Article Text

Original research
Depression, parenting and the COVID-19 pandemic in Canada: results from three nationally representative cross-sectional surveys
  1. Margot Shields1,
  2. Lil Tonmyr1,
  3. Andrea Gonzalez2,
  4. Leslie Atkinson3,
  5. Dawn-Li Blair1,
  6. Wendy Hovdestad1,
  7. Harriet MacMillan4
  1. 1Public Health Agency of Canada, Ottawa, Ontario, Canada
  2. 2Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
  4. 4Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Lil Tonmyr; lil.tonmyr{at}phac-aspc.gc.ca

Abstract

Objectives Depression is associated with problems in functioning in many aspects of life, including parenting. COVID-19 has increased risk factors for depression. We investigated the prevalence of depression among parents during the pandemic and the association with dysfunctional parenting.

Design Canadian nationwide cross-sectional study.

Setting and participants The 2020 and 2021 Surveys on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015‒2019). Responding sample sizes for parents were 3121 for the 2020-SCMH; 1574 for the 2021-SCMH and 6076 for the CCHS.

Primary outcome measures All three surveys collected information on symptoms of major depressive disorder (MDD). The SCMH measured harsh parenting.

Results Based on data from the 2021-SCMH collected during wave 3 of COVID-19, 14.4% of fathers and 21.2% of mothers screened positive for MDD. These prevalence estimates were similar to those from the 2020-SCMH during wave 2, but at least two times higher than pre-COVID-19 estimates from the CCHS. Multivariate analyses revealed a linear association between MDD and harsh parenting. COVID-19-related stressors were associated with harsh parenting. Among mothers, feeling lonely or isolated because of COVID-19 was a risk factor for harsh parenting; among fathers, being a front-line worker was a risk factor. Meditation was a protective factor for mothers.

Conclusions After years of stability, the prevalence of MDD increased substantially among Canadian parents during the pandemic. Ongoing monitoring is vital to determine if elevated levels of depression persist because chronic depression increases the likelihood of negative child outcomes. Programmes aimed at addressing depression and bolstering parenting skills are needed as families continue to face stressors associated with COVID-19.

  • MENTAL HEALTH
  • COVID-19
  • EPIDEMIOLOGY
  • Child protection
  • Adult psychiatry

Data availability statement

Data may be obtained from Statistics Canada.

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STRENGTHS AND LIMITATIONS OF THIS STUDY

  • The data are from large representative samples of the Canadian population.

  • The data collected during waves 2 and 3 of COVID-19 provide a unique opportunity to investigate the well-being of Canadian parents during the pandemic.

  • The scales used to measure depression and harsh parenting have good test–retest reliability and high validity.

  • However, depressive symptoms and harsh parenting are based on self-reported data.

  • The Surveys on COVID-19 and Mental Health measured only one aspect of dysfunctional parenting—harsh parenting. Links between depressive symptoms and parental behaviour have been found to be stronger if composite parenting measures covering both positive and negative aspects are employed.

Introduction

The COVID-19 pandemic and public health measures imposed to contain it have had a profound impact on Canadian families. School and daycare closures and cancellation of extracurricular activities placed an unprecedented burden on families. Parents have had to assume roles, such as teacher, friend and coach, and at the same time, fulfil work responsibilities. This was in addition to financial strains and social isolation mandated by physical distancing.1

Since the onset of the pandemic, studies have examined adult mental health. Early published rapid literature reviews revealed increases in negative psychological outcomes, such as post-traumatic stress symptoms, anger, anxiety and depression.2–5 However, many early studies were of low-to-moderate quality. They used convenience samples and mental health measures of low validity, which made it difficult to draw conclusions and generalise findings.2 4 5 Nonetheless, a systematic review concluded that depressive and anxiety disorders increased globally during 2020.3 Since then, two other large-scale systematic reviews based on data collected up to February 2021 reached similar conclusions about increases in mental health conditions.6 7 Furthermore, two systematic reviews based on longitudinal data observed a spike in mental health problems during the early months of the pandemic (April–May 2020).8 9 This was followed by a stabilisation or decrease in mental health symptoms,8 9 and then another spike coinciding with the second wave of COVID-19 in North America late in 2021.8 Some analyses suggested that specific subpopulations, notably, women and parents, may be at increased risk of adverse mental health outcomes.4 5 10 Longitudinal studies9 found that changes in mental health symptoms varied considerably by subpopulation after the early months of the pandemic.

In Canada, the Surveys on COVID-19 and Mental Health (SCMH) collected information on symptoms of major depressive disorder (MDD) based on nationally representative samples—from September to December 2020 (during wave 2 of COVID-19) and from February to May 2021 (wave 3).11

Among Canadians aged 18 years or older, the prevalence of screening positive for MDD12–14 was higher during wave 3 than wave 2 (19% vs 15%),15 and during wave 2, prevalence was more than twice as high as in the pre-COVID-19 period.16 Before the pandemic, the prevalence of depression in Canada had been stable for more than two decades.17 Similar increases have been reported in the USA.18

Increases in the prevalence of depression among parents are particularly concerning, because depression is associated with dysfunctional parenting.19–24 Even subclinical levels have been implicated, so it is important to consider the severity of depressive symptoms when examining associations with parenting behaviour.20 25

Pre-COVID-19 research on associations between depression and dysfunctional parenting often had limitations. Studies tended to focus on mothers; information about paternal depression is sparse.22 Most analyses were based on observational studies with small samples rather than large population-based samples.19–24 As well, the role of potentially protective factors was rarely examined. Evidence suggests that psychosocial resources, such as a sense of mastery (perception of being in control of one’s life circumstances), coping mechanisms26 and a sense of community belonging reduce the likelihood of depressive symptoms.16 27–32 The same factors might be protective for dysfunctional parenting.

Both parental depression and dysfunctional parenting have been associated with negative outcomes for children, including impaired socioemotional and cognitive development and mental health disorders.20 25 33–43

We used data from the nationally representative 2020-SCMH and 2021-SCMH and the 2015‒2019 Canadian Community Health Survey (CCHS)—Annual Component44 to examine trends in depression among Canadian parents and relationships between depression and dysfunctional parenting. Dysfunctional parenting is a general term that covers various aspects of ineffective parenting. We focused on harsh parenting: overreacting in discipline situations (measured in the SCMH).

Our study examined the following research questions:

  1. Did the prevalence of MDD among Canadian parents change from pre-COVID-19 times to waves 2 and 3 of the pandemic?

  2. Was depression associated with harsh parenting?

  3. What other risk and protective factors were associated with harsh parenting? Factors investigated were as follows:

    • Sociodemographic characteristics of the parent, age and gender of the child, and number of children in the household.

    • Risk factors related to COVID-19 (such as loss of job or income, financial strain, increased alcohol consumption).

    • Psychosocial protective factors, including mastery, coping mechanisms and sense of belonging to the local community.

Methods

Data sources

Data from the SCMH11 were used to obtain estimates of depression among Canadian parents during the COVID-19 pandemic and to examine harsh parenting in relation to depression and other risk and protective factors. The SCMH collected cross-sectional data from September to December 2020 and from February to May 2021. The target population was individuals aged 18 years or older living in the 10 provinces and the three territorial capital cities. Individuals living on reserves, in institutions or in the territories outside the capitals were excluded (fewer than 2% of the population). In each province and territorial capital, a simple random sample of dwellings was selected, and one person aged 18 or older from each occupied dwelling was randomly chosen to participate. Respondents completed the survey online or by telephone. Response rates were 53.3% for the 2020-SCMH (14 689 respondents) and 49.3% for the 2021-SCMH (8032 respondents). Respondents were asked for permission to share their information with the Public Health Agency of Canada—12 344 agreed to share in 2020; 6592 in 2021. This article is based on data for parents in the share files: 1960 fathers (1305 in 2020; 655 in 2021) and 2735 mothers (1816 in 2020; 919 in 2021). Gender-diverse parents were not included owing to insufficient sample sizes, and 28 records were dropped where parental status was unknown. A value for depression was missing for 22 fathers and 40 mothers in 2020, and 16 and 21, respectively, in 2021.

Data from the 2015‒2019 CCHS—Annual Component44 were used to obtain pre-COVID-19 baseline estimates of depression among parents, which were compared with estimates from the SCMH. The CCHS target population was individuals aged 12 or older living in the 10 provinces and the three territories. Residents of reserves and other Indigenous settlements in the provinces, full-time members of the Canadian Forces, the institutionalised population and people in some remote regions were excluded (fewer than 3% of the population). The CCHS was completed by telephone or in person using computer-assisted interviewing. In the annual CCHS, the depression module is optional content; every year, each province/territory decides if this module will be administered. The most recent years in which the depression module was administered were: 2019 in Ontario and Manitoba; 2018 in Prince Edward Island; 2016 in Newfoundland and Labrador, Nova Scotia, New Brunswick, and Saskatchewan; and 2015 in British Columbia. The CCHS annual files exclude the territories because territorial data become representative of the population only after 2 years of data have been collected. Therefore, the comparison of results from the SCMH with the CCHS excluded the territories and two provinces (Quebec and Alberta). From 2015 to 2019, CCHS response rates ranged from a low of 54.4% (2019) to a high of 62.8% (2017). Respondents were asked for permission to share their information; each year, more than 90% agreed to share. For the eight provinces for which comparisons with the SCMH were made, the combined CCHS sample size of parents aged 18 or older on the share files was 2515 for fathers and 3738 for mothers; 44 records were dropped because of unknown parental status, and the value for depression was missing value for 79 fathers and 97 mothers.

Measures

MDD symptoms

Both the CCHS and SCMH measured MDD symptoms using the Patient Health Questionnaire-9 (PHQ-9).12–14 Table 1 provides details on PHQ-9 items and scoring.

Table 1

Measures for depression, harsh parenting and COVID-19-related risk factors

Harsh parenting

The Parenting Scale is a 30-item instrument that measures dysfunctional parenting in discipline situations.45–48 The scale contains two subscales assessing two dimensions of dysfunctional parenting: lax and harsh (also referred to as ‘over-reactive’). The Parenting Scale has been shown to have adequate internal consistency, good test–retest reliability, and good discriminatory and predictive validity.45–48 The SCMH included the 10-item harsh parenting subscale. It was administered to respondents who had at least one child aged 18 months to 17 years living with them full time or part time (many questions are not appropriate for children younger than 18 months). Parents with more than one child living in the household were asked about the child who had the most recent birthday. Table 1 provides details on items and scoring for the harsh parenting scale.

Covariates

Harsh parenting was examined in relation to sociodemographic variables, COVID-19-reated risk factors and psychosocial protective factors.

The sociodemographic variables comprised characteristics of the parent, household and child. Parent characteristics were: age group (18‒34, 35‒44 and 45 or older); racialised group member (non-white, white); immigrant status (yes, no); educational attainment (high school or less; postsecondary certificate/degree/diploma; and university certificate, diploma or degree above bachelor’s level); and front-line worker (yes, no). Front-line worker was defined as ‘an individual who has the potential to come in direct contact with COVID-19 by assisting those who have been diagnosed with the virus’. Examples provided were ‘police officers, firefighters, paramedics, nurses or doctors’. Household characteristics were: two or more adults (18+) in household (yes, no); place of residence (urban centre, rural); household income quintile and number of children (<18) living in household (one, two or more). The child characteristics were: gender (female, male) and age group (18 months to 4 years, 5‒11 years, 12‒17 years). The age groupings for children and adults were based on sample size and a review of the literature.

Eight COVID-19-related risk factors were examined (table 1).

The psychosocial protective factors examined were: mastery, coping mechanisms and sense of belonging to the local community (table 2).

Table 2

Measures for psychosocial protective factors

Analysis

All analyses were stratified by gender of parent.

Changes in depression were assessed by comparing prevalence estimates of a positive screen for MDD in the 2020-SCMH, 2021-SCMH and CCHS. Comparisons of estimates between the 2020-SCMH and 2021-SCMH and the CCHS were based on the eight provinces for which CCHS depression data were available.

Research questions 2 and 3 (factors associated with harsh parenting) were addressed based on combined 2020-SCMH and 2021-SCMH data. Because harsh parenting scores were stable between the 2020-SCMH and 2021-SCMH, and interaction with time was not significant, the two cycles were combined to maximise sample size. This component of the analysis is based on parents with at least one child aged 18 months to 17 years, who responded to the harsh parenting items (n=1702 for fathers and 2502 for mothers). For parents with a missing value for 1–3 of the harsh parenting items (n=46 for fathers and 54 mothers), a score was derived based on the average score for items where a response was provided; records were dropped if there was non-response to four or more items (seven fathers & seven mothers).

Depression was examined in relation to harsh parenting by comparing mean scores (from the harsh parenting scale) for parents who screened positive for MDD with mean scores for those who did not screen positive. Scores were also compared across levels of depression severity to determine if a gradient existed in associations with harsh parenting.

Ordinary least squares (OLS) regression was used to examine harsh parenting in relation to depression and other risk and protective factors. The regression models simultaneously controlled for depressive symptoms (used as a continuous score), sociodemographic variables, COVID-19-related risk factors and psychosocial protective factors (mastery, coping mechanisms and sense of belonging to the local community). Unadjusted means/corrections of harsh parenting in relation to depression and other risk and protective factors are provided in online supplemental table A, as well as the number of missing values for all variables included in the models. In preliminary analyses, we examined interactions between depression and other risk and protective factors in relation to harsh parenting; none of the interactions were statistically significant.

Analyses were based on weighted data. Weights created by Statistics Canada ensure that data are representative of the population and incorporate several factors to reduce bias, including an adjustment for non-response and poststratification to Census population counts. To account for survey design effects of the SCMH/CCHS, SEs, coefficients of variation and 95% CIs were estimated using the bootstrap technique.49 Differences between estimates were tested for statistical significance, established at the p<0.05 level. Analyses were conducted in SAS Enterprise Guide version V.7.1 (SAS Institute).

The study used Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional reporting guidelines.50

Patient and public involvement

None.

Results

Changes in depression over time (research question 1)

Table 3 shows the prevalence of a positive screen for MDD among Canadian parents and compares estimates from the 2020-SCMH and 2021-SCMH, and the CCHS. In the 2021-SCMH, 14.4% of fathers and 21.2% of mothers screened positive for MDD. These percentages were not statistically higher than those observed in the 2020-SCMH. However, based on data for eight provinces, among both fathers and mothers, the prevalence of a positive screen for MDD was substantially higher in the 2020-SCMH and 2021-SCMH than in the CCHS. The prevalence of MDD in the 2021-SCMH has at least doubled compared with what was observed pre-COVID-19 (for fathers, from 3.9% in the CCHS to 13.2% in the 2021-SCMH; for mothers, from 6.9% to 24.1%).

Table 3

Prevalence of positive screen for MDD, by gender, parents aged 18 or older, Canada, 2021, 2020 and 2015–2019

Harsh parenting in relation to depression (research question 2)

Based on data from the combined 2020/2021-SCMH, mothers were more likely than fathers to report harsh parenting (mean score 1.19 vs 1.02). For both fathers and mothers (table 4), mean scores for harsh parenting were higher among those who screened positive for MDD than among those who did not screen positive (for fathers, 1.27 vs 1.00; for mothers, 1.53 vs 1.10). A gradient emerged by severity of depression. For fathers, mean harsh parenting scores ranged from 0.69 among those reporting no depressive symptoms to 1.34 among those reporting symptoms indicative of moderately severe or severe depression; for mothers, the corresponding scores ranged from 0.79 to 1.55.

Table 4

Mean harsh parenting scores, by depression and gender, parents aged 18 or older (with at least one child aged 18 months to 17 years), Canada, 2020/2021

Other risk and protective factors for harsh parenting (research question 3)

Table 5 shows OLS regression model results examining depression and other risk and protective factors in relation to harsh parenting. Depressive symptoms were entered as a continuous variable. Among fathers, factors associated with elevated harsh parenting scores were depressive symptoms, being a front-line worker, two or more adult household members, male child, child aged 5 or older, and two or more children in the household. Protective factors were being non-white and higher levels of mastery.

Table 5

Regression coefficients relating depressive symptoms score and other factors to harsh parenting, by gender, parents aged 18 or older (with at least one child aged 18 months to 17 years), Canada, 2020/2021

Among mothers, elevated harsh parenting scores were associated with depressive symptoms, household income in the top two quintiles, child aged 5‒11 (compared with younger children), two or more children in household, feeling lonely or isolated due to COVID-19 and increased alcohol consumption since the pandemic onset. Meditation was a protective factor.

The standardised beta coefficients provide information on the relative importance of the risk and protective factors. For both genders, the strongest predictors of harsh parenting were the depressive symptoms score and the child being aged 5‒11.

Discussion

Based on SCMH data pertaining to wave 3 of the COVID-19 pandemic, 14.4% of fathers and 21.2% of mothers screened positive for MDD. Estimates were similar for wave 2. Comparable estimates for pre-COVID-19 years (2015–2019) in eight provinces showed that the prevalence of screening positive for MDD had at least more than doubled among Canadian parents during the pandemic. By contrast, rates of depression among Canadian adults had been stable from the early 2000s to the pre-COVID-19 era.51 52

Mothers were more likely than fathers to report harsh parenting, and for both genders, depressive symptoms were related to harsh parenting. A gradient was observed—parents in the highest category for depressive symptoms had the highest harsh parenting scores. When associations were examined in multivariate regression models controlling for other risk and protective factors, the association between depressive symptoms and harsh parenting remained significant for both genders. Pre-COVID-19 baseline data are not available for harsh parenting, but a crowd-sourcing Statistics Canada survey conducted in June 2020 found that 46% of parents reported that, because of the pandemic, they were ‘very’ or ‘extremely’ concerned about having less patience, raising their voices, or scolding or yelling at their children.44 A study in the Netherlands, where pre-COVID-19 data were available, reported significantly higher harsh parenting levels during COVID-19, compared with pre-COVID-19 times.53

According to Coyne et al,54 because of COVID-19, parents are facing a ‘collision of roles’, which has heightened stress levels. The parental stress model55 56 proposes that stress occurs when demands conflict with expectations (their own or others’) and resources needed to cope are lacking.56 Previous research has shown that adults with high parental stress are more likely to engage in harsh parenting.19 56–59

For mothers, the associations of loneliness, isolation and greater alcohol consumption with higher levels of harsh parenting may reflect increased parental stress due to COVID-19. Most mothers who reported higher alcohol use attributed the increase to stress. Other research has shown that maternal alcohol consumption is a predictor of harsh parenting.60 Among fathers, being a front-line worker during COVID-19, with the chronic strain inherent in such jobs, may have impeded their ability to fulfil their role as parents.

Our findings that parents were more likely to resort to harsh parenting with school-aged children and when there were two or more children in the household are consistent with previous research.23 57 58 61 Multiple children in the household and the strain of helping young children with schooling may be particularly stressful. The results of analyses of socioeconomic status (SES) in relation to harsh parenting have been inconsistent.62 Although some studies have shown that low SES is a risk factor for harsh parenting,57 61 63 64 we found that mothers with higher incomes were more likely to engage in harsh parenting. This may be specific to COVID-19; two-thirds of Canadian mothers reported the extra responsibility of home schooling.65 For women with higher incomes and demanding jobs, the added responsibility may have contributed to stress. A German study reported that decreased sharing of childcare responsibilities during COVID-19 was a risk factor for harsh parenting,57 and may be relevant to our finding that harsh parenting was more common among mothers than fathers. This is consistent with previous research suggesting that if mothers assume more responsibility in parenting than fathers, the resulting stress may intensify emotional responses in discipline situations.47

Studies of protective factors for harsh parenting are rare. Our finding that psychosocial factors were protective (mastery for fathers and meditation for mothers) likely reflects the role of these psychosocial resources in stress reduction. Previous research has found that women benefit more from meditation than men do.66 67 A review article concluded that mindful meditation could be taught to parents and was effective in improving self-regulation among those experiencing chronic stress.68 A Norwegian study69 reported that fathers’ positive engagement with children was dependent on a sense of mastery.

Consistent with our results, previous research has found that maternal20 22 and paternal depressive symptoms19–21 were associated with harsh parenting. For both genders, depression was a strong risk factor for harsh parenting. It has been proposed that the association stems from irritability that often accompanies depression. Parents experiencing irritability express more negative feelings toward their children, are less tolerant and capable of resolving issues through reasoning, and are more likely to resort to harsh techniques to deal with misbehaviour. Feeling helpless may also be relevant. A study carried out during COVID-19 found that such feelings were the main mechanism predicting depressive symptomology,70 which, in turn, led to emotional regulation problems that negatively affected parent–child interactions.

During these COVID-19-dominated times, Canadian parents have reported struggles with their mental health and challenges with parenting.23 65 Parental depression and dysfunctional parenting are associated with negative child outcomes such as attachment issues, lower cognitive/intellectual functioning performance, anxiety, depression, conduct disorder, attention deficit hyperactivity disorder, impaired socioemotional development and child maltreatment.20 25 33–43 Although the cross-sectional nature of the data precludes drawing conclusions, a recent meta-analysis showed that the association between parental depression and negative child outcomes (cognitive and intellectual functioning, impairment in social interactions, and internalising and externalising symptoms)20 was at least partially mediated via dysfunctional parenting. That is, depression led to dysfunctional parenting, which negatively affected children’s health and well-being. A systematic review published in 202271 concluded that there had been a deterioration in the mental health of children and youth since the onset of COVID-19.

The findings of this study underscore the importance of the implementation of and access to programmes that identify and treat depression among parents. However, during COVID-19, access to healthcare of any type has been particularly challenging; in a survey conducted during the first year of the pandemic, half of Canadian adults reported difficulties obtaining the care they needed.72 This is unfortunate given that programmes aimed at identifying and treating depression among adults in primary care settings have been shown to be effective in decreasing depression-related morbidity.73

Strengths and limitations

A strength of this study is the use of data based on large representative samples that can be generalised to the Canadian population. Research has repeatedly shown that mental health deteriorates after a natural disaster,74 75 but the evidence was largely based on retrospective data. Our study used data collected during waves 2 and 3 of COVID-19, thereby providing an opportunity to investigate the well-being of Canadian parents as the pandemic evolved. The scales measuring depression and parenting have good test–retest reliability and high validity.12 45–48 76 Also, we were able to examine how COVID-19-related stressors and psychosocial protective factors were associated with harsh parenting. This study is an important contribution to the literature given that call-to-action papers on the impact of COVID-19 on mental health77 78 emphasise the importance of high-quality research aimed at identifying vulnerable populations and how mental health consequences can be mitigated.

Nonetheless, several limitations should be considered when assessing the findings. Changes in estimates of depression over time were not based on data for all provinces, and the baseline years for comparisons differed. We implicitly assumed stable estimates of depression across these early years (2015–2019). This assumption was supported by a sensitivity analysis of Ontario and Manitoba data, which found stable estimates of depression among adults from 2015 to 2019, followed by an upturn in the 2020 SCMH.16

The SCMH collects cross-sectional self-reported data. The extent of harsh parenting may be underestimated because of some respondents’ reluctance to disclose such behaviour. How this influences associations between depression and parenting is unknown.

The SCMH measured only one aspect of dysfunctional parenting—harsh parenting; questions about positive parenting and lax parenting were not asked. A recent meta-analysis concluded that links between depressive symptoms and parental behaviour are stronger if a composite measure of parenting that incorporates both positive and negative aspects is employed.20 The answer categories for all 10 items in the harsh parenting subscale were in the same direction from least to most harsh; this might have promoted ‘acquiescence bias’.

CCHS data were collected throughout the year, while SCMH data were collected from September to December in 2020 and from February to May in 2021. Therefore, comparisons of estimates over time are potentially subject to seasonality bias.79

The degree to which the SCMH response rates influenced associations between risk and protective factors and harsh parenting is unknown.

Conclusion

COVID-19 has had an unprecedented impact on Canadian families. After more than two decades of stability, rates of depression increased substantially. Furthermore, a strong association was observed between depression and harsh parenting. Since depression and dysfunctional parenting are associated with negative child outcomes,20 25 33–43 80 programmes aimed at identifying and treating parents with depression would be beneficial. When the parents in this study were being interviewed, COVID-19 cases, hospitalisations and deaths were rising. The psychological and economic repercussions of lockdowns have yet to be fully evaluated. Ongoing monitoring is needed to determine if elevated levels of parental depression persist beyond the pandemic.81 Furthermore, dysfunctional parenting behaviours can continue even after parents are no longer experiencing depressive symptoms.81 This underscores the importance of programmes aimed at bolstering parenting skills as families continue to face the challenges associated with COVID-19.

Data availability statement

Data may be obtained from Statistics Canada.

Ethics statements

Patient consent for publication

Ethics approval

Data for the CCHS and SCMH were collected by Statistics Canada under the provisions of the Statistics Act. Before participating in the surveys, respondents were informed that the information they provided would be used for statistical purposes, that their answers would be strictly confidential, and that their participation was voluntary. Respondents consented to reply to the survey and were asked for permission to share the information they provided with the Public Health Agency of Canada. Because this article is based on data from those share files, the project did not undergo ethics review. The SCMH underwent a privacy impact assessment and was reviewed by Statistic Canada’s internal ethics committee using the Necessity and Proportionality Framework.

Acknowledgments

The authors thank Dr. Leslie E. Roos for her advice and assistance with the parenting module included in the SCMH. HM was supported by the Chedoke Health Chair in Child Psychiatry.

References

Supplementary materials

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Footnotes

  • Twitter @DawnLiBlair

  • Contributors MS, LT and AG conceived of the project. MS, LT and LA decided on the analytical approach. MS conducted the analyses. MS, LT, AG, LA, D-LB, WH and HM interpreted the results. MS drafted and revised the document in response to feedback from LT, AG, LA, D-LB, WH and HM. MS is the guarantor for this study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.