*2.4. Statistical Analysis*

Statistical analysis was performed using SPSS Statistic 16.0 (IBM SPSS Statistics, New York, NY, USA). The descriptive statistics were analyzed and expressed as mean ± standard deviation or as median ± first third quartile for continuous variables, as appropriate; frequencies (%) were used for categorical variables. Clinical scale scores were expressed as a mean and standard deviation; the perception of usability of the questionnaire was expressed in percentages. We used linear regressions to calculate the univariate associations between two categorical variables. All tests were two-tailed, with a significance level of *p* < 0.05.

### **3. Results**

One hundred and ninety-two participants (96 parents: mean age ± SD: 44.62 ± 5.30 years; and 96 children: mean age ± SD: 11.81 ± 3.23) were included in the study. A more detailed description of the sample is reported in Table 1. All of the participants completed the online questionnaire, with good usability of the tool and without reporting excessive difficulties. In fact, both parents (89%) and children (94%) indicated that the questionnaire was easy to fill out.

As shown in Table 2, parents had higher levels of stress (SDC Questionnaire: 4.41 ± 4.1; DASS-21 S: 10.66 ± 4.3) and anxiety (DASS-21 A: 9.03 ± 4.1). The children reported higher mood depression (CDI: 24.04 ± 3.3) and anxiety (S.T.A.I.C. 1: 41.81 ± 4.9).


**Table 2.** Average of the clinical scale of caregivers.

Legend: DASS-21 S = Depression Anxiety Stress Scales—Stress; DASS-21 A = Depression Anxiety Stress Scales— Anxiety; DASS-21 D = Depression Anxiety Stress Scales—Depression; SDC Q= Stress for Distance learning in COVID-19 era Questionnaire; SUS Parents = System Usability Scale; CDI = Children Depression Inventory; S.T.A.I.C. 1 = State-Trait Anxiety Inventory for Children—State; S.T.A.I.C. 2 = State-Trait Anxiety Inventory for Children—Trait; SUS Children = System Usability Scale. Significant mean ± standard deviations are in bold.

Following linear regression analysis, there were no statistically significant differences in sex and age of the children, or in levels of anxiety (*p* = 0.621), stress (*p* = 0.116), depression (*p* = 0.756), or stress for DL (*p* = 0.324) in the parent group.

Parental stress was positively correlated with anxiety (*p* < 0.001), depressive symptoms (*p* < 0.001), and stress for DL (*p* = 0.004), whereas in children/adolescents, depression correlated with their anxious status (*p* < 0.001 for both tests). Furthermore, as the children got older, their depressive and anxious symptoms increased.

Parental depression symptoms were correlated with their children's anxiety symptoms (*p* = 0.03 for both tests). Moreover, parents' anxiety and stress were correlated with anxiety and depressive symptoms of their children (*p* < 0.01 for both tests). The stress for DL during COVID-19 in parents was associated with trait anxiety of their children/adolescents (*p* < 0.001).

Children's depression symptoms correlated with their parent's anxiety levels (*p* < 0.001) and stress (*p* = 0.01). A higher level of anxiety in children/adolescents was also positively correlated with parental stress (*p* = 0.003).

Finally, we observed that 61.5% of children/adolescents liked to use the DL system and would like to employ it in the future (54.2%), but they believed that this system was not the same as face-to-face lessons (60.4%).

As regards acceptance of the DL, we found high usability, as parents obtained an average score of 70.47 (SD 19.9) and children of 70.46 (SD 19.9).

### **4. Discussion**

In our study, we evaluated the psychological impact of COVID-19 on Italian children aged 5–16 and their parents, with regard to the use of DL. Our results showed that lockdown measures due to the COVID-19 have negatively affected the behavioral and emotional aspects of both children and parents. Regarding the well-being of children during the quarantine, our results underlined high levels of depressive symptoms and event-related anxiety, compared to the general population. This finding is in line with previous reports, which highlight an increase in emotional symptoms in children during periods of lockdown [6,9]. Moreover, our sample showed high levels of parents' anxiety and stress, as compared to the general population. The data are in line with previous studies [7–10], which have also been carried out in other countries [26,27]. Finally, the parental symptoms are related to the psychological symptoms of the children. Given that the presence of higher levels of stress and the onset of psychological problems in parents can adversely affect the psychological well-being of children [10–16], cooperation between parents and teachers is essential not only for educational purposes but also in the support of children [9,10]. For this reason, DL could be a good education tool in the lockdown phase, also considering that most of the children/adolescents liked the DL system and would like to use it in the future. Furthermore, both children and parents have declared high usability and acceptance of the DL.

To the best of our knowledge, few studies have been carried out to evaluate wellbeing in the parent–child dyad [5,7–10,28,29] during the pandemic, especially investigating the correlation between emotional symptoms (anxiety, depression, stress) of parents and children. However, the COVID-19 pandemic has significantly affected family daily life by changing established routines and presenting new educational challenges for parents and children. In particular, the restrictions on going out and the need to use DL have forced parents to spend many hours managing their children and the psychological problems deriving from the reduction of social activities. Parents and children faced an unknown situation with a highly stressful value, amplified by the media hype and by the uncertainty and fear of the virus [6]. Orgilés et al. [10] observed that 85.7% of parents perceived changes in their children's emotional state and behaviors during the quarantine. Moreover, parents had higher levels of anxiety and psychological distress, and lower levels of perceived selfcontrol and psychological well-being [4,5,7,8,11]. In particular, the risk of psychological distress is higher in parents of children with pre-existing psychological and behavioral difficulties, who require personalized teaching because of their special needs [4,7,30]. This aspect is particularly important in DL, where the presence of remote teaching can reduce the active involvement of the child, who also needs the parent to solve the technical problems

of the DL platforms [31]. This is why parents of children with intellectual disabilities present with a higher burden and stress.

Notably, in our study, nearly all parents responding to the questionnaire were females. These data are in line with the literature [7], demonstrating that the pandemic had a negative psychological impact on Italian mothers, who are mainly responsible for the child's management, especially regarding DL. Indeed, it has been shown that quarantine and COVID-19 restrictions can be perceived as an uncertain and threatening situation, capable of triggering symptoms of anxiety [32] and stress [33].

Furthermore, as observed by Cusinato et al. [7], our study shows that some sociodemographic and contextual variables can influence parental well-being. Particularly, the type of profession, such as freelancer or unemployment, is related to greater stress and anxiety. This is probably due to the economic uncertainties of these jobs that prevent them from finding the right strategies to deal with it.

According to our results, there is a positive association between the emotional symptoms of the parents (in particular the DL-related stress experienced in the COVID-19 period) and the depressive and anxious symptoms of the children. This further supports the idea that, in the parent–child dyad, there is a reciprocal enhancement of negative symptoms, which can affect the quality of life. Moreover, these data underline the mutual influence between the psychological health of children and parents [7].

It is, therefore, essential that both parents and children are considered in planning interventions in the family environment, avoiding isolated approaches. In fact, it has been shown that parents who have a better psychological adaptation can experience fewer difficulties in their parental role, and this in turn can positively affect the well-being of their children [7]. To this aim, the family should be considered from a systemic perspective, in which all family members mutually influence each other's adaptation, favoring the development of new resources that promote well-being even in difficult times, including pandemics [1,34]. This important approach may be of help when dealing with DL, which has revolutionized the way children learn and study, involving parents more than in previous times.

We believe that it is important to deepen these issues, as remote school and teleconferencing could be a useful resource when integrated with normal teaching, also considering their impact on the family context [1].

Another important result of our study is that we did not find statistically significant relationships between the child's age and sex and the levels of anxiety, stress, depression, and stress of their parents. However, it would be useful to explore this aspect in larger samples involving more male parents to confirm these results.

Despite the interesting results, our study has some limitations. First of all is the online modality to assess the participants. In fact, although it allowed us to reach a fair sample during the lockdown, it did not allow us to control for some contextual variables (such as noise or other distractions) or verify if the participants completed the questionnaire accurately. These potential biases due to the online survey indicate the need for some caution in interpreting the results. Our sample is not representative of fathers, because only 5.2% of the enrolled parents were males. Moreover, most participants had a median/high education, and this could represent a sample bias, as parents with lower education and incomes could have had worse outcomes. Finally, although the study confirmed a correlation between children's behavior and parents' well-being, we did not properly address the effects of confinement on parent–child relationships. Future surveys should address these important concerns.
