Pre-Pandemic Adversity Buffers the Role of Social Loneliness in Depression and Extreme Stress Among Caregivers of Infants during the COVID-19 Pandemic

Background and Purpose

The consequences of the COVID-19 pandemic have affected parents’ well-being and heightened incidents of anxiety and mental health disorders. Additionally, the COVID-19 pandemic introduced global experiences of social isolation. The inability to see close friends and family and being forced to work and provide childcare within the home likely added significant additional stress to caregivers. Finally, while COVID-19 affected all families in the United States, the disruptions of the pandemic have disproportionately impacted the well-being of families who have historically faced greater adversity, particularly families of color and low-income families. As a result, pre-existing inequities have been exacerbated by the COVID-19 pandemic. All of these stressors can heighten feelings of anxiety, depression, and other mental health challenges. This leads to the question of how the impact of the COVID-19 pandemic on mental health may differ based on experiences of risk and resilience prior to the onset of the pandemic, which presents an opportunity to examine the mechanisms driving heterogeneity. Thus, the current study investigates how the mental health of caregivers have changed over the course of pandemic, and how this differs by previous risk/resilience characteristics and experiences of social loneliness.

Methods

This study design re-administered survey measures that were also collected prior to the pandemic (February 2019 - February 2020). Consequently, we can investigate how family experiences have changed over the first year of the COVID-19 pandemic. Additionally, in prior research, we conducted a Latent Profile Analysis with the full, baseline sample (n=888) using measures of family risk and resilience. In the current analysis, these profiles are central for understanding how risk and protective factors prior to the pandemic are differentially associated with family experiences during the pandemic. In the follow-up study, we interviewed 243 families. The key outcomes in this analysis are depressive feelings, stress, and the impact of stress on parent functioning. Social loneliness is included as a moderator. For longitudinal analyses, multi-level modeling is used to leverage the longitudinal dataset and account for the nesting of families within communities. Specifically, mixed effects models were used to include both fixed effects (direct estimations of associations between profiles of risk and resilience and outcome variables) and random effects (indirect estimates of second-level community effects).

Results

All caregivers reported increases in extreme stress during the pandemic. Caregivers with less relative adversity pre-pandemic showed significantly greater depression and loneliness in the pandemic compared to caregivers with higher pre-pandemic adversity. Social loneliness was a moderator of the association between pre-pandemic adversity and mental health.

Conclusions and Implications

The study suggests families with more pre-pandemic adversity demonstrate coping that buffers the negative impact of social loneliness on mental health, emphasizing the strengths of these families that are assets to build upon in crisis. Families with more relative advantage pre-pandemic likely need assistance to reduce feelings of stress and depression in the face of increased social loneliness.