High Levels of Stress Due to the SARS-CoV-2 Pandemic among Parents of Children with and without Chronic Conditions across the USA
2. Materials and Methods
- Perceived Stress was measured by the 10-item Perceived Stress Scale, which has been widely validated and is highly reliable . Cronbach’s alpha in the current sample was 0.83. An example item is: “In the last week, how often have you been upset because of something that happened unexpectedly?” scored on a 5-point Likert scale ranging from “never” (1) to “very often” (5). All items are summed to create a total score.
- Coping was measured by the Brief Resilient Coping Scale  as well as a COVID-19 self-efficacy scale. The Brief Resilient Coping scale contains four items scored on a 5-point Likert scale ranging from “does not describe me at all” to “describes me very well”. An example item is: “Please indicate how you have been dealing with stress in the past 7 days—I actively look for ways to replace the losses I encounter in life”. Internal reliability was high (0.83) in the current study. The COVID-19 self-efficacy scale was developed for this study based on guidelines by Bandura . Cronbach’s alpha (0.93) for this scale was high in the current study, indicating good internal reliability. COVID-19 self-efficacy also correlated with anxiety (r = −0.24), coping (r = 0.41), and perceived stress (r = −0.38), indicating validity. An example item is: “Rate your level of confidence about your current ability to do these tasks:—Keep my family physically safe from the virus” rated on an 0–10 scale ranging from “cannot do at all” to “highly certain I can do”. All scores are summed to create a total score.
- Marital satisfaction was measured with the Kansas Marital Satisfaction Scale, a validated and reliable measure  (three questions scored on a 7-point Likert scale). Internal reliability in our sample was high (α = 0.96). An example item is: “In the past 7 days, how satisfied have you been with your marriage/relationship?” Items are summed to create a total score.
- Parenting Stress was measured by the Parental Stress Scale  (18 items scored on a 5-point Likert scale). Previous studies have shown this scale is highly reliable . Cronbach’s alpha for this scale in the current study was reasonable (0.78). An example item is: “In the past 7 days, it is difficult to balance different responsibilities because of my child(ren).”, answered on 5-point scale ranging from “strongly disagree” to “strongly agree”. All items are summed to create a total score.
- Social support was assessed by indicating who is available to help with childcare besides the parent, as well as how much a spouse/partner is available for contributing to childcare, work and chores (rated on a 5-point Likert scale ranging from “I do most” to “partner does most”).
- Work stress was measured by asking about changes in job status (job loss, reduced hours/pay, working from home), and a rating of job stress (on a 10-point scale). Items included changes in child’s schooling as well as a rating of parent stress related to online schooling (if applicable, rated on 10-point scale).
- The degree of restrictions in the community and worries around infection as well as exposure to SARS-CoV-2 infection were assessed.
2.3. Data Analysis
3.2. Pandemic Stressors
3.3. Stressors, Perceived Stress and Coping
3.4. Parenting-Related Stressors and Perceived Stress
3.5. Work-Related Stressors and Perceived Stress
3.6. Mental Health
Conflicts of Interest
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|Parents of Healthy Children||Parents of Children with Chronic Conditions||p-Value *|
|N = 308||N = 302|
|Mean (SD) or Frequency (%)||Mean (SD) or Frequency (%)|
|Age||40.61 (10.6)||40.61 (9.7)||0.998|
|Caucasian||208 (67.5%)||232 (76.8%)|
|African American||51 (16.6%)||47 (15.6%)|
|Hispanic||46 (14.9%)||50 (16.6%)||0.582|
|Median income||USD 50.000–75.000||USD 50.000–75.000||0.105|
|Number of children||1.74 (1.0)||1.90 (1.0)||0.064|
|Age youngest child||8.30 (5.2)||9.47 (4.9)||0.005|
|Private insurance||195 (63.7%)||178 (59.5%)||0.190|
|Chronic health condition (At least n = 10 children; other conditions can be requested from authors)||N/A|
|Attention deficit||50 (8.2%)|
|Parents of Healthy Children||Parents of Children with Physical Conditions||Parents of Children with Mental Conditions||p-Value *|
|N = 308||N = 168||N = 134|
|Mean (SD) or N (%)||Mean (SD) or N (%)||Mean (SD) or N (%)|
|Confirmed by test||12 (3.9%)||23 (13.7%)||7 (5.2%)||<0.001|
|Suspected||15 (4.9%)||25 (14.9%)||6 (4.5%)||<0.001|
|Confirmed by test||11 (3.6%)||23 (13.7%)||8 (6.0%)||<0.001|
|Suspected||14 (4.5%)||22 (13.1%)||6 (4.5%)||<0.001|
|Work Stressors due to Pandemic|
|Lost job||43 (14%)||35 (20.8%)||16 (11.9%)||0.063|
|Reduced pay||118 (38.3%)||77 (45.8%)||56 (41.8%)||0.277|
|Work from home||121 (39.3%)||74 (44.0%)||61 (45.5%)||0.386|
|Essential worker||94 (30.5%)||55 (32.7%)||57 (42.5%)||0.046|
|Children switched to home/online school||221 (72.70%)||148 (88.63%)||114 (85.07%)||<0.001|
|How stressful is online schooling?||5.25 (2.9)||5.86 (3.0)||5.75 (2.6)||0.099|
|Parenting more stressful due to pandemic||135 (44.9%)||68 (40.7%)||67 (50.0%)||0.014|
|Kansas Marital Satisfaction Scale||6.34 (4.7)||6.07 (3.7)||6.34 (4.2)||0.825|
|Perceived Stress Scale||16.41 (7.1)|
|Stress related to pandemic||6.25 (2.6)||7.49 (2.3)||6.63 (2.6)||<0.001|
|Dealing with Stress|
|COVID self-efficacy||69.64 (15.8)||66.92 (16.7)||65.94 (16.0)||0.049|
|Resilient coping||15.2 (2.9)||15.05 (3.1)||14.42 (3.4)||0.065|
|PROMIS depression (T-score)||52.52 (13.1)|
|PROMIS anxiety (T-score)||55.8 (10.7)|
|Stomachaches (#days/week)||1.45 (1.2)||2.77 (2.0)||2.01 (1.5)||<0.001|
|Headaches (#days/week)||1.93 (1.3)||3.17 (2.7)||3.01 (1.9)||<0.001|
|Sleep problems (#days/week)||2.13 (1.9)||3.45 (2.4)||3.59 (2.4)||<0.001|
|Eating problems (#days/week)||1.48 (1.4)||2.57 (2.1)||2.24 (2.1)||<0.001|
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A.L. van Tilburg, M.; Edlynn, E.; Maddaloni, M.; van Kempen, K.; Díaz-González de Ferris, M.; Thomas, J. High Levels of Stress Due to the SARS-CoV-2 Pandemic among Parents of Children with and without Chronic Conditions across the USA. Children 2020, 7, 193. https://doi.org/10.3390/children7100193
A.L. van Tilburg M, Edlynn E, Maddaloni M, van Kempen K, Díaz-González de Ferris M, Thomas J. High Levels of Stress Due to the SARS-CoV-2 Pandemic among Parents of Children with and without Chronic Conditions across the USA. Children. 2020; 7(10):193. https://doi.org/10.3390/children7100193Chicago/Turabian Style
A.L. van Tilburg, Miranda, Emily Edlynn, Marina Maddaloni, Klaas van Kempen, Maria Díaz-González de Ferris, and Jody Thomas. 2020. "High Levels of Stress Due to the SARS-CoV-2 Pandemic among Parents of Children with and without Chronic Conditions across the USA" Children 7, no. 10: 193. https://doi.org/10.3390/children7100193