The Psychosocial Impact of the COVID-19 Pandemic on Italian Families: The Perception of Quality of Life and Screening of Psychological Symptoms

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study addresses, in line with a rich literature from 2020 to 2022, the issues related to the well-being and mental health of children, adolescents and parents in the immediate post-covid era; the authors, in fact, wanted to verify the psychosocial impact of the covid 19 pandemic on Italian families; in particular, they focused attention on psychological symptoms, such as anxiety, anger... and on the perceived of quality of life.

The most interesting aspect of this study is the comparison between children’s self reported perception of quality of life and the perception reported by  their parents (proxy-report); in fact, the data on discrepancy between children and parents perception of QoL is very interesting. These data should be discussed more and better interpreted.

Certainly the article presents two important limitations declared by the authors themselves: there are no data  from the children and parents  participants regarding the pre-pandemic period; so all the reflections  lose strength; furthermore, parents are mostly mothers

It is not possible to intervene on these limitations of the study, however, I believe it is necessary for the authors to improve some aspects:

- The participants belong to different Italian regions, but no reference appears: which regions? have you considered the different impact of covid in the different Italian regions?

- The introduction must be deepened with relevant literature: for example, there have been studies that have highlighted the impact of parental stress during the pandemic on the perception of children's abilities, such as executive functions; this literature should also be recovered

Comments on the Quality of English Language

Minor editing of English language required

Author Response

- The participants belong to different Italian regions, but no reference appears: which regions? have you considered the different impact of covid in the different Italian regions?

To ensure anonymity and prevent the identification of participants, specific data about their region of origin were not collected; only their affiliation with the Veneto region or otherwise was requested. For this reason, it was not possible to investigate the impact of COVID in the different Italian regions.

Change to line 122

- The introduction must be deepened with relevant literature: for example, there have been studies that have highlighted the impact of parental stress during the pandemic on the perception of children's abilities, such as executive functions; this literature should also be recovered

Addition to line 72: Moreover, it is related to their perception of children’s executive functions (EFs): the most distressed parents perceived their children as less competent in EF, highlighting a cognitive fragility on attention, memory, and self-regulation.

- Minor editing of English language required

We revised English with the software Writefull

 

Reviewer 2 Report

Comments and Suggestions for Authors

Psychosocial Impact of the COVID-19 Pandemic on Italian Families: Perception of Quality of Life and Screening of Psychological Symptoms

This study explores the psychosocial effects of the COVID-19 pandemic on Italian families using self- and proxy-report questionnaires on anxiety, anger, and health-related quality of life. The results showed that approximately 20% of participants obtained a clinical anxiety score, while only 10% obtained a clinical anger score. A significant difference was found between the perception of quality of life reported by children and that perceived by parents. The stepwise regression model indicated that total anxiety scores were predicted by sex, parents' self-reported quality of life scores, and total anger scores. Another stepwise regression model identified physiological and social anxiety as the best predictors impacting the quality of life. Parental well-being actively influences the well-being of children.

1.     There is some missing elements in the summary: A conclusion is absent. Also, recommendations for future research in this area are missing.

 

2.     Introduction: I know there is extensive literature on this subject, and a better selection of references should be made. In any case, the introduction needs to be enriched with more studies on this topic.

 

 

3.     Line 120: "The data necessary for this study were collected between April and June 2022 by psychology students." Specify that the data were collected through personal meetings with psychology students.

4.     Line 129: Revised Children’s Manifest Anxiety Scale.
Line 139: ChIA
Line 160: PedsQoL 3.0 Multidimensional Fatigue Scale.

5.     For all these instruments, no reliability and validity values are presented. This is a crucial part of the methodology and a significant weakness of this research.

6.     Line 389: Discussion. The main limitation of this study is its small sample size.

7.     Additionally, this study does not present suggestions for future research in this area, which is important.

8.     Practical implications for parents and specialists should also be added.

9.     Overall, more relevant publications, critical analysis, and comparisons need to be included in the discussion section.

Comments on the Quality of English Language

.

Author Response

1. There is some missing elements in the summary: A conclusion is absent. Also, recommendations for future research in this area are missing.

Change to line 438: These research perspectives could contribute to a better understanding of the long-term effects of COVID-19 on the mental health of young people and their families through longitudinal studies. The development and effectiveness of specific interventions for anger management in young people during stressful situations, such as those caused by the pandemic, could also be deepened. These interventions could be designed to improve emotion regulation skills and reduce internalized anger, with a focus on anxiety and psychological well-being. Additionally, studying the relationship between these variables and further information regarding the health status of parents could provide valuable insights into how different psychological issues in parents influence their children. Future research could also include data on specific clinical populations to understand how the COVID-19 pandemic has affected well-being and mental health across various groups.

Change to line 451: To conclude, it is essential to pay attention to the mental health of children and their parents. The well-being of parents has a direct influence on that of their children; therefore, in prevention and well-being promotion programs for children, it is crucial to also consider the role of parents to provide them with adequate support to cope with stress and improve their own well-being. This study has also highlighted that anger is strongly correlated with anxiety, which in turn is linked to quality of life. Consequently, in prevention and well-being promotion programs, it is important to consider these interconnections and to organize comprehensive interventions that include the management of externalizing symptoms such as anger to prevent the onset of anxiety symptoms.

2. Introduction: I know there is extensive literature on this subject, and a better selection of references should be made. In any case, the introduction needs to be enriched with more studies on this topic.

 We add new references in the introduction.

3. Line 120: "The data necessary for this study were collected between April and June 2022 by psychology students." Specify that the data were collected through personal meetings with psychology students.

Change to line 120: The data necessary for this study were collected between April and June 2022 through personal meetings with psychology students at the University of Padua referring to different regions of the country.

4. Line 129: Revised Children’s Manifest Anxiety Scale.

Line 139: ChIA

Line 160: PedsQoL 3.0 Multidimensional Fatigue Scale.

 We revised as you suggested

5. For all these instruments, no reliability and validity values are presented. This is a crucial part of the methodology and a significant weakness of this research.

Addition to Line 136: Designed as a self-administered instrument using “yes” and “no” questions, this instrument has been validated and found reliable for use in children, with norms reported in 3 age groups: 6-18, 9-14, and 15-19 years.

Addition to Line 141: Reliability of the scales and subscales of the RCMAS-2 is reported via Cronbach alpha as follows: 0.92 for TOT, 0.75 for PHY, 0.86 for Worry, and 0.80 for Social Anxiety. The Cronbach alpha estimate for the RCMAS-2 represented homogeneity of the instrument items and scale scores and was adequate in reliability. Validity of the RCMAS-2 was established via interscale correlations with moderate to high ranging from 0.59 to 0.73 for the Anxiety scales and 0.83 to 0.93 for the scales and TOT. (Filce, H. G., & LaVergne, L. (2015). Absenteeism, educational plans, and anxiety among children with incontinence and their parents. Journal of School Health, 85(4), 241-250.)

Addition to Line 180: The ChIA's internal consistency reliability was evaluated using coefficient alpha. In a study involving 1604 young participants, impressive values were obtained, with coefficients of 0.95 for the total scale and 0.85–0.86 for each of the four subscales. Additionally, test-retest reliability was assessed in a sample of 87 children aged 6–11 over a 1-week interval, resulting in a coefficient of 0.75 for the total scale and ranging from 0.65 to 0.75 for the subscales. Furthermore, content validity for the instruments was deemed satisfactory based on feedback from professionals who used the scale, while concurrent validity was established through examination of the ChIA's relationship with other measures.

6. Line 389: Discussion. The main limitation of this study is its small sample size.

Change to line 387: A final limitation is that the responses to the items of the various tests and questionnaires administered to the subjects may have been influenced by social desirability bias. Participants might have altered their responses due to concerns about presenting a negative or overly problematic image of themselves. Additionally, the small sample size is another limitation to consider.

7. Additionally, this study does not present suggestions for future research in this area, which is important.

Change to line 438: These research perspectives could contribute to a better understanding of the long-term effects of COVID-19 on the mental health of young people and their families through longitudinal studies.

Line 444: Additionally, studying the relationship between these variables and further information regarding the health status of parents could provide valuable insights into how different psychological issues in parents influence their children. Future research could also include data on specific clinical populations to understand how the COVID-19 pandemic has affected well-being and mental health across various groups.

8. Practical implications for parents and specialists should also be added.

Change to line 451: To conclude, it is essential to pay attention to the mental health of children and their parents. The well-being of parents has a direct influence on that of their children; therefore, in prevention and well-being promotion programs for children, it is crucial to also consider the role of parents to provide them with adequate support to cope with stress and improve their own well-being. This study has also highlighted that anger is strongly correlated with anxiety, which in turn is linked to quality of life. Consequently, in prevention and well-being promotion programs, it is important to consider these interconnections and to organize comprehensive interventions that include the management of externalizing symptoms such as anger to prevent the onset of anxiety symptoms.

9. Overall, more relevant publications, critical analysis, and comparisons need to be included in the discussion section.

We included and critically analyze more relevant publications in the discussion section