With the onset of the coronavirus disease 2019 (COVID-19) pandemic, family behaviors underwent a rapid forced change as work-from-home became the new norm due to social distancing recommendations. As the primary caregiver for children in most families, mothers typically shoulder the bulk of the increased responsibility at home as children must be educated, amused, and cared for all day.

In addition, mothers were more likely to lose their jobs when schools closed; they were less likely to have coping mechanisms. Simultaneously, they were faced with unanticipated expenses for childcare, even as school meals were lost. A new research paper presents the results of a study on how this affected maternal stress levels in American mothers, concomitant with other factors such as financial hardship.

Study: COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US. Image Credit: fizkes / Shutterstock

Introduction

Despite intensive studies on the physical aspects of COVID-19 and the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), not much is known about the mental health of mothers with children during the pandemic.  

The current study, which appeared in the journal JAMA Network, looked at data from the Environmental influences on Child Health Outcomes (ECHO) Program, which examined hardships, coping mechanisms, and behaviors in mothers of children. This program included 69 cohorts of mothers and children from birth or early childhood, followed over time.

The study included almost 11,500 participants from various social backgrounds, household incomes, ethnicities, and racial origins. The study period was extended from April 2020 to August 2021. The median age was 38 years, with almost two out of three being White, one in seven Black, a fifth Hispanic or Latina, and about 3% each being Asian and American Indian.

The scientists analyzed these data and their links with maternal pandemic-related traumatic stress symptoms. The researchers looked at changes in maternal health, how far mothers used healthcare services, and the impact on their work and their financial status, following the onset of the pandemic. This was measured as the total symptoms score of pandemic-associated traumatic stress (PTS) regarding how many items on the self-reported questionnaire were reported.

What did the study show?

Two clusters of pandemic-related experiences were identified. One group reported more significant disruption to their lives, as in work and healthcare. These mothers were more likely to feel socially cut off, to use more coping behaviors, and to have more changes in their health behaviors. These mothers were dubbed high-change mothers, making up about a third of the cohort.

The second group, dubbed low-change mothers, were more likely to be poorer and/or from lower social strata, had more significant hardships, and had fewer coping mechanisms. Their mean lower income was below $30,000 in almost a fifth of these mothers, vs. 7% in the high-change cluster.

About 27% in the former group were single mothers, compared to half this percentage in the high-change cluster. Again, a quarter of the low-change cluster was Black compared to 12% in the other group, while the proportion of indigenous community members was also doubled in the former.

The mean symptom score for significant PTS symptoms was 3.4, while the mean total PTS score was 21. The average total symptom categories score was 2.

The high-change cluster was more likely (36% vs. 30%) to report financial stress, disruption of healthcare, and social isolation. The mean total PTS symptom number was 3.7 in this group compared to 2.5 in the low-change cluster.

In the low-change cluster, COVID-19 infection was associated with higher PTS. This cluster also showed a more significant change in PTS scores with changes in healthcare access, employment, or reduced earnings, though both groups showed an increase in PTS scores in these situations. Not having the same degree of contact with friends was associated with lower PTS in the low-change cluster. 

The use of coping strategies increased PTS in either cluster. Such mechanisms included eating more, watching more on big or small screens, smoking tobacco or marijuana, seeing doctors or other healthcare workers, or meditation. In addition, conversations with family and friends boosted PTS in the low-change cluster, while alcohol use increased it in both, especially the high-change group.

Time spent with family, reading, or puzzling increased PTS in the former but reduced it in the latter. This apparent paradox could be due to the inability to relax since these mothers, more likely to live in smaller or more crowded houses, could not escape family members even for a short while.

The high-change group showed higher PTS in those who exercised less and spent less time outdoors. This finding supports the benefit of active coping strategies since quiet or family time in the high-change cluster was linked to reduced PTS. Conversely, those who ate less homemade food reported more PTS only in the low-change cluster. This cluster also reported less PTS when the woman continued all pre-pandemic behaviors. 

The results showed that a higher level of hardship associated with the pandemic was linked to more symptoms of pandemic stress. Similarly, traumatic stress levels rose with a higher level of use of coping mechanisms and increased behavior changes. Moreover, this trend was maintained across a diverse range of mothers in the US.

The strength of these associations was higher in the low-change group than in the high-change group. Both groups contained mothers who reported all ten symptoms in the questionnaire, but the overall distribution of symptoms was skewed to the right in the low-change cluster. In contrast, a more normal distribution was observable in the other cluster.

What are the implications?

The findings of this study suggest a network of associations between the social and demographic backgrounds from which mothers came, the life events that caused stress, and their subsequent mental health. For instance, socially and economically privileged women could often work from home. Nevertheless, these amenities were accompanied by loneliness due to isolation from family, friends, and workplace colleagues, lowering the degree of social support available.

Some confusing patterns have been thrown up by this study, such as increased PTS with more home-cooked food in the low-change group. “These results suggest that change itself may be a key factor associated with PTS, or, alternatively, that we may not have asked the right questions about what coping mechanisms are effective in communities with lower socioeconomic advantage.”

These interwoven associations “should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic and other traumatic life events.” This will help shape better interventions to soften the long-term impacts of such public health crises.