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Parental anxiety and decision-making on return to school

Author(s): By Donna Hallas PhD, PPC-NP, CPNP, PMHS, FAANP, FAAN

COVID-19 has disrupted every portion of our ‘normal lives.’ It has exacerbated the mental health problems of parents and especially those parents who are responsible for the care of infants, young children and school-age children.1 The Canadian investigators, report that parents of young children are experiencing a three to five-fold increase in anxiety and depression symptoms1. Anxiety leads to fear and many parents, who are experiencing high levels of anxiety, may be overwhelmed by loss of employment, the uncertainties of what will happen when unemployment benefits are no longer available, concerns about finding jobs in a ‘new world’ for which they may need a new skill-set, food insecurity for themselves and their families, and overall fear of what the future holds. Decision-making during high levels of anxiety create additional stressors. Parents facing personal mental health diagnoses of anxiety or depression may also be experiencing a difficult time in the decision-making for their children, and in particular, on the topic of whether their children should or can return safely to school or daycare.

When most of the country went on pause in March 2020, parents suddenly were working from home and simultaneously attempting to guide their children’s education from home. Some parents experienced increased anxiety based on new, unprecedented stressors. Parents with a known diagnosis of depression prior to COVID-19, experienced increased feelings of depression that affected both their personal feelings and their child’s daily lives. Now, five and one-half months after COVID-19 impacted their lives, parents are faced with new decisions about their child’s education and are feeling anxious and have increased feelings of depression as they struggle with their decision about their children’s education. Parents are trying to determine what is best for themselves and their children’s education: 1). at home – all online; 2). hybrid, or 3). full in-person model. While educational opportunities vary by states and communities, parents are working hard to determine what’s right for their children and personal circumstances.2 However, parents who are experiencing anxiety and depression may not feel prepared to make return to school decisions. This is especially true for parents who have not had treatment their anxiety or depression during the pandemic. Additionally, children exposed to parents with anxiety and depression are more likely to experience mental health problems themselves, which may translate into learning problems and possible long term mental and behavioral health problems.3

How can we help parents who have personal mental health problems exacerbated by COVID-19 and newly emerging mental health problems as a result of COVID-19? How can we help parents and children who are experiencing mental and behavioral health problems related to COVID-19? Primary care NPs and midwives may be the first to encounter parents who are expressing anxiety or symptoms of depression. It is our responsibility to screen parents for anxiety and/or depressive symptoms and to screen the children. Individuals with positive screening results should be referred for treatment as soon as possible. Telemedicine appointments are the new norm for psychiatric mental health appointments and NPs should establish practice connections to enable an easy referral for adult and pediatric patients who need referrals.

Decision-making is anxiety producing for parents and in particular for the decision on return to school for their children. The discussion should focus on The Center for Disease Control (CDC) has guidelines for K through 12 decision making for parents on return to school.4 Other resources for NPs and midwives on the topic for a call to action on return to school and recommendations for all schools to have a school nurse are also available for all healthcare providers and for parents to enable better decision making by parents.5,6

As we work together to identify adults and children experiencing anxiety and depression during COVID-19, we can help parents by knowing where to refer parents to help them make the best personal decision for their household and their children.


  1. Tomofohr-Madsen, L., & Roos, L.E. Parental depression, anxiety during COVID-10 will affect kids too. Accessed August, 25, 2020. Published August 17, 2020. Retrieved from https://www.healthing.ca/mental-health/parental-depression-anxiety-during-covid-19-will-affect-kids-too

2. Miller, A., & Lafrance, A. Back to school during COVID-19. Psychology Today. Accessed August 25, 2020. Published August 6, 2020. Retrieved from https://www.psychologytoday.com/us/blog/what-say-kids/202008/back-school-during-covid-19

3. Tomofohe-Madsen, L. & Roos, L. Family mental health crisis: Parental depression, anxiety during COVID-19 will affect kids too. Medical Press. Accessed August 25, 2020. Published August 17, 2020.

4. Center for Disease Control and Prevention. School decision-making tool for parents, caregivers, and guardians. Accessed August 25, 2020. Published July 23, 2020. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/decision-tool.html

5. Hallas, D., Spratling, R., Cupelli, E.,T. Safe return to school: A call to action. Accessed August 24, 2020. Published August 5, 2020. Retrieved from https://www.contemporarypediatrics.com/view/safe-return-to-school-a-call-to-action

6. Koslap-Petraco, M. Taub, A. & Hallas, D. Safe return to school. Part 2. Accessed August 24, 2020. Published August 19, 2020. Retrieved from https://www.contemporarypediatrics.com/view/safe-return-to-school-part-2

Donna Hallas PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN is a certified as a pediatric nurse practitioner and pediatric primary care mental health specialist. She is a Clinical Professor and Director of the PNP program at New York University Rory Meyers College of Nursing. She has presented nationally and internationally on numerous research and clinical topics with the overall goal of improving health care outcomes for infants, children, adolescents and young adults. 

Her first book, Behavioral pediatric healthcare: A growth and developmental approach to intercepting abnormal behaviors, earned the prestigious American Journal of Nursing 2018 Book of the Year Award earning first place for Psychiatric and Mental Health Nursing and third place for Child Health.

Dr. Hallas is a digital editor for Contemporary Pediatrics and writes a monthly commentary which focuses on applying information in one or more journal articles to pediatric clinical practice. Here is a link to the PNP corner www.contemporarypediatrics.com/pnp-corner.

Dr. Hallas’ most recent research focuses on vaccine hesitancy. She and colleagues designed a web-based intervention study using the concepts of informed decision making and the influence of social media. The study was conducted using two populations: pregnant women  and mothers of newborns and young infants to determine the effectiveness of population-specific web-based interventions to reduce the incidence of vaccine hesitancy (Hallas, Altman, & Fletcher, 2018). The study was statistically significant for prenatal women and approached statistical significance for mothers of newborns and young infants. 

Please click on this link for a brief discussion by Dr. Hallas on vaccine hesitancy and the most recent measles outbreak: https://www.nyu.edu/about/news-publications/news/2019/october/one-question–why-do-some-parents-hesitate-to-vaccinate-their-ch.html.

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