Insights into the current state of the mental, emotional and physical health of parents and kids, to inform health system strategy, marketing and communications
As we prepare to field a new study of healthcare market research on parents in the pandemic, we’ve completed a review of other recent research on the topic. These findings help illuminate the current mindset of parents and children, their stressors, and what they need most from health systems and their healthcare marketing services.
Even before the pandemic, parents were stressed and many young people were struggling mightily with mental, emotional and behavioral health.
As of 2018, our youngest generation was “the most stressed and anxious consumer cohort on record,” according to Gartner research. Sadly, the number of teens who reported feeling useless and joyless had increased 33% over the prior five years. Furthermore, suicides among children and young adults aged 10 to 24 increased by more than half (57%) between 2007 and 2018, from 6.8 per 100,000 to 10.7 per 100,000, according to a recent report from the Centers for Disease Control and Prevention (CDC). They also documented that health problems such as anxiety and depression were on the rise in children ages 6-17.
In 2019, the Children’s Hospital Association documented that children’s hospitals were seeing a continued increase in the number of patients that needed mental health services in addition to the injury or illness that brought them in for care. One in five children and adolescents experienced a mental health disorder in a given year.
Then 2020 happened.
COVID-19 has had a compounding effect, with the pandemic called a ‘mental health crisis’ for parents and children alike. Let’s unpack what that looks like.
A recent American Academy of Pediatrics (AAP) study found that between March and June 2020, more than one in four parents (27%) reported worsening mental health for themselves, and one in seven (14%) experienced worsening behavioral health for their children. Unsurprisingly, declines in parent’s mental health and children’s behavioral health were at times “intertwined,” with nearly one in 10 families reporting declines in both. (I’m surprised that number isn’t higher.) Findings were generally similar across socio-demographic groups; however, single parent families and those with young children were disproportionately affected. This is unsurprising, given the extra challenges these groups face juggling work and childcare, among other factors.
As would be expected, social isolation and the corresponding loneliness can have a significant negative impact on mental health in children. According to a June 2020 Gallup poll, three in 10 parents said their child was “already experiencing harm to their emotional or mental health” as a result of social distancing practices and school closures. And, another third (37%) said at that time that it would take a few more weeks or months of social distancing and school closures before their child would experience harm. That, of course, was nearly five months ago. And while some children are back in school, at least part of the time, there is no doubt that more and more children are experiencing prolonged stress.
That is consistent with the levels of depression self-reported by high school youth in a Spring 2020 study, in which nearly one in three high school students in the U.S. said they were unhappy and depressed “much more than usual” in the past month.
The most definitive research I have found on this topic to date is the American Psychological Association’s (APA) Stress in America study, published in October 2020, which states:
“...Americans have been profoundly affected by the COVID-19 pandemic...the external factors Americans have listed in previous years as significant sources of stress remain present and problematic. These compounding stressors are having real consequences on our minds and bodies. It is the unusual combination of these factors and the persistent drumbeat of a crisis that shows no signs of abating that is leading APA to sound the alarm: We are facing a national mental health crisis that could yield serious health and social consequences for years to come.”
That study yields great insight into the myriad stressors of parents, as well as the pandemic’s impact on children and young adults, all of which is discussed below.
For parents, the pile-up of pressures is so overwhelming that it’s easy to understand why their mental and emotional health is increasingly strained.
As the Stress in America study sums up so well: “Parents are bearing an enormous burden during the pandemic. Daily lives and routines seem to change in an instant. Many schools remain closed. Child care was discontinued abruptly and in some areas remains largely unavailable. Work situations changed rapidly: Jobs were lost, essential workers continued with employment with the health and safety of their family in the balance, and for many, work was shifted into the home. This all occurred at a time when social contact was largely lost due to the recommended physical distancing guidelines. Given the wide-reaching disruption for this part of the population, it may not be surprising to see that parents, on average, report a higher level of stress during the past month than those who are not parents.”
In fact, nearly half of parents rated their stress level between eight and 10, a “great deal of stress’, compared with 28% of adults without children who said the same.
In May, an earlier volume of the APA study called Stress in the Time of COVID-19 compared the pandemic-stress levels of parents to non-parents. Parents rated their average pandemic stress 6.7 out of 10, versus a 5.5 mean rating for non-parents. Numerous different factors represented significant sources of stress for a strong majority of parents, as shown in this summary.
Notably, two out of three parents (66%) were stressed about access to healthcare services.
Furthermore, in the second volume of the APA study published in June, most parents (71%) expressed worry about the impact the pandemic has had on their child’s social development. And — this one is very telling from a behavioral health perspective — over half (55%) reported that their child has been acting out more since the start of the pandemic.
The list of stressors goes on and on; one could easily write a book about the pandemic stress of parents. For more on this topic, I highly recommend the recent New York Times article, Pandemic Parenting, for a window into the worlds of parents with a wide range of pressures and challenges.
Certain subgroups of parents are disproportionately pressured, including: women who are pregnant or have newborns; parents of young children; single parent families; and, of course, those who are struggling to meet their children’s basic needs.
One Canadian study of nearly 2,000 pregnant women found elevated symptoms of depression and anxiety during the COVID-19 pandemic, as published in the Journal of Affective Disorders. Whereas anxiety and depression typically affect between 10 and 25 percent of pregnant women, in this case over one third (37%) reported symptoms of depression and well over half (57%) acknowledged symptoms of anxiety. Another Canadian study of pregnant women and women with newborns found even greater increases. The journal notes that higher levels of anxiety and depression are associated with higher risk of preterm birth, postpartum depression and behavioral difficulties in children, so these findings have far-reaching health implications.
Households in the U.S. with young children have been hit especially hard, according to The University of Oregon’s RAPID-EC (early childhood) survey. This extremely interesting ongoing research project found early in the pandemic that these households are experiencing “troubling increases in difficulties across a range of areas, including child social-emotional well-being, household economic security, physical health of the household, access to early learning and childcare, caregiver/parent mental health, and household basic needs.”
Quite recently, the same study spotlighted how the pandemic is overloading single-parent families. Single moms and dads reported higher levels of emotional distress than caregivers in other households with young children, including anxiety, depression, loneliness and stress. What’s more, they also observed higher levels of distress in their young children. Single parents tend to be more isolated, as described by this single parent from Iowa:
I feel incredibly lonely. As a single parent, I often rely on my family and friends to help me out. Now I’m working from home and sheltering in place. I don’t have that help from my family and friends. I’m lonely and overwhelmed.
Single parent households are also more likely to be experiencing financial and material hardships. It stands to reason that those parents and caregivers struggling with the greatest financial and material hardship would also experience the greatest health and emotional hardship. In July, the RAPID-EC research identified a “Hardship Chain Reaction”, in which financial difficulties are causing many parents of young children emotional distress which in turn having adverse effects on the emotional health of their young children.
Our youngest generation will continue to have unprecedented levels of need for mental, emotional and behavioral health care.
According to the APA Stress in America study: “The potential long-term consequences of the persistent stress and trauma created by the pandemic are particularly serious for our country’s youngest individuals, known as Generation Z (Gen Z). Our 2020 survey shows that Gen Z teens (ages 13-17) and Gen Z adults (ages 18-23) are facing unprecedented uncertainty, are experiencing elevated stress and are already reporting symptoms of depression.”
In that research, Young Gen Z adults reported the highest stress level during the prior month, on average, at 6.1 out of 10, significantly higher than all other generations. Two thirds (67%) said the pandemic makes planning for their future feel impossible. Nearly two thirds (62%) said the rise in suicide rates itself a significant source of stress.
Teens are struggling as well, as evidenced by this snapshot of some of their thoughts and feelings.
It may be particularly telling that so many are having difficulty concentrating on schoolwork, as this can sometimes be a sign of traumatic stress.
More childrens’ mental health issues are very serious in nature, with apparent increased emergency department visits.
Last week, a study released by the Centers for Disease Control found that from mid-March through October, the proportion of emergency room visits related to children’s mental health rose dramatically for school-aged children and adolescents. The proportion grew 24% for kids aged 5-11 and 31% among those aged 12-17, compared to the same period a year ago.
As a report on that CDC study by NBC News noted: “Dr. Candice Norcott, a clinical psychologist and professor at the University of Chicago, said that the “enduring uncertainty of the pandemic represents a particular challenge for teenagers during a crucial stage in their development. They struggle with seeing down the road into a post-pandemic world and they are asking, ‘what’s the point?' Teens also aren’t great with delayed gratification, so losing milestones and rites of passage like graduations, birthday parties, (and) athletic seasons are felt deeply.”
While the CDC report explained that the increased proportion of children’s mental health-related ED visits may be somewhat inflated because of decreased overall ED visits during the same time period, there’s no shortage of other documentation of the mental, emotional and behavioral health struggles of kids today.
For a qualitative perspective, Saun-Troy Trotter, a psychotherapist in California, told National Public Radio that her school-based clinic recorded more youth suicide attempts in the first four weeks of the pandemic than it did in the entire previous year. “They’re giving up hope,” she said. “There’s nowhere to go. There’s nothing to do. There’s nothing to connect with. There’s just deflatedness.”
Physical health is also suffering. Healthcare continues to be delayed in many cases.
To date, there seems to be far less research coverage on the state of families’ general physical health (outside of COVID-19 cases) than on mounting mental health concerns. Still, the American Academy of Pediatrics study did document that physical health also declined, though less so, with about one in five parents (18%) reporting worse physical health for themselves and 4% citing worse physical health for their kids. Negative physical health effects may take longer to be recognized than the immediate mental health consequences.
As widely discussed, families have delayed and continue to delay some essential health care. As of June, when the AAP study was fielded, more than one third of families reported delays or cancellations in their children’s health care, most commonly well-child visits (49%), subspecialist visits (13%) and behavioral health visits (9%).
Just last month (October), the University of Oregon research found that “eight months into the pandemic missed child wellness visits and vaccinations are continuing at a steady rate.” More than one in four families with young children (28%) have missed a well-baby/well-child visit, a threefold increase over pre-pandemic levels. One in 10 children (12%) have not received a recommended vaccination, primarily due to caregivers’ concerns about contracting the virus. Wellness checks and vaccinations for children 18 months to 5 years old are being missed more than those for children under 18 months of age.
Yet, in their resilience, most parents still have a positive outlook and feel hopeful.
While there are certainly many challenges for health systems seeking to help families through the pandemic, this story is not without hope.
Despite the many challenges, the lion’s share of parents (82%) agree that they are grateful for the additional time they’ve had with their child during the coronavirus pandemic, according to the APA June report. That is a significant bright spot for us all to keep top of mind.
Also, according to Gartner research, while consumers feel worse about their mental and physical health than they did before the pandemic, the majority still has a positive outlook on both. This is true among parents as well as the general population. In fact, in Gartner’s data, more parents than non-parents rated their present-day physical health as “good.”
What does all of this research mean for health systems’ strategies?
The intention of this curated research is to help health systems cultivate greater empathy in their marketing. If we don’t keep top of mind how people are feeling, we can’t deliver services and messages that demonstrate our understanding and therefore most effectively meet needs and help build trust.
Parents at all stages — and particularly those in pregnancy, post-partum, and early childhood stages — need mental and emotional health support more than ever. Health systems need to strategize how they can best facilitate this.
It’s clear and widely accepted that there is a high need for greater access to mental, emotional and behavioral health services for children. In 2018, the Children’s Hospital Association identified a shortage of care providers and care models focused on serving pediatric patients.
This comprehensive story from the Children’s Hospital Association is a useful look at some potential care delivery strategies, including improved screening, urgent care, psychiatric ED, behavioral health in the primary care office and telemedicine, and other cost-effective care models.
I will likely explore in depth in a future article what health systems and children’s hospitals are doing now to address this urgent need. In recent conversations with our children’s hospital clients and contacts, this has emerged as a clear strategic priority for 2021 and beyond.