Helping Families Deal with Stress in a Pandemic

Source: Heather Prime, used with permission

The healing power of relationships is tried and true, but often paying attention to well-being and mental health, as well as that of others, is easier said than done. Staying healthy while also taking care of the health of a family in the midst of a pandemic is quite the challenge.

Heather Prime, Ph.D., is a clinical psychologist living in Toronto, Canada. She recently joined York University as an assistant professor in the Department of Psychology. Dr. Prime uses a family-centered framework to understand and support socio-emotional and cognitive development in young children. She is particularly interested in risk and resilience processes within families experiencing adversity. As a clinical psychologist, she is committed to using her clinical training to guide her research, and she emphasizes clinical utility in her research endeavors. Dr. Prime recently published an article in American Psychologist, which provides a conceptual framework for how we can understand the potential impact of COVID-19 on the well-being of families and children.

Jamie Aten: How did you first get interested in this topic?

Heather Prime: When the social disruptions of COVID-19 came to Canada in mid-March, I got on a Zoom call with some of my closest colleagues. We shared our concerns about the sheer number of ways that families were being tested during COVID-19 – job uncertainty and job loss, fears for the health of our loved ones, catastrophic thoughts about the state and future of the economy. We also had shared concerns, in particular, about the potential disproportionate impact on families who were already experiencing adverse circumstances such as poverty, racism, and pre-existing trauma. It felt overwhelming to feel the weight of the potential impact without knowing how it would play out.

At the same time, our field has come a long way in understanding the potential impact of adversity on children and families, and the resilience processes that can occur in the face of threat. Although there is an immense amount of uncertainty when it comes to the potential sequelae of the pandemic on the well-being of children and families, I was reminded that we actually do know a lot about how families respond to stress and adversity. I decided to pull together this literature in order to help make a map for researchers, practitioners, and policymakers working with children and families during and after the pandemic.

JA: What was the focus of your study?

HP: There have been several well-designed studies following previous historical events such as 9/11, Hurricane Katrina, and the 2008 economic recession, among others. We reviewed the literature of natural and human-made disasters, economic recessions, and cumulative risk (e.g., poverty) to examine the ways in which adversity impacts caregivers, family relationships and child adjustment. My colleagues and I then derived a conceptual model for understanding the potential threats of COVID-19 to family well-being, drawing on previous developmental and clinical theories and empirical evidence. What was unique about our paper was that we were able to take the large number of threats associated with the pandemic – health, economic, and social – and draw associations between them in order to theorize about how they would operate similarly to impact families. This is important because it helps to reign in our fears about the limitless number of threats and find a common pathway through which we can understand and intervene to support families. Relatedly, it took something that felt largely unknown – the pandemic – and brought some familiarity to help researchers and clinicians gain a sense of knowingness and confidence in working with families. There have been decades of theories and empirical studies on the topic of risk and resilience in families – we brought it together into one conceptual model as applied to the pandemic.

JA: What did you discover in your study?

HP: The social disruptions due to COVID-19, including job insecurity and job loss, threats to the health of ourselves and loved ones, social isolation and distancing, and family crowding, among others, are likely to impact family well-being through the caregivers. That is, caregivers (i.e., parents/guardians) will act as a funnel through which social disruptions infiltrate the family. Caregivers are at heightened risk for distress and poor mental health due to the stressors associated with COVID-19 (this is something that has been shown since our paper was published). When caregiver well-being and mental health are negatively impacted, there is often a ripple effect on all family relationships – marital, parent-child, sibling, and whole-family cohesion. Children’s emotional, behavioral, and social adjustment is largely influenced by the quality of their home relationships and interactions and, as such, children’s adjustment is at risk through this negative cascade through the family.

Importantly, there is plenty of research to show that caregivers and families can demonstrate resilience in the face of significant stressors such as those associated with the pandemic. If families can nourish their relationships, cultivate positive family interactions, maintain previous and develop new rituals, routines, and rules, then they may come out of the pandemic seemingly unscathed, or stronger.

We need to remember that these patterns of risk and resilience are likely to operate differently depending on pre-existing circumstances. Many families will be vulnerable to the risk factors associated with the pandemic due to socioeconomic vulnerability, experiences of racism and discrimination, and pre-existing mental health challenges in children and caregivers. It is these families that require support both from a policy standpoint in addition to community-level supports from clinicians and school workers.

JA: Is there anything that surprised you in your findings, or that you weren't fully expecting?

HP: The one thing that can support us through the pandemic – our relationships – is also the thing that is at risk due to the stressors of the pandemic. This balance between risk/resilience and control/helplessness is tenuous. I’m not sure if I would call this surprising – but it was poignant.

JA: How might readers apply what you found to their lives during COVID-19?

HP: The healing power of relationships is real and has been shown time and time again. The pandemic is characterized by feelings of fear, uncertainty, and helplessness. However, caregivers can regain control by paying attention to what they need for their own mental health and well-being, by being intentional in the ways in which they interact with one another and with their children, and by seeking help through the many online resources or professionally in order to do something different (if what they are doing isn’t working). The place we have most control is in how we treat ourselves and our loved ones – this is the power we have right now. It is simple but not easy.

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Imagine All the People: Building Inner Strength Through Social Connection

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JA: What are you currently working on that you might like to share about?

HP: With colleagues at the Universities of Waterloo and Toronto, we have collected data from over 500 families internationally. We are studying the family stress processes that we outlined in our conceptual model, over time, in order to validate this conceptual model. Perhaps the model will be adjusted as we learn more about pandemic-specific stressors and processes, which will help us better understand patterns of risk and resilience in the context of the pandemic. Most importantly, we will use the results from this study to inform policy and practices to support vulnerable families throughout the pandemic and for years to come.