Associations Between Mothers' COVID-Related Perceived Stress and Children's Internalizing and Externalizing Symptoms in Peru

Emily J Blevins; Yinxian Chen; Elena Sanchez; Marta B Rondon; Sixto Sanchez; Bizu Gelaye; Archana Basu

doi:10.1007/s10578-025-01872-w

Associations Between Mothers' COVID-Related Perceived Stress and Children's Internalizing and Externalizing Symptoms in Peru

Child Psychiatry Hum Dev. 2025 Jun 27. doi: 10.1007/s10578-025-01872-w. Online ahead of print.

Authors

Emily J Blevins¹, Yinxian Chen^{2

3}, Elena Sanchez⁴, Marta B Rondon⁵, Sixto Sanchez⁵, Bizu Gelaye^{2

6}, Archana Basu^{7

2}

Affiliations

¹ Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. ejblevins@mgh.harvard.edu.
² Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, USA.
⁴ Asociación Civil PROESA, Lima, Peru.
⁵ Facultad de Medicina, Universidad San Martin de Porres, Lima, Peru.
⁶ Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
⁷ Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 40571864
DOI: 10.1007/s10578-025-01872-w

Abstract

During the COVID-19 pandemic, parents in low- and middle-income countries (LMICs) faced greater income loss, high fatality rates, and less accessible healthcare. Peru reported the highest COVID-19 mortality rate globally; yet no known study in Peru has examined the unique impact of COVID-related stressors on parents or their children's behavioral health. Cross-sectional data were drawn from 672 mothers (mean age = 32.5) on COVID-related perceived stress, as part of a longitudinal birth cohort. Factor analyses of COVID-related perceived stress identified three domains which were used in multivariate logistic regression to examine associations with children's (mean age = 7.6; 50.9% boys) internalizing and externalizing symptoms. Mothers reported worries about contracting COVID-19 (86%), losing a job/income (73%), family/friend dying (63.8%), and food intake (60%). Economic insecurity (OR_int = 1.38 [1.13, 1.68]; OR_ext = 1.99 [1.55, 2.58]) and physical and mental health worries (OR_int = 1.77 [1.44, 2.18]; OR_ext = 1.88 [1.46, 2.44]) were positively associated with children's symptoms. This is one of the few LMIC-based studies that examines the prevalence of COVID-19 perceived stress among mothers and how perceived stress relates to children's behaviors and emotions during the COVID-19 pandemic. Implications are discussed for improving parent-child well-being in LMICs with high rates of COVID-19 disease and death.

Keywords: COVID-19; Externalizing behaviors; Internalizing symptoms; LMIC; Parenting stress.

Abstract

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