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.