key: cord-0867784-lvr8wbob
authors: Trumello, Carmen; Bramanti, Sonia M.; Lombardi, Lucia; Ricciardi, Piera; Morelli, Mara; Candelori, Carla; Crudele, Monia; Cattelino, Elena; Baiocco, Roberto; Chirumbolo, Antonio; Babore, Alessandra
title: COVID‐19 and home confinement: A study on fathers, father–child relationships and child adjustment
date: 2021-09-22
journal: Child Care Health Dev
DOI: 10.1111/cch.12912
sha: c016bfb91bac1a8248f366abf4753906cf86cdd3
doc_id: 867784
cord_uid: lvr8wbob

BACKGROUND: The purpose of this study was to explore fathers' adjustment and father–child relationships during the first peak of the coronavirus disease 2019 (COVID‐19) outbreak (April 2020). More particularly, the study analysed paternal perceptions of changes concerning familial economic conditions and children's psychological difficulties (viz., emotional problems and hyperactivity) during the lockdown produced by the current pandemic. Furthermore, we investigated the following correlates of fathers' parenting stress: socio‐demographic condition, paternal individual stress, anxiety, depression and changes in the father–child relationship during the outbreak. METHODS: A total of 102 fathers (mean age = 41.60 years; SD = 11.54) with minor children were recruited through an online survey and reported data about their socio‐economic condition, anxiety, and depressive levels, parenting stress, offspring's adjustment, and changes in their relationship with their children. RESULTS: As for the economic conditions, participants were equally distributed between those who did not perceive changes and those who perceived a worsening. With regard to changes in the child's psychological difficulties, results showed that levels of children's emotional problems and inattention/hyperactivity had significantly increased during the lockdown period. A multiple linear regression analysis highlighted that the principal predictor of paternal parenting stress was living in the regions most affected by the COVID‐19 pandemic, followed by high levels of paternal anxiety symptomatology and high levels of worsening of the relationship with the child during the pandemic. CONCLUSIONS: Overall, our study suggests to consider the effects of COVID‐19 on fathers as well, as they have been rather overlooked by previous research that has mainly focused on mothers, and to plan specific interventions able to also take them into account.

Conclusions: Overall, our study suggests to consider the effects of COVID-19 on fathers as well, as they have been rather overlooked by previous research that has mainly focused on mothers, and to plan specific interventions able to also take them into account.

anxiety, child adjustment, COVID-19, fathers, parent-child relationship, parenting stress

Parenting stress-defined as the psychological burden derived from the discrepancy perceived by parents between the needs related to parenting and the parental resources (Deater-Deckard, 1998 )-may negatively affect parents' attitudes towards the child and the quality of their interactions (Morelli et al., 2020) . A recent meta-analysis (Pinquart, 2017) underscored that, compared with mothers, fathers were underrepresented in studies on parenting stress, although it has been shown that fathers' parenting stress is associated with less involvement (Bronte-Tinkew et al., 2010) and long-term effects on child difficulties (Wilson & Durbin, 2010) .

Previous studies found that the parent-child relationship may also be affected by adverse life events (Ren et al., 2019) , as socioeconomic disadvantages (Malmberg & Flouri, 2011) , a preterm birth (Candelori et al., 2015) , serious childhood illness (Pinquart, 2013) , a parent's serious illness (Babore et al., 2019) , divorce or separation (Kalmijn, 2013) and natural disasters (Dyb et al., 2011) . Existing research suggested that stressors affect father-child relationships significantly more than mother-child relationships (Almeida et al., 1999) .

The current pandemic produced by the COVID-19 could be considered a stressful life event. In Italy, the first outbreak was detected in Lombardy, on 21 February 2020. After that, thousands of cases have occurred, with the following regions most affected during the first wave of the pandemic: Lombardy, Piedmont, Emilia Romagna and Veneto; each one has had more than 10,000 cases of infected individuals in less than 1 month from the beginning of the outbreak (Johns Hopkins University, 2020).

To face this critical emergency and reduce the risk of spreading the virus, the Government issued a legal decree (Decreto del Presidente del Consiglio dei Ministri [DPCM] , 2020) that imposed a lockdown in the entire national territory from 11 March to 4 May 2020, with the closure of all public places (e.g., schools, parks and shopping centres), the suspension or remodelling of work activities (with the activation of smart-working from home, except for professional categories that provide essential service for the community), and a ban on leaving home, except for proven work and health needs and for reasons of necessity.

This critical emergency has produced consequences not only for work activities and economic income but also on mental health and stress levels (Mazza et al., 2020; Özdin & Özdin, 2020) , individual and familial daily routines and functioning (Bai et al., 2020) , parent-child relationships and children's outcomes (Jiao et al., 2020; Zhang et al., 2020) . The negative effects could be more evident in individuals living in the regions most affected by the virus (Özdin & Özdin, 2020) .

Changes produced by the COVID-19 pandemic on daily routines, work activities and socio-economic conditions have found to be associated with psychological distress (Bai et al., 2020; Zhang et al., 2020) .

Previous research on a sample of fathers has investigated the association between work situations and relationships with children, showing that a negative economic status increases parenting stress levels (Bronte-Tinkew et al., 2010) . The research revealed that high levels of stress, depression, and anxiety reduced parental self-efficacy and competence (Crnic & Ross, 2017) , with consequences on the quantity and quality of parent-child interactions and children's adjustment (Ramchandani & Psychogiou, 2009) . Indeed, fathers' mental health difficulties have been associated with hostile parent-child interactions and emotional-behavioural difficulties in children (Giallo et al., 2020) .

To our knowledge, no previous study has explored fathers' emotional distress and father-child relationships during the COVID-19

pandemic. With the current research, we pursued a twofold objective. 

A total of 102 fathers with children aged between 0 and 18 years took part in this study. The mean age of the participants was 41.60 years (SD = 11.54; range 15-62). Eighty-nine per cent of participants had a current marital relationship.

Regarding the offspring's characteristics, the children had a mean age of 8.50 years (SD = 5.68), and most of them (59%) were males.

Most participants had a medium-high socio-economic status (income ≥ 28,000 euros per year).

We created an ad hoc questionnaire to explore socio-demographic data to assess fathers' general information (e.g., age, profession and region of residence), changes caused by the COVID-19 pandemic (in socio-economic status and employment status before and during the lockdown) and the child's characteristics (gender and age).

To assess the fathers' parenting stress, we used the subscale Parent-Child Dysfunctional Interaction (P-CDI) of the Parenting Stress Index Short Form (PSI-SF; Abidin, 1995) that measures the parent's view of expectations and interactions with the child. The P-CDI scale consists of 12 items (e.g., 'My child rarely does things for me that make me feel very good') scored on a 5-point scale. The reliability of this tool was excellent (Cronbach's α = .906).

The Perceived Stress Scale (PSS) is a valid self-report instrument to assess the perceived stress in the last month (Cohen et al., 1983) .

This tool measures life events considered and perceived as stressful. It consists of 10 items evaluated on a 5-point Likert scale. The items concern the uncontrollable, unpredictable and overloaded life events that the individuals have experienced (sample items: 'In the last month, how often have you been upset because of something that happened unexpectedly?'). The total scores range from 0 to 40, with higher levels reflecting higher levels of perceived stress. The reliability was very good (Cronbach's α = .881).

To assess states of anxiety and depression, we used a reliable selfreport instrument, the Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983) . It consists of 14 items, rated on a 4-point Likert scale and is composed of two scales that evaluate anxiety (HADS-A; sample item: 'I feel tense or wound up') and depressive symptoms (HADS-D; sample item: 'I look forward to enjoying things').

The total score ranges between 0 and 21 for each scale, with the higher score denoting a greater number of symptoms of either anxiety and/or depression. The reliability of the full scale was very good (Cronbach's α = .849).

To assess children's emotional and behavioural problems, we used the parent-form of the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) . It is a 25-item screening instrument rated on a 3-point Likert scale, composed of five subscales that evaluate emotional symptoms, behavioural problems, inattention/hyperactivity, peer problems and prosocial behaviour. In this study, we considered the two subscales of emotional symptoms (sample item: 'Nervous or clingy in new situations, easily loses confidence') and inattention/ hyperactivity (sample item: 'Restless, overactive, cannot stay still for long'). Both scales were administered to fathers twice: the first with the instruction to refer to the past 2 weeks and the second thinking of their child's adjustment before the start of the COVID-19 emergency. Higher scores reflect greater difficulties. Cronbach's alphas for the past and current form were satisfactory (respectively .701 and .791).

2.3.6 | Change in the relationship with the child Fathers were asked to answer questions created ad hoc to evaluate the change in the relationship with their child during the COVID-19

pandemic. This questionnaire consists of 16 items, assessed on a 3-point Likert. It investigates parental involvement (sample item, 'During this emergency period, we take more pleasure doing things together, for example playing, reading, talking …'), and the parent's perception of the child's attitude (sample item 'Since this emergency started, I feel that my child is moving away from me'). The total score ranges between 0 and 48; the higher the score, the worse the relationship during the COVID-19 pandemic. In this study, the reliability was satisfactory (Cronbach's α = .701). 

The first purpose of the study was to investigate paternal perceptions of changes during the outbreak concerning familial economic conditions and the child's psychological maladjustment (viz., emotional problems and hyperactivity). As for economic conditions, the sample was equally distributed between those who did not perceive changes (49.0%) and those who perceived a worsening (50.0%); only 1% of the sample noted an improvement. With regard to changes in the child's psychological difficulties (in terms of emotional problems and hyperactivity), the paired t test results (summarized in Table the dependent variable were observed with fathers' perceived stress, depression, and age, familial annual income, the method of working during the pandemic, child's sex, or age.

This study aimed to analyse father-child interactions during the COVID-19 outbreak, considering the paternal perceptions of the child's psychological maladjustment-in terms of emotional problems and hyperactivity-and the quality of father-child relations.

To our knowledge, a few studies analysed the effects of the COVID-19 pandemic on parental mental health and child's adjustment considering both parents (Bai et al., 2020; Orgilés et al., 2020) , but no study has specifically investigated the father-child relationship. Regarding the child's psychological difficulties, fathers referred to an increase in children's levels of emotional problems and inattention/ hyperactivity. This is consistent with previous findings in recent literature. Available studies from different countries underlined the psychological impact of the COVID-19 outbreak on children Jiao et al., 2020; Pisano & Galimi, 2020) . During this unusual period, as also suggested by the United Nations (2020), lifestyle changes (e.g., social isolation, interruption of school and educational activity, and uncertainty for the future) and family stress due to home confinement could have produced a negative effect on children's and adolescents' emotional problems. This worsening has also been detected by the participants in this research.

An additional aim was to analyse some risk factors associated with fathers' parenting stress. The results of the multiple linear regression analysis showed three statistically significant variables: living in the regions with high contagion and death rates, high levels of paternal anxiety and high levels of perceived worsening of the relationship with the child during the pandemic. As for the first factor, the study result is consistent with previous literature among healthcare workers and the general population, finding that living in regions with higher rates of contagion and death is a risk factor for greater psychological distress (Özdin & Özdin, 2020; Trumello et al., 2020) . This association was not previously investigated in the specific context of parenting and COVID-19. It may be hypothesized that in regions with the highest contagion rates, there was a greater perceived risk of contracting the virus than in the rest of Italy and this may have affected the quality of father-child interactions.

Paternal parenting stress was also predicted by fathers' high anxiety levels. This result is quite new, as most previous studies predominantly addressed depressive rather than anxious symptoms in mothers rather than fathers. The association between anxiety and parenting stress was evidenced by a recent study conducted on mothers (Tsotsi et al., 2019) highlighting that anxious mothers tend to feel less competent in their parental role. This issue is particularly critical in the specific context of the lockdown caused by the first wave of the pandemic, when anxiety levels increased due to the negative influence of the outbreak in different areas (e.g., health, economy, job and social relationships), as already reported in previous studies in the general population (Fancourt et al., 2020; Salari et al., 2020) . During such times of uncertainty and fear, with an unprecedented lack of resources and access to the usual supports (both familial and social), parental anxiety and constant worries may have had an impact on their perception of parenting skills necessary to cope with the difficult and new situation, and in turn on parenting stress, above all for fathers. Indeed, as suggested by a recent Italian study (Del Boca et al., 2020) , during the lockdown, there was an increased contribution by men to childcare with consequent higher rates of caregiver burden than before the pandemic (Russell et al., 2020) and more stress in their parental role.

Finally, the study findings revealed that another significant predictor of paternal parenting stress was the level of perceived worsening of their relationship with the child during the pandemic. The higher the perceived worsening, the higher the parenting stress. This result should be interpreted in the specific context of COVID-19; with restrictive measures and home confinement, there were increased demands on fathers to develop new routines and limits to negotiate rules that, in the pre-pandemic period, were less problematic (e.g., use of shared spaces or use of electronic devices) or non-existent (e.g., restrictions on many activities). Research has underscored that when children are not at school, they are less physically active, more bored, and spend more time in front of screens (Brazendale et al., 2017) , increasing the opportunities for conflict with parents.

Overall, it may be argued that in everyday life, parental responsibilities and duties are shared with other types of educators, such as teachers, grandparents and sport coaches. In the social isolation produced by the lockdown, parents' tasks were an exclusive burden on themselves, increasing the perception of the demands related to their role. This could be especially true for fathers, who are usually less involved than mothers in childcaring.

Several limitations should be considered in interpreting the results. First is the small sample size that may limit the generalizability of the results. In addition, we used self-report questionnaires that do not allow for a clinical diagnosis. Furthermore, the cross-sectional nature of the research design prevents us from drawing conclusions as to the directionality of the associations. Finally, all measures of the children relied on the fathers' report collected at one time measure, and this does not allow us to exclude a retrospective bias.

Despite these limitations, the current findings offer insights into the potential consequences of the COVID-19 epidemic on fatherchild relationships. The existing literature has mainly focused on mothers' adjustment and mother-child relationships, overlooking the importance of the paternal role (Babore et al., 2014) . Our research tries to address the lack of studies on fathers during the current pandemic. Given the social, economic and psychological impact of COVID-19, many fathers (and in general all caregivers) are likely facing an unprecedented increase in daily stressors (even if they are not dealing with immediate illness) that represents a significant threat to their well-being, to their parenting skills and consequently to their relationship with the child. Our data suggest some factors to consider in detecting fathers more at risk of high parenting stress, that is, high anxiety levels, perception of a worsening in their relationship with the child, and living in the regions with the highest rates of contagion.

As the pandemic is ongoing and the psychological impacts on individuals and families are likely to be longstanding, it is necessary to support both parents' and children's psychological health through targeted interventions that consider either individual or relational levels.

ACKNOWLEDGEMENT Open Access Funding provided by Universita degli Studi Gabriele d'Annunzio Chieti Pescara within the CRUI-CARE Agreement.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

https://orcid.org/0000-0003-3463-3685 Alessandra Babore https://orcid.org/0000-0002-7317-3733

Parenting stress index: Manual

Daily transmission of tensions between marital dyads and parent-child dyads

The role of depression and emotion regulation on parenting stress in a sample of mothers with cancer. Supportive Care in Cancer

The emotional relationship with parents: A validation study of the LEAP among Italian adolescents

Mothers' and children's mental health during COVID-19 pandemic lockdown: The mediating role of parenting stress

The effect of the COVID-19 outbreak on children's behavior and parents' mental health in China: A research study

Understanding differences between summer vs. school obesogenic behaviors of children: The structured days hypothesis

Aggravation and stress in parenting: Associations with coparenting and father engagement among resident fathers

The experience of premature birth for fathers: The application of the clinical interview for parents of high-risk infants (CLIP) to an Italian sample

A global measure of perceived stress

Parental stress and early child development

Parenting stress and child adjustment: Some old hypotheses and new questions

Ulteriori disposizioni attuative del decreto-legge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19, applicabili

Women's and men's work, housework and childcare, before and during COVID-19

Children's and parents' posttraumatic stress reactions after the 2004 tsunami

Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: A longitudinal observational study

Paternal Psychological Distress and Child Problem Behavior from Early Childhood to Middle Adolescence

Working out dads' to promote men's mental and physical health in early fatherhood: A mixedmethods evaluation

The strengths and difficulties questionnaire: A research note

Behavioral and emotional disorders in children during the COVID-19 epidemic

COVID-19 Map Retrieved 27

Long-term effects of divorce on parent-child relationships: Within-family comparisons of fathers and mothers

The comparison and interdependence of maternal and paternal influences on young children's behavior and resilience

Multivariate statistical methods: A first course

A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: Immediate psychological responses and associated factors

Parents and children during the COVID-19 lockdown: The influence of parenting distress and parenting self-efficacy on children's emotional well-being

Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain

Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender

Do the parent-child relationship and parenting behaviors differ between families with a child with and without chronic illness? A meta-analysis

Associations of parenting dimensions and styles with externalizing problems of children and adolescents: An updated metaanalysis

A qualitative report on exploratory data on the possible emotional/behavioral correlates of COVID-19 lockdown in 4-10 years children in Italy

Paternal psychiatric disorders and children's psychosocial development

Associations of family relationships and negative life events with depressive symptoms among Chinese adolescents: A cross-sectional study

Initial challenges of caregiving during COVID-19: Caregiver burden, mental health, and the parent-child relationship. Child Psychiatry & Human Development

Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis

Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations

Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: Differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between Frontline and Non-Frontline Professionals

Maternal anxiety, parenting stress, and preschoolers' behavior problems: The role of child self-regulation

Policy brief: COVID-19 and the need for action on mental health

Effects of paternal depression on fathers' parenting behaviors: A meta-analytic review

Acute stress, behavioural symptoms and mood states among schoolage children with attention-deficit/hyperactive disorder during the COVID-19 outbreak

The hospital anxiety and depression scale

COVID-19 and home confinement: A study on fathers, father-child relationships and child adjustment