Child Externalizing and Internalizing Behavior and Parental Well-Being During the COVID-19 Pandemic

Reviewed by: Professor Jiang Hong Liu

This is a well-written manuscript with good design and analysis. It is interesting to see that Wave I child externalizing behavior predicts Wave II parental depression and stress to some degree. I would like to see further discussion on the rationale for why externalizing behavior but not internalizing behavior had this impact, as internalizing behavior is usually related to maternal depression. I would also like to see the transactional model mentioned in the Introduction to be integrated more in the Discussion. Otherwise, this was a  scholarly and well-crafted piece of work

This is an interesting and important topic - and the authors set up their hypotheses clearly but are let down by the dataset that they are analysing. The data come from 66 countries and two waves so the term prediction can legitimately be used - but with only 175 familes out of over 2000 initially recruited and the use of a convenience sample recruited via social media severely limit both the generalisability of the findings and the statistic power for the analyses. JA flow diagram of participant inclusion would help, because the tables also suggest signifcant attrition between wave 1 and wave 2 among the original 175 families. An analysis that compared those who participated in wave 1 and wave 2 compared to those who dropped out would be revealing and would help intepret the findings. Sadly, the lack of power is mentioned briefly in the limitations section of the discussion, which provides lengthy explanations for the findings in much greater detail. The distribution of these families across the 66 countries is not reported, but would be important to know considering different responses and policies - might this be another reason for the authors findings?

The measures for childhood mental health, parental depression and parental relationships are valid and reliable - but I am not sure that taking the average score across the stresses, which implies that they are all equally stressful is valid - I can see why the authors did this but the limitations of such an approach should be discussed.

There is multiple testing and three outcomes, with no adjustment, and it would be useful to see the actual p values rather than report p> or p< 0.05 - given the small atypical sample, I would not report marginal findings, and would argue that p=0.08 is weak evidence indeed.

Quite a lot of the literature summarised in the discussion seems quite different to the pandemic - where the issue for most families was being locked down with each other - ie Hurrican Katrina and the Boston Marathon bombings are distinct traumatic events lasting minutes or hours and not months.

Finally, the recommendation for mental health interventions seems a big leap from these weak data - the issues that covid restrictions have thrown up for families is being confined to home, which might be overcrowded, either trying to work and home school, or housing, financial, or food insecurity  - a more nuance conclusion is that schools should be the last institutions to close and the first to reopen and that social support / or small group childcare for vulnerable families might reduce the increase in parental distress reported in Table 1, with financial support for those whose employment was at risk - of course mental health interventions for those with poor mental health (child or parent) are warranted but by no means are the only response