Impact of COVID-19 on Well-Being in Child-Rearing Families: A Systematic Review of Longitudinal Studies
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsHow were search terms determined, specifically to identify child-rearing families? Was consideration given to include "parenting" or "parent-child" or other similar terms that might indicate child-rearing families? Do you have data on the types of families included in this analysis? I.e. single parents vs. dual parent families or other non-traditional families?
Can you provide additional context on how these studies were determined to be longitudinal? It looks like only 5 were truly longitudinal. You mention 6 articles specifically looked at 2020 -- I think this section needs additional work to explain why certain articles were included or excluded and to clarify the methodological approach.
I have some concerns about generalizability due to the final sample size of 15 articles. The discussion covers some of the main highlights from each of the articles that were part of the systematic review, but I'm not sure if the information shared is enough to draw comprehensive conclusions on the main issues families experienced during the COVID-19 pandemic.
Author Response
Comment 1：[How were search terms determined, specifically to identify child-rearing families? Was consideration given to include "parenting" or "parent-child" or other similar terms that might indicate child-rearing families? Do you have data on the types of families included in this analysis? I.e. single parents vs. dual parent families or other non-traditional families?]
Response1：[Thank you very much for your question.
In our search strategy, we used the terms “family with child,” “families with child,” “child raising family,” and “child raising families” to focus on families as units in child-rearing. Our purpose to focused on the impact of the COVID-19 pandemic on the well-being of child-rearing families, rather than focusing on individual parenting behaviors. Therefore, terms such as “parenting” or “parent-child” were not included as primary search keywords.
However, we found that many studies using these terms were still captured through our existing search strategy due to overlaps in indexing and abstract terminology. That said, we acknowledge that explicitly including such terms might have broadened the scope of our search and potentially yielded additional.
In response to this comment, we have made two revisions to the manuscript:
(1). In the Methods section, we clarified that our focus was on family-level well-being in child-rearing families-page 3,paragraph 2 and 3,and line103-106.
(2). We also added this point in the Limitations section, noting that the lack of broader terms may have limited the comprehensiveness of our search-page 14-15,paragraph 3,and line 318-321]
Comment2:[Do you have data on the types of families included in this analysis? I.e. single parents vs. dual parent families of other non-traditional families?]
Response2:[Thank you for this important comment.
We acknowledge that the type of family structure (e.g., single-parent, dual-parent, or other non-traditional families) may influence how families experienced the impact of COVID-19 pandemic. In response, we have added the part of summarize the reporting of family types in the Results section-Page 5-6.paragraph 1,and lines155-159, and also included this information in newly Table 2-page7-11.
However, only 4 studies explicitly reported family structure, and most did not conduct subgroup analyses based on family type. As a result, we were unable to extract consistent or comparable data across studies to further analyze differences in outcomes by family structure.]
Comment3:[Can you provide additional context on how these studies were determined to be longitudinal? It looks like only 5 were truly longitudinal. You mention 6 articles specifically looked at 2020 -- I think this section needs additional work to explain why certain articles were included or excluded and to clarify the methodological approach.]
Response3:[Thank you very much for your insightful comment.
We agree that a clearer explanation of how studies were defined as longitudinal is essential. In our review, studies were classified as longitudinal if they involved at least two waves of data collection from the same participants, thereby allowing for the examination of change over time. Accordingly, we have revised the Methods section to clarify that longitudinal studies were defined as those that collected data from the same group of participants at two or more time points-Page 3.paragraph 2-3,and lines 108-109]
Comment4:[I have some concerns about generalizability due to the final sample size of 15 articles. The discussion covers some of the main highlights from each of the articles that were part of the systematic review, but I'm not sure if the information shared is enough to draw comprehensive conclusions on the main issues families experienced during the COVID-19 pandemic.]
Resonse 4:[Thank you for your thoughtful comment.
We have revised the limitations section to note that most studies were conducted in Western countries (e.g., the US and Canada), and that only a small number reported detailed information on family type. Furthermore, subgroup analyses by family structure were generally lacking. These limitations may affect the generalizability of our findings to diverse family types and non-Western cultural contexts-Page14-15.paragraph 3,and lines311-325. We also addressed this point in the future directions, highlighting the need for more research in East Asian and non-Western settings, as well as greater attention to family diversity-Page 14,paragraph 2,and lines327-331.]
Reviewer 2 Report
Comments and Suggestions for AuthorsThank you very much for the opportunity to conduct this review. It was a great pleasure to review this work, whose theme I find so interesting and relevant today. The study is well structured, written in a clear and objective manner, with foundation and presents an interesting contribution to the area. The procedure is very appropriate and I congratulate the authors on the fact that they carried out the quality assessment of the included studies.
I would just like to leave some suggestions that I think can contribute to its improvement:
- The objective of the study is adequate, but its relevance could be better substantiated. I mean, what sets it apart from the other reviews you consulted?
- The choice of method and inclusion criteria are not clear from the introduction.
- They indicate that they had 2 evaluators: did they perform the inter-observer agreement assessment (e.g., Cohen's Kappa)?
- In the analysis of the articles, the authors could have carried out a small characterization of their sampling characteristics (e.g., n, composition) and design (i.e., evaluation times).
- In the discussion, I would add more information regarding future considerations.
- P. 12 (lines 254-260) could introduce the respective references.
- The conclusions could be further developed.
Keep up the great work!
Author Response
Comment1:[The objective of the study is adequate, but its relevance could be better substantiated. I mean, what sets it apart from the other reviews you consulted]
Response1:[Thank you very much for your question.
In the revised Introduction, we more clearly explained how our study builds upon and differs from previous reviews. We cited two prior reviews that addressed the impact of the COVID-19 pandemic on family well-being (Gayatri & Puspitasari, 2023 and Soejima, 2021). However, these reviews mainly focused on the early stages of the pandemic, included a mix of qualitative and quantitative studies, and encompassed various types of families (e.g., child-rearing and older families). Also, those findings largely reflected individual-level outcomes (e.g., mental health). Rather than changes in overall family-level outcomes, and they did not explore the long-term impacts of the pandemic.
In contrast, our review focuses on longitudinal quantitative studies involving child-rearing families, and emphasizes changes in family well-being over time. These clarifications and refinements have been added to the Introduction section to better articulate the relevance and distinct contribution of our study-Page 1-2,paragraph 2,and line 35-58]
Comment2:[The choice of method and inclusion criteria are not clear from the introduction.]
Response2:[Thank you for your valuable comment.
We have revised the second paragraph of the Introduction to better clarify our methodological approach and inclusion criteria. In the second paragraph of the Introduction, we reviewed the limitations of previous reviews and highlighted the gap in understanding the long-term effects of the COVID-19 pandemic on family well-being-Page 2,paragraph 2 ,and lines 44-58.]
Comment3:[They indicate that they had 2 evaluators: did they perform the inter-observer agreement assessment (e.g., Cohen's Kappa)]
Response3:[Thank you for this thoughtful question.
In our review, two researchers (Q.L. and S.Z.) independently assessed the study quality using the NHLBI tool, and discrepancies were resolved through consensus. To quantify inter-observer agreement, we calculated Cohen’s Kappa for binary outcomes (Agree/Disagree, excluding unclear/missing ratings). The overall Kappa was 0.52 (95% CI: 0.38–0.66), indicating moderate agreement (Landis & Koch, 1977). This result has been added to the manuscript-Page 3,paragraph 5,and lines132-133 and Page15,lines379-380).]
Comment4:[In the analysis of the articles, the authors could have carried out a small characterization of their sampling characteristics (e.g., n, composition) and design (i.e., evaluation times)]
Response4:[Thank you for your helpful suggestion.
In response, we have added a summary in the results section describing the sample characteristics and study design of the included articles. This includes the range and median of sample sizes, family structure (e.g., single-parent or dual-parent), and the number of measurement points per study. These additions can be found on page 5-6,paragraph 2,and lines153-159.]
Comment5:[In the discussion, I would add more information regarding future considerations.]
Response5:[Thank you for your valuable comment.
In response, we have expanded the discussion on future intervention strategies in the revised manuscript-Page14,paragraph2,and lines299-305 by detailing concrete implementation plans for online co-parenting courses including core modules on conflict resolution and child-centered scheduling, while proposing rigorous evaluation through randomized controlled trials and emphasizing the need for cultural adaptation in diverse family contexts.]
Comment6:[P. 12 (lines 254-260) could introduce the respective references.]
Response6:[ Thank you for your helpful suggestion.
In response, we have added citations to support the discussion of both the direct and indirect impacts of the COVID-19 pandemic on family well-being. As a result of other content revisions, this section now appears on pages 13–14, lines 280-293. Additionally, in the sentence“ Previous studies…positive family relationships.”we added three supporting references (Pietromonaco & Overall 2021; Umberson & Thomeer 2021)-Page14.paragraph2,and lines293-294). These references were also added to the reference list-Page.17,lines 413–414 and 429–430. As a result of revisions, this section now appears on pages 14 Lines 280-294.]
Comment7:[The conclusions could be further developed.]
Response7:[Thank you for your helpful comment regarding the conclusion section.
In response, we have revised the conclusion to more clearly summarize the key findings, highlight associated risk factors, and emphasize the implications for policy and practice. We also expanded our discussion of future research directions by specifying the need to explore long-term impacts during the child-rearing period and to examine family structure differences across cultural contexts on page 15,paragraph 3,and lines 333-346.]
Reviewer 3 Report
Comments and Suggestions for AuthorsThis appears to be a competently carried out lit review of longitudinal work exploring the impact of COVID-19 on child-rearing families. I have several observations:
- the authors should make clear what it is about the cross sectional studies that makes them cross section-along what parameters were such studies cross sectionalized? What confounding factors justify longitudinal work?
- Perhaps in the text the authors should make clear what criteria exclusionized the 148 0f the 163 studies of a full text nature.
- Longitudinal studies are notoriously subject to regression effects and especially attrition. What evidence is there in the 15 studies reviewed for such effects? If families in those studies were different somehow from one another that might produce such effects the reader should be made aware if that and this should be considered as a limitation.
- The authors claim that the effects of COVID-19 are both direct and indirect-what evidence is there for each? Were mediational analyses conducted? Differentiating families along at least a single parameter would reveal this-not all families are likely to be equally impacted.
- In Table 2 the assessment criteria should be made clear. What confounding factors are being referred to on p. 11-above Table 2? Indeed, the deficits mentioned there seem significant in tempering the significance of the authors' conclusions. Perhaps this section of the paper should precede results per se and discussed in the context of the review's limitations.
Author Response
Comment1:[The authors should make clear what it is about the cross-sectional studies that makes them cross section-along what parameters were such studies cross sectionalized? What confounding factors justify longitudinal work?]
Response1:[Thank you for this insightful comment.
In response, we clarified in both the Introduction and Methods sections that our review exclusively focused on longitudinal quantitative studies in order to fill the gap in understanding the long-term impact of the COVID-19 pandemic on child-rearing families.
We chose to focus on longitudinal studies because our research aimed to examine how the COVID-19 pandemic affected family well-being over time, focusing on the longer-term impacts. To clarify this point, we have added explanations regarding the definition and rationale for selecting longitudinal studies in both the Introduction-Page 1-2,paragraph 2,and lines35-58 and Methods sections-Page 3,paragraph2-3,and lines103-109.
Regarding the confounding factors that justify longitudinal work. To address this, which pertains to the results of the methodological quality assessment-Page 4. Specifically, Item 14 focuses on evaluating whether potential confounding factors were measured and statistically adjusted for in the studies. This item helps to justify the inclusion of longitudinal studies, as it ensures that confounding variables are accounted for, enhancing the validity of the findings in understanding the long-term effects.]
Comment2:[Perhaps in the text the authors should make clear what criteria exclusionized the 148 0f the 163 studies of a full text nature.]
Response2:[Thank you for this insightful comment.
In response, of the 163 full-text articles, 148 were excluded for the following reasons: 116 studies were excluded as they either did not examine COVID-19 related impacts or not focused on families with children under 18 years old. 32 studies were removed for not being longitudinal in design. These exclusion criteria have been explicitly stated in the Methods section on Page 5,paragraph1,and lines 145-147.]
Comment3:[Longitudinal studies are notoriously subject to regression effects and especially attrition. What evidence is there in the 15 studies reviewed for such effects? If families in those studies were different somehow from one another that might produce such effects the reader should be made aware if that and this should be considered as a limitation.]
Response3:[Thank you for your comment.
In response, we conducted a targeted re-examination of 15 included studies. Only 5 studies explicitly addressed regarding regression effects (e.g., Rizeq et al., Essler et al., Overall et al., Hanno et al., Feinberg et al.), using methods such as CLPM, fixed effects modeling, and attrition bias analysis. However, 10 studies did not report on these methodological concerns.
We have added a paragraph to the Discussion section to acknowledge this as a limitation of our review-Page14-15,paragraph3,and lines316-320. We agree that the absence of consistent reporting on these issues may affect the robustness and interpretability of the findings and have emphasized the need for more rigorous methodological transparency in future longitudinal research.]
Comment4:[The authors claim that the effects of COVID-19 are both direct and indirect-what evidence is there for each? Were mediational analyses conducted? Differentiating families along at least a single parameter would reveal this-not all families are likely to be equally impacted.]
Response4:[We have revised the fourth paragraph of the Discussion section on Page14,paragraph2,and lines278-291, which discuses the direct and indirect impacts of the COVID-19 pandemic on family well-being. We added relevant references and incorporated additional content, including specific examples to provide a more comprehensive and concrete explanation of these effects.]
Comment5:[In Table 2 the assessment criteria should be made clear. What confounding factors are being referred to on p. 11-above Table 2? Indeed, the deficits mentioned there seem significant in tempering the significance of the authors' conclusions. Perhaps this section of the paper should precede results per se and discussed in the context of the review's limitations.]
Response5:[Thank you for your valuable comment.
In our review, we assessed the methodological quality of included studies using the Observational Cohort Study Quality Assessment Tool. Among the 14 items, Item 14 (“Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?”) specifically evaluates whether confounding factors were addressed.
The determination of “yes” for this item was based on the original authors’ descriptions in each study—when a study clearly reported statistical control for confounders (e.g., through multivariable regression models), we marked “yes.”
To enhance transparency, we have now added a detailed description of all 14 quality assessment criteria at the bottom of the quality assessment table. In addition, we have moved the table to follow the Quality Appraisal section (Methods 2.2, page. 4) and renamed it as Table 1.
Also, we expanded the limitations section. Specifically, we noted that only one study (Cassinat et al 2021) included the type of family as a control variable, which may limit the ability to account for its influence on family well-being outcomes-Page14,paragraph3,and lines316-318. ]
Reviewer 4 Report
Comments and Suggestions for AuthorsThe main research problem the author has addressed is: How does the COVID-19 pandemic impact the well-being of child-rearing families? Although research on the well-being of COVID-19 pandemic families is often undertaken, what is new in the article is to reach out to longitudinal studies and use the method of Systematic Literature Review with PRISMA guidelines.
The analysis of the research results and conclusions consistently stick to the stated purpose of the research and the research problem. The keywords used in the search strategy indicate this. All elements of the method were correctly applied. The study was conducted by two independent researchers. Inclusion and eligibility criteria were transparently selected.
In a well-described methodological process, 15 articles were selected for analysis. The articles concern on research conducted in different countries, in different parts of the world and in different cultural contexts. The analysis carried out focused on both the content of the articles and the quality of the research described in them.
The introduction to the article clearly shows what theoretical perspectives on the functioning of family life were taken as the starting point of the analyses conducted. Family functioning was analyzed with reference to Family Systems Theory and Walsh's Family Resilience model. These theoretical models are relevant to family well-being recognized in the research problem. In the analyses, key characteristics were identified that indicate the level of family well-being and also those elements that reduce this well-being. The following categories were selected: family relationship, family cohesion, family chaos, family satisfaction, family conflict.
The article also identified honestly the limitations of the research that was conducted.
The article is prepared at a good academic level. This is evidenced by the theoretical framework adopted, methodological clarity, analyses consistent with the research problem, and appropriately selected references.
Author Response
Comment1:[How does the COVID-19 pandemic impact the well-being of child-rearing families? ]
Response1:[Thank you for your comment.
In our review, we specifically focused on child-rearing families, a population often underrepresented in prior systematic reviews on family well-being during the COVID-19 pandemic. While previous reviews (e.g., Gayatri & Puspitasari, 2023; Soejima, 2021) provided included cross-sectional or qualitative studies conducted during the early stages of the pandemic and did not distinguish between different family types. To address these limitations, we conducted a systematic literature review following PRISMA guidelines, targeting longitudinal studies that examined changes in family well-being before and during the COVID-19 pandemic. Our review highlights how the pandemic influenced family well-being over time—issues particularly salient for child-rearing families.
Therefore, we revised the relevant section in the Introduction to emphasize the originality and focus of our review on Page1-2,paragraph2,and lines35-58.]
