Impacts of COVID-19 on Maternal Mental Health
On March 17, 2020, Ontario, Canada, went into a state of emergency in response to COVID-19. Public health measures, including physical and social distancing, quarantining, and closure of communities, were implemented to stop the virus’s spread, forcing families to remain at home for months (Lee, 2020). The pandemic shutdown led to many Canadians losing their jobs or working fewer hours than usual, with many working from home (Lemieux et al., 2020). Early in the pandemic, the percentage of mothers working declined more than fathers due to domestic and child care responsibilities falling more heavily on mothers (Alon et al., 2020). Families with school-aged children were also affected by the transition to remote learning (Courtney et al., 2020; Burns et al., 2022; Wang et al., 2020), with mothers being forced to adopt the role of teachers (Alon et al., 2020; Burns et al., 2022). Recent research has found that stress around parenting practices was significantly correlated with maternal overall stress levels (Babore et al., 2023). Furthermore, the pandemic has disproportionately impacted low-income populations (Gross et al., 2020).
Numerous studies described significant declines in maternal mental health during COVID-19, including an increase in depression (Racine et al., 2021), anxiety (Davenport et al., 2020), and stress (Lee et al., 2020). However, maternal mental health is a highly idiosyncratic construct shaped by the unique combination of mothers’ biological, psychological, and social factors. In turn, maternal mental health onset, characterization, and trajectory vary from person to person, resulting in different mental health patterns and profiles (Campbell et al., 2009; Sun et al., 2019; Wardi-Zonna, K., & Wardi, 2020; Weiss et al., 2021). Prior to the pandemic, research employing a person-centred approach identified unique subgroups of mental health experiences. For instance, using Latent Profile Analysis (LPA), Skipstein and colleagues (2010) found six trajectories’ profiles based on anxiety and depression scores among Norwegian mothers collected when their children were 18 months to 14.5 years old: ‘No symptoms’; ‘Low’; ‘Moderate-low’; ‘Moderate’ ‘High-chronic’; ‘Low-rising.’ Similarly, Campbell et al. (2009) employed a Latent Class Analysis (LCA) to model the trajectories of maternal depressive symptoms over 12 years and identified five classes: “Never depressed,”; “Stable subclinical,”; “Early-decreasing”; “Moderately elevated,”; “Chronic.”
The prevailing one-size fits all approach to pandemic research poses several problems, including masking diverse responses to the pandemic and failing to tailor preventative interventions for those at the highest risk accordingly. In addition, identifying heterogeneous profiles makes it possible to understand the complexities of maternal mental health more accurately and, in turn, determine what the pre-pandemic risk and protective factors (e.g., sociodemographic, and familial characteristics) are related to mothers’ mental health profile membership. For instance, relative to mothers without symptoms of depression, Campbell et al. (2009) found that mothers with elevated symptoms were less likely to be married, educated, and in good physical health. Similarly, the Skipstein (2010) study found that mothers with chronic anxiety and depression were significantly less educated, had less paid work, and were less likely to live with a partner than mothers in the other profiles. In addition, several studies have found a link between maternal mental health and mental health difficulties in children (Curci et al., 2022). For example, Skiptein et al. (2012) found that child-related stressors were among the strongest predictors of mothers in the high-chronic group.
Child temperament has also been associated with parental depression (Tolja, Radoš, & Anđelinović, 2020) during COVID-19 (Fiske, Scerif, & Holmboe, 2022). However, there is limited research on the associations between children’s temperament across maternal mental health symptoms (i.e., stress and anxiety) during COVID-19. More research is needed to examine whether these relationships are found in low-income mothers. Interestingly, although research converges on the impacts of parenting practices on maternal mental health (Hetherington et al., 2018; Jones et al., 2021; Lagacé‐Séguin & d’Entremont, 2006), limited research has been done to examine the role of parenting on subgroups of maternal mental health experiences prior to and during COVID-19, in low-income mothers. A better understanding of the heterogeneity within maternal mental health and its correlates with their children’s temperament and mental health may assist clinicians and policymakers in providing more effective psychological interventions to help mothers improve their mental health (Sun et al., 2019).
A growing body of research is being conducted on the heterogeneous mental health effects of COVID-19. Pierce et al. (2021), for example, identified five mental health trajectories of a large, representative sample of the UK general population during the first six months of the pandemic: “Consistently poor,”; Deteriorating,”; “Recovery,”; “Consistently good”; “Consistently very good.” Accounting for pre-pandemic mental health is critical in investigating how COVID-19 affected mothers since life drastically changed for most of the population after onset. Zalewski et al. (2022) employed growth mixture modelling for parental mental health indicators (comprised of stress, anxiety, depression, and loneliness prior to and during COVID-19) and found four trajectories: “Persistently low mental-health symptoms”; “Increasing mental-health symptoms”; “Chronically high mental-health symptoms”; “Decreasing mental-health symptoms.” Similarly, Saleem et al. (2022) used latent profile analysis to descriptively examine the maternal mental health of low-income mothers residing in Canada. They identified patterns of mental health using prior and during COVID-19 mental health scores. The authors found a profile where a small group of mothers had lower (i.e., better) mental health scores during COVID-19 than before. More mothers were identified in profiles where mental health scores tended to be stable or higher during the pandemic than before. While this study aimed to investigate the relationship between children’s mental health, they did not examine the role of children’s temperament (a more stable indicator of children’s behaviour) and their parenting practices on maternal mental health. Furthermore, studies using longitudinal LPA can descriptively report the patterns of outcomes across multiple time points. However, they assume static profile membership and cannot directly model mental health status changes over time (Nylund-Gibson et al., 2022; Wang & Wang, 2020, p. 373). In contrast, latent transition analysis (LTA) directly tests changes over time in the membership of latent profiles (Collins & Lanza, 2010). LTA allows the investigation of initial status and transitions between profiles from earlier to later time points (Hancock & Mueller, 2010). Thus, LTA allows for a more nuanced understanding of stability and change in mental health development over time that more closely aligns with research questions regarding mental health changes prior to and during the pandemic (Nylund-Gibson et al., 2022).
To date, however, no study has identified the transitions of mental health functioning prior to and during COVID-19 and how prior mental health membership predicts the changes in mental health during a pandemic. Once identified, this study will examine the unique profiles of mental health transitions. Furthermore, this study aims to investigate the role of maternal parenting practices, children’s temperament, and child mental health related to low-income mothers’ unique mental health experiences. Specifically, this study aims to address the following research questions:
What are the maternal mental health profiles prior to and during COVID-19?
This research question is exploratory since no studies have investigated the differences in maternal mental health profile membership in a sample of low-income Canadian mothers before and during the COVID-19 pandemic. Nonetheless, we predict that there will be mothers with good mental health and those who will face mental health challenges at both time points (Saleem et al., 2022). Therefore, it is possible that there the number of mental health profiles will vary between the two time periods. However, given the exploratory nature of this work, we did not make directional hypotheses about the number of profiles.
How do low-income mothers’ mental health profiles shift from prior to during COVID-19?
This research question is exploratory, as no studies have employed latent transition analysis for low-income Canadian mothers. Nonetheless, we predict 1) marked heterogeneity in mental health transition probabilities (e.g., a variety of stable and shifting latent status latent transitions) and 2) tendencies to transition to profiles with more significant mental health concerns during the pandemic.
Are mothers’ demographic and family characteristics (i.e., parenting practices and children’s temperament and mental health) associated with mental health profiles prior to and during COVID-19?
We hypothesize that mothers who had negative parenting practices (higher over protection and hostile reactions, and reduced self-efficacy and perceived impact), children with more fearful and angry temperaments, and higher mental health challenges prior to COVID-19 will be at greater risk, increasing the probability of starting and transitioning into worse maternal mental health profiles.