This study examined the social and psychological risk factors contributing to increased parenting stress amidst the COVID-19 pandemic, across countries. The results showed that, as we expected, parenting stress increased under the COVID-19 pandemic in all the Asian countries and the US compared to the pre-pandemic period. This study is the first to concurrently examine and compare parenting stress in three different Asian countries. We also found that there was originally a difference in PSI scores among countries regardless of the period, which has been discussed in detail later. However, India had the highest PSI scores, followed by the US of the sample countries. The mediation analysis showed that the number of ACE was strongly associated with higher parenting stress, and that anxiety and fear about the pandemic itself mediated the effect.
When we conducted this online survey in September-October 2020, the US and India were the first and second most infected countries globally, while Malaysia and Japan had relatively fewer cases than other countries where COVID-19 was prevalent. Nevertheless, both Malaysia and Japan showed an increase in parenting stress during the pandemic. Other studies conducted in Italy and Germany showed that parents experienced more parenting-related exhaustion due to social distancing as well as the closure of schools and child-care facilities, which manifested itself in increased parenting stress [14, 28]. However, these studies were conducted in countries with high numbers of infections and deaths, unlike Malaysia and Japan . Therefore, the present study suggests that the cause of increased parenting stress is likely not only from factors directly related to the severity of the COVID-19 pandemic, such as the high number of infections and deaths but also other factors. Many Asian countries, including Malaysia and Japan, repeatedly declared a lockdown, movement control order or state of emergency to combat the pandemic; schools were closed, activities were restricted, and many experienced social isolation [5, 40]. It is to be noted that the social environment changed drastically due to unemployment and telecommuting . The results of our textual analysis showed that the words “children,” “school,” and “time” were commonly reported as the specific stressors of the participants in every country. Although some participants viewed the situation in a positive light, reporting that they had “more family time since schools were closed and children spent more time at home,” many viewed it negatively, saying that “they had less free time and did not have time to relieve their stress.” The inflation of these inconveniences compared to the pre-pandemic era, and the maladaptation to new environmental changes, may have led to increased parenting stress. For example, Dickerson & Kemeny (2004) conducted a meta-analysis of the relationship between the characteristics of stressors and cortisol responses, and found that tasks containing uncontrollable elements were associated with robust cortisol reactivity . It is possible that in a situation where action is restricted worldwide, the physical symptoms of stress response, such as exhaustion, or changes in sleeping habits  are also seen, which may have led to an increase in parenting stress. However, there are some individual differences in tolerance to stressors. Individuals vulnerable to ambiguity are more stressed and rate their subjective well-being lower . The spread of COVID-19 can also be considered as an ambiguous situation, unlikely to be resolved immediately , and the adaptation to this situation may be affected by individual differences. Further identification of factors may be necessary for the future.
We also found that childhood adversity as well as anxiety and fear about COVID-19 were risk factors for increased parenting stress during the pandemic. If high parenting stress is a risk factor for child maltreatment, our results support the well-known theory concerning the intergenerational cycle in survivors who were exposed to maltreatment during childhood that leads them to maltreat their child after becoming a parent [26, 46]. In the mediation analysis, it was found that those with more ACEs were more likely to have increased anxiety and fear about the COVID-19 pandemic. A model for predicting parenting stress has been suggested from childhood adversity, anxiety and fear about COVID-19. Numerous studies suggest that individuals who have experienced many childhood adversities, are vulnerable to hypothalamic pituitary adrenal (HPA) axis responses and a variety of other psychiatric disorders . Kalia et al. reported that individuals who were maltreated as children, but were not exposed to other social adversities such as poverty, were associated with increased fear of COVID-19, which resulted in higher anxiety . Moreover, given that a higher number of ACE is linked to greater susceptibility to parenting stress, this influence may occur with additional reinforcement in this unusual situation. The simultaneous multi-population analysis revealed that this mediation model was not completely common in every country. Cultural differences may exist across countries. Guo et al. studied maternal mental health in China, Italy, and the Netherlands under the impact of the current pandemic and reported the protective effect of grandparenting support and higher number of children, on mental health symptoms of Chinese mothers, but not Italian and Dutch mothers. Protective/risk factors on maternal mental health may differ according to each country's socio-cultural background . Thus, the relationship between ACEs, anxiety and fear due to COVID-19, and parenting stress might be influenced by each country's socio-cultural background, including history, culture, ideology, and values. India and the US, where the influence of ACEs was profound, were the regions with the most significant spread of infections globally during the study (October 2020), where parents were more likely to be anxious about COVID-19. Those who had ACEs and were highly vulnerable to stress were more likely to be affected emotionally by their childhood adversity in situations where the infection rate had substantially increased such as India and the US. It is possible that the link between the ACEs and anxiety and fear in these countries appeared stronger than in Malaysia and Japan. It appears that the pandemic situation and lockdown will continue intermittently. Above all, when the infection rates rise, social support and mental health care would be required, especially for individuals with more ACEs than usual.
Furthermore, our data indicated that the original level of parenting stress differed in each country, and India had the highest level. In some areas in India, the standard of living remains low ; thus, economic poverty may have been directly related to high parenting stress. Furthermore, insufficient mental health care systems , labor shortages, high population densities that make it easier for infections to spread, and shortages and price surges of face masks and other protective equipment may also have contributed to the high levels of parenting stress . Moreover, it was noticed that many of the respondents in India were men (64%). Under the pandemic, men's burden of housework and childcare may have increased. In contrast, several studies have reported that COVID-19 has increased the psychological burden on Indian women [52, 53]. Traditionally, there is a longstanding concept of “patriarchy” in certain parts of India, a family structure in which the father has absolute power and control over family members. Therefore, Indian women and children tend to internalize distress from an early age, based on the socially accepted notion that externalizing feelings is unacceptable . The extra stress caused by the unexpected pandemic added to the original oppressive stress may result in a higher level of parenting stress than in other countries. Parenting stress in the US was the second-highest after India, probably because the US has been the world's leading country in terms of the number of infections and deaths for an extended period . This may lead to a high level of anxiety about the threat to life directly related to COVID-19 infection.
The present study has four major research limitations. First, it did not have a consistent online survey platform across countries. India and the US used Amazon Mturk, Japan used CrowdWorks, and Malaysia did not use any online worker pool. As a result, there was a bias in the number of participants and their characteristics among the countries. However, the online survey itself was effective as it allowed us to promptly collect a large amount of data in a short period because of the ever-changing situation due to the COVID-19 pandemic and the period of social distancing and self-isolation. Second, we did not match age and gender across the countries. There is a report that Mturk workers are predominantly male . In this instance, the percentage of males was high in India and the US. Third, the evaluation instrument was a self-administered questionnaire, leading to a bias toward socially desirable answers. Although there is a problem of accuracy, since online behavioral experiments are now available , a more objective evaluation could have been made if such experiments were utilized. Finally, the assessment of parenting stress before the pandemic was conducted using a retrospective response method. Although the reliability of retrospective response methods may be questioned as the data is limited to individual data, it is more consistent at the population level . Therefore, we did not use retrospective response methods in our analysis except when comparing before and after the pandemic. Longitudinal studies in particular, should be conducted prospectively. However, as we had to capture response promptly due to the unpredictable situation, this method was unavoidable.
In the present study, we found that parenting stress increased in the three Asian countries and the US during the COVID-19 pandemic. Higher number of ACEs were strongly associated with increased parenting stress, an influential risk factor across countries. Anxiety and fear about the COVID-19 pandemic also mediated the effect. ACEs may lead to vulnerable parenting and trigger stress responses which induce child maltreatment, which can be aggravated by a negative unprecedented situation. In addition to examining the caregivers' current state, a retrospective assessment of past adversity experiences is warranted, because it can be expected to capture the risk of maltreatment more closely representative of the actual situation. A focus on ACEs to provide more accurate support for parents and their evaluation should also be considered.