The COVID-19 pandemic brought about sudden change and probably some amount of stress for most people in 2020. But, according to a new study led by a researcher from the Keck School of Medicine of USC, mothers who experienced sweeping changes to their daily lives were particularly susceptible to experiencing symptoms of traumatic stress specific to the pandemic.
The research, which was published in JAMA Network Open, is the largest study to date of how mothers experienced the pandemic. The paper's lead author, Theresa "Tracy" Bastain, PhD, MPH, associate professor of clinical population and public health sciences at the Keck School of Medicine of USC, said the team of researchers wanted to study mothers because they suffered a large share of the income and job losses and shouldered much of the responsibility of childcare and homeschooling children.
"We can't conclude from this research that these mothers will have negative mental health outcomes from the pandemic, but it raises that concern," said Bastain.
High change, high stress
The researchers surveyed more than 11,000 mothers starting shortly after the lockdowns of 2020 through August of 2021. The mothers are participants in a nationwide research study of child health and development called the Environmental Influences on Child Health Outcomes Program, or ECHO. The Keck School of Medicine of USC is one of several institutions that participates in ECHO.
The mothers involved with ECHO, which includes diverse participants from across the United States and Puerto Rico, were asked about changes they experienced as a result of the pandemic such as beginning to work remotely, spending less time with friends, and changing their exercise routines. They were also asked whether they had experienced traumatic stress symptoms similar to acute stress disorder, including sleeplessness, angry outbursts or startling easily. Additionally, they also answered questions about whether they were adopting coping mechanisms such as meditation, smoking marijuana or drinking more alcohol.
In analyzing the responses, the team of researchers noted that mothers tended to cluster into two groups: one that experienced high levels of disruption relating to the pandemic and a second that experienced much less change. The group of mothers that experienced the greatest change also reported experiencing more symptoms of traumatic stress specific to the pandemic.
An unexpected finding
In raw numbers, far more mothers fell into the high change group. Of the 11,473 respondents, only 3,061 reported having few changes to their daily lives while 8,412 fell into the category of mothers who experienced major disruptions.
The mothers who fell into the high change cluster, which experienced more symptoms of traumatic stress, tended to be women with higher incomes, higher education and 66% of them were white. The group that reported few changes tended to have lower education, lower income and were primarily Black and Native American. Hispanic women were split fairly evenly between the two groups.
Bastain noted that this finding was somewhat unexpected because studies have consistently documented the disproportionate impact of COVID-19 morbidity and mortality on communities of color in the U.S. In this case, the mothers from less socioeconomically disadvantaged groups did not suffer disproportionate levels of traumatic stress.
"It really came down to change and those mothers whose lives carried on much as they normally had, did not report as much stress," said Bastain. "It was the mothers who had big disruptions who reported the higher levels of stress."
Possible negative mental health outcomes
One key takeaway of the research is that a significant percentage of mothers surveyed said they had experienced symptoms of acute stress disorder. People who develop acute stress disorder display symptoms including anxiety, mood symptoms, dissociation or avoidance after experiencing a traumatic event, such as a global pandemic.
Some people who develop acute stress disorder, but not all, will develop post-traumatic stress disorder, or PTSD. Bastain notes that this research demonstrates that this event could have serious, long-term mental health consequences for those women who reported having symptoms of acute stress disorder.
While this research focuses on the COVID-19 pandemic, Bastain added that the study points to the need for more research on the lasting health consequences of traumatic events.
"I think it shows that we need to think about traumatic experiences like natural disasters, pandemics or mass shootings more holistically," said Bastain. "There is a wide range of hardships that people experience from these events that we need to understand so that we can protect people from long term effects."
About the study
Additional authors of the study include Zoe Birnhak, Carrie V. Breton, and Ixel Hernandez-Castro from the Keck School of Medicine of USC; Emily A. Knapp, Andrew Law, and Ghassan Hamra from the Johns Hopkins Bloomberg School of Public Health; Molly Algermissen, Paige Greenwood, David Pagliaccio, and Amy Margolis of the Columbia University Irving Medical Center; Lyndsay A. Avalos of Kaiser Permanente Northern California; Courtney Blackwell and Xiaodan Tang from Northwestern University Feinberg School of Medicine; Cristiane Duarte of the Columbia University-New York State Psychiatric Institute; Jean Frazier of University of Massachusetts Chan Medical School; Jody Ganiban of George Washington University; Julie Herbstman of Columbia Mailman School of Public Health; Julie Hofheimer from the University of North Carolina at Chapel Hill; Margaret Karagas from the Geisel School of Medicine at Dartmouth; Johnnye Lewis of the University of New Mexico at Albuquerque; Bruce Ramphal from Harvard University Medical School; Darby Saxbe of the University of Southern California; Rebecca Schmidt of the University of California, Davis; and Carment Velez-Vega from the University of Puerto Rico Graduate School of Public Health.
This work was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center),U24OD023319 (PRO Core), UH3OD023251 (Alshawabkeh), UH3OD023320 (Aschner), UH3OD023332 (Blair), UH3OD023253 (Camargo), UH3OD023248 (Dabelea), UH3OD023313 (Deoni), UH3OD023328 (Duarte), UH3OD023318 (Dunlop), UH3OD023279 (Elliott), UH3OD023289 (Ferrara), UH3OD023282 (Gern), UH3OD023287 (Breton), UH3OD023365 (Hertz-Picciotto), UH3OD023244 (Hipwell), UH3OD023275 (Karagas), UH3OD023271 (Karr), UH3OD023347 (Lester), UH3OD023389 (Leve), UH3OD023344 (MacKenzie), UH3OD023268 (Weiss), UH3OD023288 (McEvoy), UH3OD023342 (Lyall), UH3OD023349 (O'Connor), UH3OD023286 (Oken), UH3OD023348 (O'Shea), UH3OD023285 (Kerver), UH3OD023290 (Herbstman), UH3OD023272 (Schantz), UH3OD023249 (Stanford), UH3OD023305 (Trasande), and UH3OD023337 (Wright).
ECHO is a nationwide research program supported by the National Institutes of Health (NIH). Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. The program consists of two major components, including 69 existing and ongoing observational study cohorts and a pediatric clinical trials network. Research conducted through ECHO focuses on five key pediatric outcomes that have a high public health impact: pre-, peri- and postnatal outcomes; upper and lower airway health; obesity; neurodevelopment; and positive health, such as happiness and a sense of wellbeing.
