Association of Family Financial Stress During the COVID-19 Pandemic and Child Social and Emotional Difficulties.

Context: The COVID-19 pandemic and associated public health measures have substantially increased stress on families, including financial stress. Objective: To explore the association between familial financial stress and child socioemotional and behavioural difficulties during the COVID-19 pandemic and examine parenting behaviour as a potential mediator to this relationship. Study Design and Analysis: Cross-sectional cohort study using online survey data. We used multivariable linear regression models to examine the association between parent-reported financial worry and child social and emotional health. We tested the role of parenting behaviour as a mediator. Setting or Dataset: Online survey data from the Cost of COVID study, primarily collected in Eastern Ontario, Canada. Population Studied: Parents over age 18 years caring for children under age 18 years. Instruments: Financial worry was measured with a 3-item measure assessing worry about maintaining housing, paying bills, and ability to purchase food. Parenting behaviours were assessed using Parenting Scale 8-item (PS-8) questionnaire. Outcome measure: Child social and emotional health was assessed using the Strengths and Difficulties Total Difficulties Score. Results: Study sample of 528 parent and child pairs were from largely European ancestry (78%) and varied household income levels. The majority of parental respondents were female (93%). Increased financial worry during the COVID-19 pandemic was significantly associated with increased child SDQ total difficulties scores (β = 0.23, SE = 0.10, p = 0.03). This relationship was mediated by parenting behaviour, independent of parent education, household income, parent age, parent sex, parent anxiety and child sex (Total Effect: β = 0.69, p = 0.02, Average Causal Mediation Effects: β = 0.50, p = 0.02, Average Direct Effects: estimate = 0.19, p = 0.08). Conclusion: Financial stress during the COVID-19 pandemic was associated with poorer child social and emotional health. Unproductive parenting behaviours, including overreactivity and laxness, significantly mediated these effects. This work supports the importance of policies aimed to alleviate family financial stresses and highlights the potential impact such policies have on child health.