of things that don’t get as much funding or had to close their doors during COVID and maybe haven’t quite opened up yet. So, I think it’s, again, ideal world scenario, but I think if more funding could be flooded into support resources for parents, for themselves, but also more tailored support for the children in terms of what their needing would be so lovely.

[00:22:31.080] Jo Carlowe: You’ve mentioned other research. Can you tell us a bit about this? Are you planning any follow-up research to this or is there anything else in the pipeline that you can share with us.

[00:22:41.150] Dr. Hope Christie: I’m personally not planning any follow up research. I’m sure some research will come out of– and I think actually should come off the back of the review that we did because we did it at a time where there wasn’t actually a lot of evidence– obviously the peer review publication process is– can be quite a long one, so there wasn’t a whole wealth of evidence there in terms of peer-reviewed articles. And I’m sure if we were to go back and do the same search now with the same terms, there would be so much more to work through, which would actually be really interesting to see what else there would be available now.

So, I think– although that’s personally not something I’m doing, I think would– if anyone wants to take on that task, it would be good to see the new existing and emerging evidence now, especially just [INAUDIBLE] as we’ve moved out of lockdown. It would be interesting to see what the evidence is telling us.

In terms of the project that I’ve been referencing as we’ve gone through, it’s called The Road to Recovery Project. So that was led by Dr. Karri Gillespie Smith in the Department of Clinical Psychology at Edinburgh. I was fortunate enough to be a research fellow on that project at the time. So, Karri was primarily working on looking at families with neurotypical children that had special educational needs or other needs that how they had experienced lockdown.

And they did fantastic work with interviews with the parents but also a photo-voice work with the children so– who maybe wouldn’t be able to communicate the way you and I are talking now but we’d be able to take pictures and talk around those pictures a bit more. So that was– it was a really wonderful project and we’re starting to– we’ve produced a number of policy reviews and government reports, which are available to be accessed now. We are working on the publication process of the other work as well. So, I’d definitely say keep your eye out for that.

[00:24:35.900] Jo Carlowe: Right. If people wanted to look at those now is there a link?

[00:24:40.620] Dr. Hope Christie: If you go on the Edinburgh University website and search for Road to Recovery, you’ll be able to find the project page and the reports will be there.

[00:24:49.375] Jo Carlowe: All right, sounds fascinating. Finally, Hope, what is your take home message for our listeners?

[00:24:55.160] Dr. Hope Christie: I’d say a lot when I do other talks about my research– I think– and I know I said it earlier on in this talk, but being a parent is an incredibly hard job and probably actually one of the most judged jobs as well. I think people always feel a need to share their opinion with you unsolicited or otherwise. And– do you know, like I say, parents are just trying their best on a day-to-day basis to make the best for their child.

And I think that was really clear in the Road to Recovery work and– in terms of that then given us a little bit of an insight into the review findings as well that, do you know, parents have really suffered disproportionately during lockdown, and they took on a tremendous amount of additional stress on top of just being a parent anyway. And they’ve managed through it, which is fantastic. But just because they manage through it, doesn’t mean they don’t still need the help.

And I think that’s something that’s really important to emphasize is that they manage through it because they’re resilient and they’re drive and force is protecting their child. But actually, now there is the capacity and space to be able to offer help and support, that should definitely be offered to parents and families.

[00:26:11.110] Jo Carlowe: Hope, thank you so much. For more details on Dr. Hope Christie, please visit the ACAMH website, www.acamh.org, and Twitter, @acamh. ACAMH is spelled A-C-A-M-H. And don’t forget to follow us on your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues.

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