COVID-19 Stress and Child Behavior: Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts

program collaborators for Environmental influences on Child Health Outcomes

doi:10.1016/j.jaac.2023.07.996

COVID-19 Stress and Child Behavior: Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts

program collaborators for Environmental influences on Child Health Outcomes

Medical Social Sciences

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Objective: 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. Method: 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). Results: 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. Conclusion: Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.

Original language	English (US)
Pages (from-to)	528-538
Number of pages	11
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	63
Issue number	5
DOIs	https://doi.org/10.1016/j.jaac.2023.07.996
State	Published - May 2024

Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health (NIH), under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with co-funding from the Office of Behavioral and Social Science Research (PRO Core), UH3OD023332 (Trasande), UH3OD023313 (Koinis Mitchell), UH3OD023248 (Dabelea), UH3OD023318 (Dunlop/Brennan), UH3OD023271 (Karr), UH3OD023348 (Fry, O'Shea), UH3OD023344 (Lewis, MacKenzie), UH3OD023389 (Leve, Ganiban, Neiderhiser), UH3OD023288 (McEvoy), and UH3OD023249 (Stanford). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Author Contributions Conceptualization: Brennan, Nozadi, Lewis Data curation: McGrath Formal analysis: McGrath, Churchill Funding acquisition: Brennan, Dunlop, Elliott, Lewis Methodology: McGrath, Churchill, Margolis Writing \u2013 original draft: Brennan, Nozadi, McGrath, Churchill Writing \u2013 review and editing: Brennan, Nozadi, McGrath, Churchill, Dunlop, Elliott, MacKenzie, Margolis, Ghassabian, McEvoy, Fry, Bekelman, Ganiban, Williams, Wilson, Lewis Disclosure: Dr. Margolis is a Principal or Co-investigator on several NIH-funded projects investigating environmental influences on children's learning and development (PI: P20HD109965, R01ES032296, R01ES030950-1, R01ES030950-02S1, K23-ES-026239, Translational Therapeutics (TRx) Pilot Award, New York Nutrition and Obesity Research Center; Co-I: ES032818-01A1, R01ES027424; UG3OD023290-01). Drs. Brennan, Nozadi, McGrath, Dunlop, Elliott, MacKenzie, Ghassabian, McEvoy, Fry, Bekelman, Ganiban, and Lewis and Mss. Churchill, Williams, and Wilson have reported no biomedical financial interests or potential conflicts of interest. Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health (NIH), under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with co-funding from the Office of Behavioral and Social Science Research (PRO Core), UH3OD023332 (Trasande), UH3OD023313 (Koinis Mitchell), UH3OD023248 (Dabelea), UH3OD023318 (Dunlop/Brennan), UH3OD023271 (Karr), UH3OD023348 (Fry, O\u2019Shea), UH3OD023344 (Lewis, MacKenzie), UH3OD023389 (Leve, Ganiban, Neiderhiser), UH3OD023288 (McEvoy), and UH3OD023249 (Stanford). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

COVID-19
discrimination
externalizing
internalizing
stress

ASJC Scopus subject areas

Developmental and Educational Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jaac.2023.07.996

Cite this

@article{57f9990a6904469cb313227bad8efffc,

title = "COVID-19 Stress and Child Behavior: Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts",

abstract = "Objective: 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. Method: 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). Results: 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. Conclusion: Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.",

keywords = "COVID-19, discrimination, externalizing, internalizing, stress",

author = "{program collaborators for Environmental influences on Child Health Outcomes} and Brennan, {Patricia A.} and Nozadi, {Sara S.} and Monica McGrath and Churchill, {Marie L.} and Dunlop, {Anne L.} and Elliott, {Amy J.} and Debra MacKenzie and Margolis, {Amy E.} and Akhgar Ghassabian and McEvoy, {Cindy T.} and Fry, {Rebecca C.} and Bekelman, {Traci A.} and Ganiban, {Jody M.} and Lue Williams and Wilson, {Constance L.} and Johnnye Lewis and Smith, {P. B.} and Newby, {K. L.} and Hopkins Johns and Jacobson, {L. P.} and Catellier, {D. J.} and R. Gershon and D. Cella and L. Trasande and L. Gatzke-Kopp and M. Swingler and D. Dabelea and {Koinis Mitchell}, D. and S. Deoni and V. D'Sa and C. Karr and F. Tylavsky and A. Mason and Q. Zhao and S. Sathyanarayana and N. Bush and LeWinn, {K. Z.} and L. Leve and J. Neiderhiser and R. Tepper and M. O'Shea and R. Vaidya and R. Obeid and C. Rollins and K. Bear and S. Pastyrnak and M. Lenski and R. Singh and M. Msall and J. Frazier",

note = "Publisher Copyright: {\textcopyright} 2023 American Academy of Child and Adolescent Psychiatry",

year = "2024",

month = may,

doi = "10.1016/j.jaac.2023.07.996",

language = "English (US)",

volume = "63",

pages = "528--538",

journal = "Journal of the American Academy of Child and Adolescent Psychiatry",

issn = "0890-8567",

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number = "5",

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TY - JOUR

T1 - COVID-19 Stress and Child Behavior

T2 - Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts

AU - program collaborators for Environmental influences on Child Health Outcomes

AU - Brennan, Patricia A.

AU - Nozadi, Sara S.

AU - McGrath, Monica

AU - Churchill, Marie L.

AU - Dunlop, Anne L.

AU - Elliott, Amy J.

AU - MacKenzie, Debra

AU - Margolis, Amy E.

AU - Ghassabian, Akhgar

AU - McEvoy, Cindy T.

AU - Fry, Rebecca C.

AU - Bekelman, Traci A.

AU - Ganiban, Jody M.

AU - Williams, Lue

AU - Wilson, Constance L.

AU - Lewis, Johnnye

AU - Smith, P. B.

AU - Newby, K. L.

AU - Johns, Hopkins

AU - Jacobson, L. P.

AU - Catellier, D. J.

AU - Gershon, R.

AU - Cella, D.

AU - Trasande, L.

AU - Gatzke-Kopp, L.

AU - Swingler, M.

AU - Dabelea, D.

AU - Koinis Mitchell, D.

AU - Deoni, S.

AU - D'Sa, V.

AU - Karr, C.

AU - Tylavsky, F.

AU - Mason, A.

AU - Zhao, Q.

AU - Sathyanarayana, S.

AU - Bush, N.

AU - LeWinn, K. Z.

AU - Leve, L.

AU - Neiderhiser, J.

AU - Tepper, R.

AU - O'Shea, M.

AU - Vaidya, R.

AU - Obeid, R.

AU - Rollins, C.

AU - Bear, K.

AU - Pastyrnak, S.

AU - Lenski, M.

AU - Singh, R.

AU - Msall, M.

AU - Frazier, J.

PY - 2024/5

Y1 - 2024/5

N2 - Objective: 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. Method: 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). Results: 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. Conclusion: Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.

AB - Objective: 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. Method: 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). Results: 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. Conclusion: Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.

KW - COVID-19

KW - discrimination

KW - externalizing

KW - internalizing

KW - stress

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UR - http://www.scopus.com/inward/citedby.url?scp=85169821248&partnerID=8YFLogxK

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DO - 10.1016/j.jaac.2023.07.996

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SN - 0890-8567

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JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

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ER -

COVID-19 Stress and Child Behavior: Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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