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      Psychological Flexibility and Inflexibility as Sources of Resiliency and Risk during a Pandemic: Modeling the Cascade of COVID-19 Stress on Family Systems with a Contextual Behavioral Science Lens

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          Abstract

          Background

          The coronavirus disease (COVID-19) pandemic and the historic economic shutdown and stay-at-home efforts to slow its spread have radically impacted the lives of families across the world, completely disrupting routines and challenging them to adjust to new health risks as well as to new work and family demands. The current study applied a contextual behavioral science lens to the spillover hypothesis of Family Systems Theory to develop a multi-stage mechanistic model for how COVID-19 stress could impact family and child functioning and how parents’ psychological flexibility could shape those processes.

          Methods

          A total of 742 coparents (71% female; 84% Caucasian, 85% married, M = 41 years old) of children (ages 5-18, M = 9.4 years old, 50% male) completed an online survey from March 27 th to the end of April, 2014.

          Results

          Path analyses highlighted robust links from parent inflexibility to all components of the model, predicting: greater COVID-19 stress, greater coparenting discord and family discord, greater caustic parenting, and greater parent and child distress. Parent flexibility was associated with greater family cohesion, lower family discord and greater use of constructive parenting strategies (inductive, democratic/autonomy supportive, positive). Results further suggested that COVID-19 stressors predicted greater family and coparent discord, which in turn predicted greater use of caustic parenting (reactive, inconsistent, aggressive), which in turn predicted greater child and parent distress. Conclusions: The current results highlight parental flexibility and inflexibility as key points of intervention for helping families navigate the current global health crisis, highlighting the crucial role they play in the lives of families.

          Highlights

          • •

            Parent inflexibility was linked to lower functioning across all family sub-systems.

          • •

            Parent flexibility was linked to greater families cohesion and constructive parenting.

          • •

            Parent inflexibility predicted more COVID-1992 related stress.

          • •

            Stress from the new work/family demands of COVID-19 predicted more family discord.

          • •

            Family discord predicted more caustic parenting, which predicted child distress.

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          Most cited references42

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Early dynamics of transmission and control of COVID-19: a mathematical modelling study

            Adam Kucharski, Timothy Russell, Charlie Diamond … (2020)
            Summary Background An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 95 333 confirmed cases as of March 5, 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced. Methods We combined a stochastic transmission model with data on cases of coronavirus disease 2019 (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January, 2020, and February, 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. To estimate the early dynamics of transmission in Wuhan, we fitted a stochastic transmission dynamic model to multiple publicly available datasets on cases in Wuhan and internationally exported cases from Wuhan. The four datasets we fitted to were: daily number of new internationally exported cases (or lack thereof), by date of onset, as of Jan 26, 2020; daily number of new cases in Wuhan with no market exposure, by date of onset, between Dec 1, 2019, and Jan 1, 2020; daily number of new cases in China, by date of onset, between Dec 29, 2019, and Jan 23, 2020; and proportion of infected passengers on evacuation flights between Jan 29, 2020, and Feb 4, 2020. We used an additional two datasets for comparison with model outputs: daily number of new exported cases from Wuhan (or lack thereof) in countries with high connectivity to Wuhan (ie, top 20 most at-risk countries), by date of confirmation, as of Feb 10, 2020; and data on new confirmed cases reported in Wuhan between Jan 16, 2020, and Feb 11, 2020. Findings We estimated that the median daily reproduction number (R t) in Wuhan declined from 2·35 (95% CI 1·15–4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41–2·39) 1 week after. Based on our estimates of R t, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population. Interpretation Our results show that COVID-19 transmission probably declined in Wuhan during late January, 2020, coinciding with the introduction of travel control measures. As more cases arrive in international locations with similar transmission potential to Wuhan before these control measures, it is likely many chains of transmission will fail to establish initially, but might lead to new outbreaks eventually. Funding Wellcome Trust, Health Data Research UK, Bill & Melinda Gates Foundation, and National Institute for Health Research.
            Article 0 comments Cited 1018 times – based on 0 reviews     Review now
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              Economic stress, coercive family process, and developmental problems of adolescents.

              R Conger, X. Ge, G H Elder … (1994)
              We propose a model of family conflict and coercion that links economic stress in family life to adolescent symptoms of internalizing and externalizing emotions and behaviors. The 180 boys and 198 girls in the study were living in intact families in the rural Midwest, an area characterized by economic decline and uncertainty. Theoretical constructs in the model were measured using both trained observer and family member reports. These adolescents and their parents were interviewed each year for 3 years during the seventh, eighth, and ninth grades. Our theoretical model proposes that economic pressure experienced by parents increases parental dysphoria and marital conflict as well as conflicts between parents and children over money. High levels of spousal irritability, coupled with coercive exchanges over money matters, were expected to be associated with greater hostility in general by parents toward their children. These hostile/coercive exchanges were expected to increase the likelihood of adolescent emotional and behavioral problems. Overall, results were consistent with the proposed model. Moreover, the hypothesized processes applied equally well to the behavior of mothers and fathers, as well as sons and daughters.
              Article 0 comments Cited 324 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jennifer S. Daks
                Journal
                Journal ID (nlm-ta): J Contextual Behav Sci
                Journal ID (iso-abbrev): J Contextual Behav Sci
                Title: Journal of Contextual Behavioral Science
                Publisher: Association for Contextual Behavioral Science. Published by Elsevier Inc.
                ISSN (Print): 2212-1447
                ISSN (Electronic): 2212-1455
                Publication date PMC-release: 15 August 2020
                Publication date (Electronic): 15 August 2020
                Affiliations
                [1 ]University of Rochester, Department of Psychology
                [2 ]Daemen College, Department of Psycholoy
                Author notes
                [∗ ]Corresponding author. CONTACT INFORMATION: For questions regarding this paper, please contact Jennifer Daks, 480 Meliora Hall, RC Box 270266, University of Rochester, Rochester, NY, 14627-0266. . Jennnifer.daks@ 123456rochester.edu
                Article
                Publisher ID: S2212-1447(20)30169-1
                DOI: 10.1016/j.jcbs.2020.08.003
                PMC ID: 7428754
                PubMed ID: 32834972
                SO-VID: 3f0090ca-e4e3-4253-aa0d-3101f61523a4
                Copyright © © 2020 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 22 June 2020
                Date revision received : 29 July 2020
                Date accepted : 3 August 2020
                Categories
                Subject: Article

                Keywords: covid-19,family,parents,children,psychological flexibility/inflexibility
                Data availability:
                Keywords: covid-19, family, parents, children, psychological flexibility/inflexibility

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