Increases in Stressors Prior to-Versus During the COVID-19 Pandemic in the United States Are Associated With Depression Among Middle-Aged Mothers

Abstract

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small-N study to explore the associations between stress and psychological symptoms during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms (Beck Anxiety and Depression Index, respectively), as well as stressful life experiences prior to-versus during the pandemic (Social Readjustment Rating Scale). Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers' experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers' mental health.

Keywords: anxiety; coronavirus – COVID-19; depression; maternal; stress.

Figure 1

Number of Stressors Endorsed before and after March 15, 2020. Box plots showing the distribution of stressful events endorsed my mothers in the six months prior to local lockdowns beginning (around March 15, 2020; “Pre-lockdown”), and in the time since local lockdowns began (“Post-Lockdown”). A Wilcoxon Z showed a statistically significant increase in the number of stressful events endorsed by mothers since lockdowns began.

Figure 2

Relative Risk of Stress-Induced Physical Illness in the Near Future. Pie charts showing the proportion of the sample of mothers who were at low risk (30% chance), moderate risk (50% chance) and high risk (80% chance) of contracting a physical illness in the near future based on stress impact scores computed from the Social Readjustment Rating Scale (SRRS) prior to lockdowns versus since lockdowns began. Box plots in the lower right corner demonstrate the distribution of total stress impact scores for the two time periods of interest.

Figure 3

Latent Change Score Model of Stress, Anxiety, and Depression. The latent change score model of changes in stress impact (ΔStress) predicting self-reported anxiety Beck Anxiety Inventory (BAI) and depression Beck Depression Inventory (BDI) scores. Double-headed arrows represent correlations, and single-headed arrows represent unidirectional effects; solid black lines indicate statistically significant effects at the p < 0.05 level, and dashed gray lines indicate non-statistically significant effects. Coefficients reported in the figure are standardized effects.

Figure 4

Associations between Stress, Anxiety, and Depression. Scatterplots demonstrating significant associations found in the latent change score model of life stress impact, depression, and anxiety. (A) Associations between self-reported anxiety scores (BAI) and life stress impact scores prior to local lockdowns beginning. Dashed gray lines and associated labels demonstrate different clinical cutoff criteria for anxiety scores obtained from the BAI, with “moderate” and “severe” categories considered clinically significant. (B) Associations between self-reported depression scores (BDI) and the latent change in life stress impact scores assessed as the difference between post-and pre-lockdown stress impact scores. Dashed gray lines and associated labels demonstrate different clinical cutoff criteria for depression scores obtained from the BDI, with the “moderate” category considered clinically significant.