Parent Child Relationship During COVID-19 in Saudi Arabia

Background: Coronavirus disease in 2019, also known as COVID-19, is a respiratory disease that is cause by Severe Acute Respiratory Coronavirus 2. In March 2020, the World Health Organization Declared the disease as a pandemic. Social Distancing is to prevent the transmission of the virus from the asymptomatic persons, who are not yet isolated. Aim: To measure the parent-child relationship during the COVID-19 Social Distancing in Saudi Arabia. Method: A cross sectional survey study, done from 2020 April to July and shortly after the quarantine was stopped. Questionnaire used was the short version of a validated survey created by Robert Pianta to assess the parents-child relationship during and before the quarantine period in the western part of Saudi Arabia, mainly Jeddah and adjacent cities. Result: Total participants were 377, and the mean age of the parents is 37 years. On average, parents have from 1-3 children. The mean average number of hours parent stayed with their children before the Social Distancing was 8 hours and this increased to 12 hours after Social Distancing. Women tend to have average number of hours stayed with children higher than men. Comparing the closeness score and con�ict score between before the Quarantine and after it showed a statistically signi�cant more con�ict before the Quarantine than after it. It was higher among female parents compared to male parents. For closeness there was no statistical signi�cance as both scores were close to 31. Conclusion: There is a statistical signi�cance improve in the closeness between parents and their children after the COVID-19 social distancing and more time spent with them. However, the con�ict between mothers and their children were less comparing before and during the quarantine.


Introduction
Coronavirus disease in 2019, also known as COVID-19, is a respiratory disease that is cause by Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2).The disease was rst discovered in Wuhan wet market (Hubei, China) and then spread all-over the word. 1,2In March, 2020 the World Health Organization Declared the disease as a pandemic. 1,2During the pandemic, countries started to isolate the ill, quarantine the exposed to the ill and apply community containment measures that include social distancing. 3Social Distancing is reducing the interactions among the community to prevent the transmission of the virus from the asymptomatic persons, who are not yet isolated. 3e psychological effects of the quarantine on 15,000 during SARS outbreak in Toronto showed increase risk of developing major depression and post-traumatic stress disorder (PTSD). 4Another study found that people at risk of developing PTSD were more to be healthcare provider or those who are immediately affected by the disease. 5ike many other countries, Saudi Arabia was affected by COVID-19 in many aspects; economically, health care related, educational and psychological aspects.The relationship between parents and their children is well studied in previous research and has a dedicated scale to measure it such as Parent-Child Relationship Scale. 6However, our literature search found that there is no study that explore the parentchild relationship in Saudi Arabia.Therefore, in this study, we decide to measure the parent-child relationship during the Social Distancing in Saudi Arabia by using the Parent-Child Relationship Scale (CPRS) by Robert Pianta and comparing with the same scale before the Social Distancing. 6thods This is a cross sectional survey study that was done at during the quarantine of COVID-19 (from 2020 April to July) and shortly after the quarantine was stopped.We used the short version of a validated survey created by Robert Pianta 6 to assess the parents-child relationship during and before the quarantine period in the western part of Saudi Arabia, mainly Jeddah and adjacent cities.The survey was translated from English to Arabic using the World Health Organization (WHO) front-to-back translation by a committee.The survey was piloted on 14 subjects and Cronbach's score was more than 0.7.
Institutional Review Board was obtained from King Fahad Armed Forces Hospital in Jeddah and informed consents were obtained from subject before the data collection.The survey consists of 15 question items that has a ver Likert scale answer (strongly disagree, disagree, neutral, agree & strongly disagree).The survey was sent online, lled through telephone interviews or lled through face to face interview with participants.Participants were recruited conveniently from King Fahad hospitals psychiatry outpatients' clinics/the telephone services for patients during quarantine, through people in Jeddah malls or through snowball sampling by getting telephone number from participants we already sampled.
Sample size was calculated to be 377 subjects for 95% con dence interval and 5% margin of errors.The data were entered through Google Form, cleaned and analyzed using IBM SPSS Statistics version 26.

Descriptive Statistics:
The mean age of the parents is 37 years with minimum of 19 years old, maximum of 64 years old, and standard deviation of 7.7 years, see Fig. 1.On average, parents have from 1-3 children with some parent have only one child and other have more than 3 reaching to 9 kids per family, see Fig. 2.
The mean average number of hours parent stayed with their children before the Social Distancing was 8 hours and this increased to 12 hours after Social Distancing.Women tend to have average number of hours stayed with children higher than men (8.4 vs. 6 hours) while after Social Distancing it was increased for both (13.7.hours for women vs. 9.17 for men), see Figs. 4 & 5.More than 90% of the participants were married, 7% are divorced, and only 1.4% are widowed.Around 50% of the children whom their parent participated were boys and 42% were girls, see Table 1.Before the Social Distancing the con ict score mean was 24 and after the Quarantine it became 20 while for the con ict score it was almost the same before and after at 31.

Inferential Statistics:
When the number of hours spent with children are compared between men and women before the pandemic, women tend to stay longer than men (8.3 vs. 6.0,P-value 0.05), see Fig. 3.After the pandemic, the rate increased for both gender (9.17 vs. 13.91 hours p-value is < 0.001), see Fig. 4.
Comparing the closeness score and con ict score between before the Quarantine and after it showed the following.Paired t test was statistically signi cant (p-value < 0.001) between con ict before the quarantine and during it.There was more con ict before the Quarantine than after it.
For closeness, paired t test didn't show any statistically signi cance as both scores were close to 31 (pvalue 0.266).When con ict score during the Quarantine was tested against the parent gender, con ict was higher among female parents compared to male parents (20 vs. 18).Independent t test was done and showed statistical signi cance (p-value < 0.001)

Discussion
The quarantine and Social Distancing had a tremendous effect on families.Many countries applied the wide lock down on many cities to control the spread of COVID-19 As a result, many people were laid off, forelaughed or have their business shot down.This led to signi cant psychological stress on people and families due to restriction in movement and staying homes for long time.
Figure 2 shows the majority of the parents have from 1-3 children with the mean age of the parent is 37 years old.Because more than 50% of our sample was obtained through the Social Media, this might justify the quite younger population of the sample.The average number of children in the family indicates the average size of the Saudi family (1-3) for such age group.The Western region of Saudi Arabia, Makkah Almukarammah region, where our study took place has one of the highest population in the country.A study found that fourth of the Saudi households are present in the Western region while other fourth is in Riyadh region. 7Another report showed that in Saudi around 3/5 of the population live in major cities. 8 Calculating the con ict and closeness score depends on the total population of the sample and increased number of hours the parent stayed with their children.As expected from the Saudi Arabia culture, women were more likely to stay with their children and during the quarantine this was even more obvious.
Con ict score was higher before the Quarantine than during it for both group (statistically signi cant) but it was more obvious for females than males.Although females stayed longer hours with their children during the lock down and the con ict score was expected to be higher due to stress but our result showed the opposite.This might indicate parents need enough time with their children to have a better relationship.Closeness score was the same before and after the quarantine for both genders.

Figure 1 Age of the Parents Figure 2 Average
Figure 1

Table 1
Gender of the Children