Emory University, Atlanta, Georgia.
University of New Mexico, Albuquerque, New Mexico.
J Am Acad Child Adolesc Psychiatry. 2024 May;63(5):528-538. doi: 10.1016/j.jaac.2023.07.996. Epub 2023 Aug 4.
To examine the additive or moderating influences of caregiver COVID-19-related stress, social support, and discrimination on children's behavior problems across racially diverse populations.
In this Environmental influences on Child Health Outcomes (ECHO) cohort study (N = 1,999 caregiver/child pairs), we operationalized caregiver COVID-19-related stress in 2 ways: first, as the number of stressors (eg, financial concerns, social distancing); and second, as the level of pandemic-related traumatic stress symptoms reported via questionnaires administered between April 2020 and August 2022. At the same assessment visit, caregivers also reported their current levels of discrimination, and a subsample (n = 968) reported their emotional and instrumental support. Either concurrently or at a later assessment visit, caregivers reported on their children's internalizing and externalizing behavior problems using the Child Behavior Checklist for Ages 6-18 (CBCL/6-18).
Multivariable analyses controlling for maternal education, marital status, child age, and child sex revealed that COVID-19-related stress (caregiver stressors and symptoms) and discrimination were positively associated, and that perceived support was negatively associated with child internalizing and externalizing behavior problems. Unexpectedly, neither emotional nor instrumental support attenuated the relationship between caregiver COVID-19-related stressors nor traumatic stress symptoms and child behavior problems. In the subset of Black American participants, caregiver perceived discrimination moderated the relationship between caregiver COVID-19 traumatic stress symptoms and child internalizing problems, such that the association was stronger at higher levels of discrimination.
Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.
研究在不同种族的人群中，照顾者 COVID-19 相关压力、社会支持和歧视对儿童行为问题的影响。
在这项环境对儿童健康结果的影响（ECHO）队列研究（N=1999 名照顾者/儿童对）中，我们通过两种方式来操作照顾者的 COVID-19 相关压力：一是压力源的数量（例如，财务问题、社交距离）；二是通过 2020 年 4 月至 2022 年 8 月期间通过问卷报告的与大流行相关的创伤后应激症状的程度。在同一评估访问中，照顾者还报告了他们当前的歧视程度，而一个子样本（n=968）报告了他们的情感和工具支持。照顾者要么在同一评估访问中，要么在稍后的评估访问中，使用儿童行为检查表（6-18 岁）（CBCL/6-18）报告他们孩子的内化和外化行为问题。
控制母亲教育、婚姻状况、儿童年龄和性别后，多变量分析显示，COVID-19 相关压力（照顾者压力源和症状）和歧视呈正相关，而感知支持与儿童的内化和外化行为问题呈负相关。出乎意料的是，情感支持和工具支持都没有减弱照顾者 COVID-19 压力源与儿童行为问题之间的关系，也没有减弱创伤后应激症状与儿童行为问题之间的关系。在黑人美国参与者的子集中，照顾者感知到的歧视调节了照顾者 COVID-19 创伤后应激症状与儿童内化问题之间的关系，即在歧视程度较高时，这种关系更强。
我们的研究结果强调了减轻照顾者压力和增加照顾者社会支持以优化儿童行为结果的重要性。
