Stress, Resilience, and Well-Being in Italian Children and Their Parents during the COVID-19 Pandemic

The novel coronavirus (COVID-19) rapidly spread in China, reaching several countries in a short amount of time [1]. Italy was the second country affected by the COVID-19 pandemic outbreak: more than 100,000 people (including at least 8956 health-care workers) have been infected and over 11,000 have died [2] (data updated on 2 April 2020). To control and prevent disease transmission, many countries have implemented mass quarantine measures. Due to the rise in COVID-19 cases, on 9 March 2020, the Italian government issued a decree imposing lockdown measures on the country, intending to prevent the further spread of coronavirus in both the most- (e.g., Lombardy) and least-affected areas. In addition to closing all non-essential activities and suspending all public gatherings, the decree banned people from leaving their house unless strictly necessary, under penalty of severe sanctions (e.g., fines and imprisonment), until 3 April. The containment measures were then extended and progressively lifted until 13 April and finally until 3 May. Mass quarantine (also known as “lockdown”) is the primary tool used by governments to manage an epidemic outbreak, forcing citizens living in affected areas to stay inside their house, only leaving in a few selected circumstances, e.g., for medical examinations, to look after a vulnerable person, buy essential goods like pharmaceuticals, food, and beverages, or carry out essential work. Any other type of non-essential activity is therefore suspended or carried out from home through “smart (remote) working” [3]. Such drastic changes, which include bans on a wide range of activities, school closures, travel restrictions, social distancing, and the rapid deterioration of local businesses, have generated a considerable amount of stress among the population. Stress during lockdown was also associated with amplified media coverage of the COVID-19 pandemic, and with both the transformation of work and education models and substantial general lifestyle alterations for millions of people all over the world [4].

Studies conducted on the adult population have highlighted that social isolation measures might negatively affect psychological health [5]. People in quarantine are more likely to exhibit psychological symptoms and disorders, such as anxiety, anger, sleep disorders, depression, and post-traumatic stress disorder (PTSD) [6].

Because of the serious psychological implications of school closures and significant changes in daily routine, quarantine could have traumatic consequences not only on the adult population but on the pediatric one too [7].

Specifically, previous research has demonstrated that children who were subjected to quarantine and social isolation show higher levels of post-traumatic stress disorder (PTSD) compared to children who did not experience such measures [8]. Research conducted during the COVID-19 pandemic highlighted that children and adolescents were more likely to manifest externalized symptoms, such as inattention, persistent inquiry, irritability, and internalized symptoms, such as anxiety and depression or hyperactivity [9,10]. Moreover, children and adolescents exposed to traumatic events presented anxiety, depression, lethargy, reduced appetite, and emotional and behavioral difficulties several years after the events [11,12].

Nevertheless, several personal and interpersonal variables such as age, personality, developmental level, cognitive and emotional abilities, coping strategies, and resilience may influence children’s reactions to disaster [13,14], as well as parents’ responses and family support systems [15].

Recent studies have shown that, during potentially traumatic events, some people can adaptively face negative circumstances, with mild or moderate reactions that do not interfere with their functional abilities [16,17,18]. The ability to thrive despite exposure to adversity is known as resilience. In a social–ecological framework, resilience depends on the quality of the interactions with the environment, which allows individuals to maintain their psychological, social, and physical well-being [19,20,21,22].

Children’s adjustment to unknown situations is also influenced by distal factors, such as social changes and rules imposed during the COVID-19 pandemic, and proximal factors, including peer and infant–caregiver relationships [23]. The research on distal factors suggests that children and their parents constitute an “at-risk group” for maladjustment due to lifestyle disruption caused by COVID-19 [24]. In fact, children may be more sensitive to routine changes compared to the general population [25]. The significant changes in daily routine that children have experienced during quarantine might interfere with their sense of predictability and security—both essential factors for healthy development [26]. Indeed, these modifications expose children to a higher risk for negative health outcomes resulting from lower levels of physical activity, longer screen time, irregular sleep patterns, and poorer eating habits [27]. In particular, school routine constitutes an important coping mechanism for children, allowing them to schedule their time, interact with their peers, and focus on achieving bigger and bigger goals [28].

Concerning proximal factors, it is important to highlight that children’s well-being is strictly linked to their parents’ physical, psychological, and social health [29]. A recent study showed how parental presence may decrease the child’s stress levels during quarantine [25].

Like their children, adults have faced different stressors linked to the quarantine period as well. Specifically, parents have had to cope with social distancing and changes in their daily routine, such as remote working or unemployment, as well as caring for their children during school hours. In some cases, the changes brought about by lockdown measures were accompanied by a reduced income and new responsibilities that may exacerbate pre-existing difficulties and stress [30,31,32].

Because of the COVID-19 outbreak and the resulting need for social distancing, many organizations have imposed a remote work policy, forcing individual citizens to work from home [33], therefore gradually blurring the boundaries between work and family roles [34]. At the same time, the closing of schools and childcare facilities has forced many working parents to take on full-time responsibility for their children’s care and home education, while simultaneously adapting to a new “smart working” lifestyle and daily structure. Parents found themselves having to manage their time during quarantine while balancing personal life, work, and their children’s education without any external help. This situation has put parents at increased risk for personal distress, potentially compromising their own well-being and, as a result, their children’s well-being [32].

The effects of the COVID-19 pandemic on families vary considerably based on what contextual stress factors parents are exposed to; data indicates that the consequences of lockdown tend to negatively affect low-income families the most [35]. More specifically, parental stress represents a negative psychological response to parental obligations: caring for children while simultaneously worrying about not having enough resources to meet their needs can be a heavy burden for parents [36,37,38]. Several personal characteristics of both parents and children in a specific family configuration, together with various life stressors, may contribute to an increased sense of psychological pressure resulting from the caregiving role [39]. Previous research has identified different parental factors that may increase the risk of parental stress: low confidence in one’s own parental abilities, low perceived attachment to the child, health problems, role restriction (i.e., the extent to which the parental role restricts the parents’ freedom and ability to maintain their own individual identity), depression, anxiety, and low levels of emotional and practical partner involvement (particularly, single parenting) [40,41].

As is well-known, parental stress is associated with children’s behavioral and emotional problems and developmental maladjustment [42]. During infancy, parental stress can negatively alter parent–child interactions and interfere with the quality of caregiving, and, therefore, affect the formation of attachment bonds [43]. Moreover, parental stress is associated with higher levels of family conflict until adolescence [44,45], and, through parental behavior, it contributes to the creation of a chaotic family environment, which in turn, puts the child at risk for behavioral problems [46]. In addition, high levels of parental stress are thought to interfere with the caregiver’s ability to effectively cope with parenting-related difficulties [47], which may result in increased use of inappropriate disciplinary strategies and a higher risk of physical abuse [48,49].

The purpose of the present study was to investigate parents’ and children’s well-being, parental stress, and children’s resilience during the COVID-19 pandemic, more specifically during the quarantine.

Furthermore, we also aimed to investigate which proximal and distal variables constitute protective and risk factors for psychological maladjustment.

In particular:

In our study, we aimed to investigate the psychological impact of COVID-19 quarantine rules on Italian children aged 5–17 and their parents, and to unveil the contextual and personal variables associated with better overall adjustment.

To the best of our knowledge, this study is one of the few [9,32,67,68] to investigate the well-being of the parent–child dyad including the role of children’s resilience and parental stress as protective and risk factors, respectively. Due to the COVID-19 pandemic, many families faced several changes in their everyday life. Keeping their children engaged and safe at home represented a significant challenge (and sometimes a difficult task) for many parents, especially considering the psychological impact of quarantine on children.

Consistent with recent research findings, our data show that confinement measures and changes in daily routine negatively affect both children’s and parents’ behavioral and emotional dimensions [69].

Concerning our first specific aim—to evaluate children’s well-being and resilience during quarantine—our results do not indicate significant differences in terms of well-being between children (aged 6–10) compared to the normative population; however, regarding the hyperactivity scale of SDQ, the results of the one-sample t-test do not support the complete absence of such difference (t = 2.18, p = 0.036), suggesting that there might be higher levels of hyperactivity among the children during lockdown compared to the normal population (M_normative = 3.30; M_sample = 4.13, SE = 0.379). This result seems to be in line with recent studies that consider hyperactivity as a common psychological reaction during periods of confinement [9,10]. An important aspect linked to hyperactivity is the tendency for children to express their negative emotions through aggressive behaviors [70], sometimes developing externalized symptoms rather than post-traumatic stress disorder [17]. For these reasons, future research should take into consideration children’s hyperactivity to clarify and better investigate this reaction.

As for children’s well-being, we observed a negative association between children’s psychopathological symptoms and resilience. This result is consistent with the literature [22,71] and further highlights the notion that children who can thrive despite adversities and adapt to the imposed restrictions and social distancing can mitigate the negative impact of these aspects on their own well-being.

Concerning our second specific aim—to assess parents’ well-being and parental stress during the COVID-19 outbreak—our study shows that the mothers included in our sample (the majority of the respondents) report lower levels of well-being and perceived self-control and higher levels of anxiety compared to the normal population. Similarly to what has been observed in other countries [25,72], these findings confirm the negative psychological impact of the pandemic, and further highlight the presence of moderate to severe anxiety symptoms in Italian mothers during the lockdown. The quarantine measures imposed during the COVID-19 pandemic represent an uncertain and threatening situation that could trigger anxiety symptoms [73] and interfere with personal self-control [74].

In addition, results show that certain socio-demographic and contextual variables affect parental well-being and stress—changes in working conditions, younger children, and parental psychological, physical, or genetic problems appear to be linked to lower levels of psychological well-being in parents during the COVID-19 lockdown. Family structure, the number, and the presence of children with psychological, physical, or genetic diseases are all risk factors for high parental stress.

Our findings are consistent with the literature highlighting how disabilities or chronic conditions represent a high-impact stress for parents [75,76,77,78,79]. Moreover, as expected, being part of a nuclear family constitutes a protective factor for stress and psychological sequelae in parents. Parenthood is a demanding role, particularly during periods of confinement such as quarantine, in which parents must manage multiple tasks, increasing the risk of role conflict [80]. In single-parent families, parents must balance different roles on their own; this aspect could negatively affect their psychological health, exposing them to maladjustment, especially during stressful situations [81,82].

According to our results and the literature, other family structure characteristics that could increase the level of parental stress include the number of children living at home. All these aspects point out that pre-existing vulnerabilities constitute risk factors for psychological sequelae in both parents and children during the COVID-19 outbreak, as further highlighted by our results. Moreover, an additional aspect worth considering is the impact that parental stress can have on parenting skills. High levels of parental stress are thought to interfere with the caregiver’s ability to effectively cope with parenting-related difficulties [47], which may result in an increased use of inappropriate disciplinary strategies and might lead to a higher risk of physical abuse [83] and neglect [84].

Nevertheless, some family resources can help protect both children and parents from the negative impact of stressful situations and promote their well-being, as a recent study has shown [85]. According to our results, one protective factor is children’s resilience, which, as discussed above, is strictly connected to their well-being. In addition, regarding the relationship between children’s resilience and parents’ psychological health, our hypothesis was only partially confirmed: the correlations between the CYRM-R and the PGWB scales, although significant, are low. Furthermore, our results show a negative association between children’s resilience and parental stress: this indicates that the first may mitigate the latter. All these aspects emphasize the role of resilience in the family context, as well as the mutual influence that children and parent’s psychological health exert, and the ability to successfully face life’s challenges.

Children’s well-being represents an additional negative predictor of parental stress. For this reason, it may constitute a protective factor for parental distress, meaning that parents of children with better psychological adjustment experience fewer difficulties in their parental role. In this sense, all family members reciprocally influence each other’s adjustment, and can help develop new resources by promoting positive adaptation during difficult times.

Finally, regarding our third specific aim—to analyze the effects of lifestyle changes linked to the COVID-19 pandemic on parents’ and children’s psychological health—changes in working conditions seem to play a crucial role in the family’s psychological adjustment. Data show that parents who change working conditions suffer from psychological difficulties more than those who do not. Such changes include job loss or temporary suspension of work activities, which imply a reduction in income, with negative consequences for psychological and physical adjustment [86,87]. Similarly, performing one’s job through remote working constitutes another risk factor for maladjustment.

It was quite difficult for parents to balance their parental role and their work-life, with important implications for psychological health [88]. The impact of such changes must not be underestimated. Regarding the family context: maintaining clear family and work boundaries can be more difficult during the lockdown, as people must now undertake multiple role transitions during their day [89]. Although permeable family and work boundaries can represent an advantage [90], taking on different competing roles (e.g., parent and employee) can lead to conflict between them, family and work interferences, and emotional tension [91]. During quarantine, parents had to manage their work while at the same time helping their children with their homework, often without the possibility to occupy separate rooms.

In our survey, parents were asked to think about their relationship with their children during the lockdown. Some of them (18.1%) reported negative effects of the confinement measures on their interactions with their children, whereas the majority (48.8%) reported positive changes in the parent–child relationship (e.g., spending more time together). Our results show that the perception of how quarantine can transform the relationship with one’s children plays a key role in the stress experienced by parents. Those who perceived quarantine as an opportunity to spend more time with their children reported lower levels of parental stress. This aspect highlights the crucial role of the cognitive representation of an event in reducing the intensity of the psychological response to it. In particular, positive parental representations of the quarantine period help caregivers implement positive parenting styles, which in turn support children’s development and decrease the incidence of externalizing behaviors [69].

Despite the interesting findings that emerged from the present study, its limitations need to be addressed.

First, online surveys certainly have their advantages, such as granting the possibility to quickly reach a high number of participants in different areas of the country; however, using one did not allow us to control the contextual features of the environment where the assessment occurred (e.g., noises and interruptions may have distracted the participants). Second, the online procedure did not allow us to check whether participants accurately completed the questionnaire in its entirety, following the instructions from beginning to end. Third, there is a possible sampling error linked to the request to take into consideration only one child for each family. On the one hand, this allowed us to avoid any bias linked to the maximization or minimization of differences between siblings, due to the repetitive compilation of the same questionnaires; on the other hand, it was not possible to control parents’ answer choice criteria. These possible errors caused by online survey administration require caution in the interpretation of these results. Moreover, basic Internet and technical skills were required to participate in the study—such skills include being able to operate smartphones, computers, or tablets. Because of this, our study only included Internet users. Although this aspect may constitute a limitation, parents of children aged 5 to 17 frequently use technological devices to surf the Web. Statistics show that in Italy, in November 2019, 83% of people aged 35 to 44, and 81% of people aged 45 to 54 were daily Internet users. Considering that the mean age of the parents included in our sample was 43.3 years, it is safe to assume that accessing the online survey did not constitute a difficult task for them.

Lastly, our sample is not representative of fathers because only 9.5% of the responders belonged to this category.

Our study provides a general view of Italian families’ experience during the quarantine. Future longitudinal studies will allow a more exhaustive understanding of the real long-term effects of the COVID-19 outbreak on children’s and parents’ psychological adjustment and the entire family system.

Currently, in Italy, the daily situation update regarding the epidemiological curve shows a rise in contagion, which has led to the government tightening social distancing rules and general security measures. As such, those most at-risk will be the most vulnerable. In this current scenario, it will be important to provide psychological support to those who have already suffered from psychological maladjustments or have been experiencing difficulty in their role as a parent or in their family relationship during quarantine; implementing preventive activities and well-being programs to support a sense of competence, social connections, and parental resilience for the new challenges expected in this new phase will be crucial for public health.

The purpose of our study was to not only on risk factors, but also on individual and family strengths. Our study highlights the importance of supporting the most vulnerable groups, and points out that even during critical times, people can rely on their existing psychological resources, which must be further developed to maximize their potential. For these reasons, our study may represent a starting point upon which to build specific psychological treatments to help the population overcome this difficult period and limit long-lasting consequences on people’s psychological health.

Our findings point out that the COVID-19 quarantine constitutes a challenging period for Italian children and parents. In fact, changes in daily routine negatively affect parents’ psychological dimensions and expose children to a significant risk for their well-being. This study identifies some personal and contextual variables involved in the psychological adjustment to the pandemic that can help the healthcare system and health care professionals in the early detection of families at risk for maladjustment. The Government should focus attention on the needs of families and children and plan ad hoc programs for families to mitigate the health and economic implications of the COVID-19 pandemic.

The authors would like to thank Francesco Scottà for the support of this research project and to all families who took part in this survey.

Conceptualization and project administration, M.C., S.I., A.S., and M.M.; methodology, M.C., S.I., A.S., M.G. and M.M.; formal analysis, S.I. and A.S.; data curation M.C., M.P., and M.M.; investigation M.C., S.I., C.M., M.G. and M.M.; reviewed the literature and first draft M.C., S.I., and M.M.; discussion, all authors; review and editing, all authors. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

The authors declare no conflict of interest.