Parental Burnout and Child Maltreatment During the COVID-19 Pandemic

Abstract

The novel coronavirus (COVID-19) has spread across the United States, resulting in significant changes in almost all aspects daily life. These changes place parents at increased risk for parental burnout. Parental burnout is a chronic condition resulting from high levels of parenting-related stress due to a mismatch between the demands of parenting and the resources available for parents to meet those demands. Research on parental burnout has suggested that parents who experience burnout are more likely to engage in child abuse and neglect, placing children at risk for detrimental short- and long-term outcomes. The purpose of this paper is to review the concept of parental burnout, discuss parental burnout in the context of the current COVID-19 pandemic, and focus specifically on the effects of child maltreatment. Implications for practitioners will be discussed.

As the novel coronavirus (COVID-19) has spread across the United States, infecting almost two million people and leading to over 110,000 deaths (as of June 9, 2020), over 96% of Americans have experienced orders to shelter in place (CDC 2020). Shelter in place orders require that people stay in their homes as much as possible and leave home for only essential activities, such as grocery shopping, visiting the doctor, or working in an essential sector (U.S. Department of Homeland Security 2020). Although people are able to engage in outdoor activities, like walking or exercising, they are required to practice social distancing by maintaining a separation from others of at least 6 ft. These new requirements came about very quickly and led to significant changes in the daily lives of almost all Americans.

Of the 74 million children under the age of 18 living in the United States (U.S. Bureau of the Census 2018), the majority reside with parents who work outside of the home; 90.8% have at least one working parent, with 63.0% of these having two working parents (Bureau of Labor Statistics 2019). Almost all of these families experienced significant disruption in their daily schedules and routines, as daycares, schools, and nonessential businesses closed. The majority (91%) of adults have reported that their lives have changed at least somewhat since the beginning of the pandemic, while almost half (44%) have said that their lives have changed in major ways (Pew Research Center 2020b). Over one quarter (28%) of adults report that at least one member of their household has lost their job or been laid off, while one-third (33%) have experienced reduced income (Pew Research Center 2020a). This is particularly concerning as over half (53%) report that they do not have emergency savings to cover even basic living expenses and that they will have difficulty paying their bills (Pew Research Center 2020a, b).

For parents who do continue to work, over one-third (35%) report that they are struggling to handle childcare responsibilities (Pew Research Center 2020a). Many must deal with a new balance of full-time parenting and homeschooling while simultaneously working from home. Those who do continue to work outside the home are likely to be working in environments that place them at high levels of personal risk such as hospitals, clinics, grocery stores, and pharmacies. For all families, these factors are likely to contribute to high levels of stress in the home environment; all while local and national narratives regarding health and financial security are reflecting a great deal of fear and uncertainty. Almost three quarters of Americans feel that the worst is yet to come (Pew Research Center 2020c).

Parental Burnout

Even at the best of times, when the world is not experiencing a pandemic, many parents experience stress specifically related to their roles as parents (Abidin 1997; Raphael et al. 2010). When it comes to their children, concerns about behavioral or health issues, educational difficulties, and even everyday tasks, can all lead parents to experience stress. For the majority of parents, parenting-related stress is transient and does not result in significant life impact; however, for as many as 5–20% of parents, parenting-related stress can escalate to the level of parental burnout (Roskam et al. 2018; Séjourné et al. 2018). Parental burnout is similar to parenting-related stress and is a stress-related disorder; however, parental burnout goes far beyond typical stress related to parenting (Mikolajczak et al. 2018a). Parental burnout is specifically defined as “a prolonged response to chronic and overwhelming parental stress” (Mikolajczak et al. 2019, p. 1319). Parents who experience parental burnout experience physical and mental exhaustion, physical symptoms such as increased somatic complaints and decreases in sleep quality, emotional distancing from their children, and a sense of incompetency in their role as a parent (Mikolajczak et al. 2018b; Roskam et al. 2018). Parents also report a feeling of being trapped in an uncomfortable situation with no way out (Hubert and Aujoulat 2018).

The Balances Between Risks and Resources theory has been put forward to explain the etiology of parental burnout (Mikolajczak and Roskam 2018). The theory posits that parental burnout is due to a perceived mismatch between parenting-related demands, including parents’ expectations of themselves and their responsibilities, and the availability of resources to meet those demands and expectations (Holly et al. 2019; Mikolajczak and Roskam 2018). Within this theory, demands are identified as risk factors that increase levels of parental stress, while resources are viewed as protective factors that can help to alleviate stress. All parents will experience varying levels of demand and will have access to varying resources; the ways that each are experienced will differ from parent to parent. When there is a chronic imbalance between demands and resources, with a greater or longer exposure to demands compared to access to resources, parental burnout may ensue (Mikolajczak and Roskam 2018).

Factors Associated with Parental Burnout

Research examining the conditions that are predictive of parental burnout (i.e., the demands that parents experience) suggest several factors that are particularly relevant during the current COVID-19 pandemic. Specifically, parental unemployment, financial insecurity, low levels of social support from family and friends, and a lack of leisure time have all been associated with an increased risk for parental burnout (Lindström et al. 2011; Parkes et al. 2015; Sorkkila and Aunola 2020). These are the very same conditions that have increased so significantly during the current requirements to shelter in place. As the majority of businesses have been forced to close or to significantly reduce their services, many families have experienced layoffs or furloughs resulting in unemployment, financial insecurity, and uncertainty about future employment stability. At the same time, resources such as free or reduced-price school meals have been limited or eliminated in many locations, and many individuals have reported difficulties in accessing unemployment insurance or other government programs (Samuels 2020).

In addition to the increased levels of unemployment and financial insecurity, the current situation has been particularly unique as access to traditional social supports from extended family and friends have been limited. For example, many parents often rely on support from grandparents or other family members for childcare or help with parenting-related activities, however, due to social distancing requirements this is no longer a possibility. This is especially true, as many grandparents may fall under the category of being at “high risk” for COVID-19-related illnesses, or even death, due to their age or the presence of underlying health conditions (Aronson 2020). While family contacts can be had through virtual methods like video conferencing, at almost no other time in history have in-person family supports decreased for such a large proportion of the population all at one time. While the wide-spread loss of traditional family supports is unprecedented, it is particularly concerning due to the research that has also shown the importance of social supports for parental wellbeing, and that frequent contact with grandparents can reduce the risk of parental burnout (Parkes et al. 2015).

As availability of social supports have decreased, it is not surprising then that parents are likely to also experience a lack of time for leisure activities. Parenting duties have increased significantly as children are home 24 h a day, 7 days a week. While many parents have experienced job loss, many others have transitioned to working from home while simultaneously engaging children in homeschooling or virtual schooling activities. Balancing everything may take more time throughout the day and may require parents to engage in more work activities outside of their typical work hours, once schooling has ended for the day or children have gone to bed. Data from NordVPN, a virtual private network service that supports many teleconference and distance working platforms, has suggested that employees may be spending upwards of 3 extra hours per day working, over and above their pre-pandemic work schedule and that work hours have shifted, with many employees logging in during late night hours (Davis and Green 2020). On top of this, many parents have lost access to common sources of leisure activity, such as community centers, churches, fitness centers, bars and restaurants, and in-person interactions with friends. Many parents can no longer take breaks outside of the home or away from their children. These changes may place parents at a greater risk for parental burnout as they have difficulty making time for themselves and finding a balance between their personal, professional, and parental responsibilities (Parkes et al. 2015).

In addition to the factors mentioned above which have clear links to the experiences that parents are facing during the pandemic, it has also been found that parental burnout is related to the combination of self-oriented and socially-prescribed perfectionism (Sorkkila and Aunola 2020). Self-oriented perfectionism refers to parents’ expectations for themselves, particularly the high expectations that they have set for what they think they should be doing and achieving as parents; while socially-prescribed perfectionism refers to parents’ perceptions of others’ expectations for them, particularly their perceptions that others judge their parenting negatively, thinking they are not good enough or not doing enough (Hewitt and Flett 1991). In the current context of the pandemic as parents are trying to balance the typical demands of parenting with the exceptional demands of a shelter in place order, coupled with high rates of financial- and health-related fear and uncertainty (Pew Research Center 2020c), it is possible that those who strive for higher levels of self-oriented and socially-prescribed perfectionism may be at a greater risk for the development of parental burnout. As mentioned above, theories of parental burnout suggest that burnout develops when the demands of parenting exceed the resources available to meet those demands. Even at the best of times, the demands of perfection are great, but in a time of pandemic the resources needed to meet those demands are likely to fall short.

Effects of Parental Burnout

As risk factors related to parental burnout have increased during the COVID-19 pandemic, it is important to understand what the effects of parental burnout may be for parents and for families. Although there is little research examining the effects of parental burnout, initial studies have found that it can have a significant impact on the parent experiencing the burnout, on their relationship with their partner, and on the health and wellbeing of their children (Mikolajczak et al. 2018a, b; Mikolajczak et al. 2019). Specifically, the researchers found that parents who scored higher on measures of parental burnout also scored higher on measures of escape and suicidal ideation, reported greater levels of conflict with their partners and higher levels of partner estrangement ideation, and indicated that that they engaged in higher levels of child abuse and neglect. The researchers also reported that associations between parental burnout and child abuse and neglect were maintained even when demographic variables such as education, income level, and presence of addiction were considered, indicating that parental burnout can have a negative effect on children and parent-child interactions across any type of family (Mikolajczak et al. 2019). These associations have also been supported in intervention research, which has found that parents with higher levels of parental burnout engaged in higher levels of child abuse and neglect, and that child abuse and neglect could be reduced through interventions aimed at reducing levels of parental burnout (Brianda et al. 2020). The fact that parental burnout may increase the risk for child abuse and neglect is not surprising, as previous research has indicated that parental stress is a risk factor for both domestic violence in general and child abuse more specifically, and that the risk for abusive behavior increases as levels of parent stress also increase (Abidin 1997; Curtis et al. 2000).

Previous research has identified a link between child abuse and neglect and parenting style, finding specifically that parents who engage in abusive behaviors are more likely to subscribe to overreactive, harsh, and authoritarian parenting styles (Rodriguez 2010). This link does not necessarily exist for parents who are experiencing parental burnout. As mentioned above, the research on the effects of parental burnout are limited so more research is needed before definitive conclusions can be drawn, however, the preliminary research that has been done suggests that parents experiencing parental burnout do not endorse harsh punishment styles and often feel guilty when they engage in abusive behaviors, feeling fear for the safety of their children when they are alone in their care (Mikolajczak et al. 2018a, b). Similar reports were made in regard to lax parenting and neglectful parenting behavior. These findings suggest that the characteristics of parental burnout, namely physical and mental exhaustion and emotional distancing, may play an important role in the presence of abuse and neglect for this population regardless of the parenting styles that parents may subscribe to. This aligns with the idea that all parents can become abusive under certain circumstances (Curtis et al. 2000), and may provide some explanation for the sense of incompetency that has been reported among parents experiencing parental burnout.

Effects of Child Maltreatment During a Pandemic

As we know that the current pandemic may lead to an increase in the risk factors associated with parental burnout and that parents who experience burnout are more likely to engage in child abuse and neglect, it is important that we understand the implications of child maltreatment. In the short term, child abuse and neglect can lead to physical illness and injury (e.g., bruises, broken bones) as well as psychological problems (e.g., posttraumatic stress disorder, anxiety) (Fortson et al. 2016). In the longer term, research has indicated that these physical and psychological effects often carry into adulthood and impact a variety of life domains (Haj-Yahia et al. 2019; Norman et al. 2012). Specifically, adults who experienced abuse and neglect as children are more likely to experience mental health issues, to use drugs, and they are at greater risk for suicide, risky sexual behavior, and sexually transmitted diseases (Norman et al. 2012). They are likely to have lower levels of education than their non-abused peers and they are at a greater risk for economic hardship, with greater levels of unemployment, lower levels of income, and fewer assets (Currie and Spatz Widom 2010). Adults who experienced abuse as children are also at a greater risk to be both perpetrators and victims of domestic violence (Widom et al. 2014) and have an increased potential to engage in child abuse themselves (Finzi-Dottan and Harel 2014).

While the effects of abuse and neglect can lead to increased levels of risk in both the short- and long-term, these risks may be compounded for children who are also experiencing the effects of the COVID-19 pandemic. Researchers examining effects of disasters, define disasters as.

one-time or ongoing events of human or natural cause that lead groups of people to experience stressors including the threat of death, bereavement, disrupted social support systems, and insecurity of basic human needs such as food, water, housing, and access to close family members. (Becker-Blease et al. 2010, p. 1040).

This definition aligns well with what many families are currently experiencing. A review of the literature examining the effects of disaster has indicated that children are often impacted to a greater extent than adults, as they are more likely to experience physical and psychological effects both during and following disasters (Norris et al. 2002; Rubens et al. 2018). While children seem to be at a lower risk for the physical symptoms of COVID-19 (Sinha et al. 2020), there may be significant effects on their psychological wellbeing due to the uncertainty of how the virus may affect them and their loved ones and the changes in daily life that have arisen due to the shelter in place order. Specifically, children may experience a range of mental health symptoms related to loss of family or friends, school closures, cancelations of extracurricular activities and milestone events, and social distancing.

While research is needed to gain an understanding of the specific effects that may arise if children experience abuse and neglect during a time of disaster and what the combined effects of these two negative experiences may be, it is clear that both can impact physical and psychological health in both the short and long term. Data have suggested that the effects of disaster can be mitigated by positive parenting and high levels of parental support (Felix et al. 2015; Sprague et al. 2015); however, research has also indicated that the rates of child abuse and neglect tend to increase during and immediately following disasters, reducing the likelihood that children may experience these positive, buffering effects (Becker-Blease et al. 2010; Curtis et al. 2000; Schneider et al. 2017).

Implications

Although a great deal of research and clinical work has been done in the area of parent stress in general (e.g., Abidin 1997; Holly et al. 2019), parental burnout has only recently gained attention (Mikolajczak et al. 2019). While research related to parental burnout has increased significantly over the past two years and has been conducted across several countries (Aunola et al. 2020a; Chen et al. 2020; Van Bagel et al. 2018), it is still not widely known or understood. Parents are unlikely to know what parental burnout is or what their risk level may be, and practitioners may also be unaware. As such, there are two main implications for practitioners that can aid in their treatment and support of parents as we continue to deal with the effects of COVID-19. First, practitioners should become familiar with the construct of parental burnout, the measures available for assessment, and the options for treatment. Second, they should consider the possibility of parental burnout as they work with parents, children, and families, understanding that the effects of the current pandemic may extend beyond the immediate period of the current shelter in place orders (Curtis et al. 2000).

Assessing Parental Burnout

Two measures available to assess for parental burnout include the Parental Burnout Inventory (PBI; Roskam et al. 2017) and the Parental Burnout Assessment (PBA; Roskam et al. 2018). Although both are in the early stages of research, each of these measures have demonstrated promise to identify parents who are experiencing, or who are at risk for, parental burnout (Mikolajczak and Roskam 2018; Roskam et al. 2017, 2018; Van Bagel et al. 2018). Each measure has also demonstrated the potential to differentiate between parental burnout specifically and other types of burnout (i.e., job burnout) and psychological distress. Despite the similarities and overlap of the two measures, the authors recommend use of the PBA (Roskam et al. 2018). They suggest that the PBI is more appropriately used in research when comparing burnout across contexts (i.e., work and family), but that the PBA is a better choice for all other situations (i.e., clinical practice). The authors report that the PBA is preferable as the diagnostic criteria focuses on contrast with previous self, there is a focus on direct assessment of burnout, specifically examining loss of pleasure and fulfillment, and the PBA is available free of charge, which may make it more accessible to a wider segment of the population.

Including these measures in an assessment process may help practitioners to identify parents who may be experiencing parental burnout, or who may be at risk; however, although both the PBI and the PBA are fairly quick to complete, consisting of 22 and 23 items respectively, they may be too time consuming for use as general screeners. To address this problem, the Brief Parental Burnout Scale (BPBs; Aunola et al. 2020a, b) was developed. The BPBs was constructed from the PBA, but is comprised of just 5 items, so it can be completed quickly and easily. Initial research suggests that the BPBs can accurately identify parents experiencing parental burnout, and that parents identified using the BPBs also scored higher on related factors such as levels of child abuse and neglect.

A final measure that should be noted is the Balances Between Risks and Resources (BR²; Mikolajczak and Roskam 2018). The BR² is a 40-item measure that can be used to identify the risk factors that parents may be experiencing, measuring the balance between parents’ experiences or perceptions of risks (or demands) and availability of resources. Research on the BR² has demonstrated that there is a strong linear relationship between BR² scores and scores on the PBI. Use of the BR² may assist parents and clinicians to identify the specific factors that are contributing to parental burnout, allowing for specific, targeted intervention.

Within clinical practice, it is recommended that the BPBs be conducted with all parents, as universal screener to identify those for whom further assessment may be warranted. Following the BPBs, the PBA can be conducted to confirm the presence of parental burnout. Finally, the BR² can be conducted to identify the specific risks and resources present for a parent, to aid in the development of an intervention.

Treatment for Parental Burnout

The literature on parental burnout is still emerging, and as a result there have been limited studies examining the effects of intervention focused on either prevention or treatment (Brianda et al. 2020); however, an initial study conducted by Brianda et al. (2020) found that both directive treatment interventions (focused on targeting the hypothesized cause of parental burnout, namely the discrepancy between parenting-related demands and available resources) and nondirective treatment interventions (focused on active listening, participant sharing, and encouragement of participants feelings of worth and ability) were equally effective at reducing rates of parental burnout as measured by participant self-reports, reports from their partners, and biological measures (i.e., hair cortisol). What was particularly noteworthy about their findings, was that both interventions appeared to be equally effective, even though the nondirective intervention was led by psychologists who were not experts in parental burnout, but who instead had training in active listening. While additional research is needed to replicate these findings, the initial results are promising and may provide practitioners with an initial direction for intervention.

Conclusion

We are currently living in an unprecedented time, when a global pandemic has led to significant changes for almost all aspects of daily living. Many of these changes are consistent with the risk factors for parental burnout, which is particularly troubling as parents experiencing parental burnout are more likely to engage in child abuse and neglect. Due to the negative effects that child abuse and neglect can have across the lifespan, it is important that we recognize parental burnout as a phenomenon that is possible, and even probable, during periods of disaster. It is important that practitioners consider parental burnout in their interactions with children, parents, and families, and that they recognize that the effects of the current COVID-19 pandemic may linger long after the current shelter in place orders come to an end.