• Ruziana Masiran Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
  • Normala Ibrahim Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
  • Hamidin Awang Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
  • Poh Ying Lim Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
Keywords: Behaviour problem, Covid-19, Lockdown, Mothers, Pandemic, Psychological Distress


The spread of COVID-19 and its subsequent social distancing measures carried a significant psychological burden on many parents worldwide. This study was done to determine the prevalence and factors associated with psychological distress experienced by mothers of children with emotional and behavioral problems (EBP) during the lockdown period in Malaysia. An online survey using purposive sampling technique was conducted. Psychological distress was determined by DASS-21 scores. Prevalence of stress, anxiety, and depressive symptoms among mothers of children with EBP during the pandemic in Malaysia was 36.4%, 43.6%, and 30.9%, respectively. Mothers with a total monthly income of ≤ RM 999 were 25 times more likely to have stress symptoms (OR = 25.275, 95% CI = 1.17 – 547.41) and ten times more likely to have depressive symptoms (OR = 10.289, 95% CI = 1.17 – 90.88). Mothers with lower incomes are more psychologically vulnerable to the pandemic impact.


Killgore WDS, Cloonan SA, Taylor EC, N.S. D. Loneliness: A signature mental health concern in the era of COVID-19. Psychiatry Res. 2020; 290:113117.

Tommasi M, Toro F, Arnò S, Carrieri A, Conte MM, Devastato MD, et al. Physical and Psychological Impact of the Phase One Lockdown for COVID-19 on Italians. Front Psychiatry. 2020; 11:563722.

Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res. 2020; 293:113429.

Killgore WDS, Cloonan SA, Taylor EC, Allbright MC, Dailey NS. Trends in suicidal ideation over the first three months of COVID-19 lockdowns. Psychiatry Res. 2020; 293:113390.

Chung G, Lanier P, Wong PYJ. Mediating Effects of Parental Stress on Harsh Parenting and Parent-Child Relationship during Coronavirus (COVID-19) Pandemic in Singapore. J Fam Violence. 2020.

Luttik MLA, Mahrer-Imhof R, García-Vivar C, Brødsgaard A, Dieperink KB, Imhof L, et al. The COVID-19 Pandemic: A Family Affair. J Fam Nurs. 2020; 26(2):87–9.

SESRIC. Socio-Economic Impacts of Covid-19 Pandemic in OIC Member Countries: Prospects and Challenges. 2020. 42.

Oreopoulos P, Page ME, Stevens AH. Does human capital transfer from parent to child? The intergenerational effects of compulsory schooling. NBER Work Pap. 2003; 24(4):729–60.

Gromada A, Richardson D, Rees G. Childcare in a global crisis: the impact of COVID-19 on work and family life. Innocenti Res Br. 2020; (Covid-19 & Children):1–11.

Adisa TA, Aiyenitaju O, Adekoya OD. The work–family balance of British working women during the COVID-19 pandemic. J Work Manag. 2021; 13(2): 241-60.

Kuehner C. Why is depression more common among women than among men? The Lancet Psychiatry. 2017; 4(2):146–58.

Afonso P. The impact of the COVID-19 pandemic on mental health. Acta Med Port. 2020; 33(5):356–7.

Hou F, Bi F, Jiao R, Luo D, Song K. Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China:a cross-sectional study. BMC Public Health. 2020; 20(1):1–11.

Ping L, Id W, Alias H, Fuzi AA, Omar IS, Nor AM, et al. Escalating progression of mental health disorders during the COVID-19 pandemic : Evidence from a nationwide survey. PLoS One. 2021; 16(3):e0248916. https://doi: 10.1371/journal.pone.0248916.

Institute for Public Health (IPH). (2020). Mental Health Status of Stable Hospitalized COVID-19 Patients at the Main Hospitals in Malaysia (MentalStatCOVID).

Cameron EE, Joyce KM, Delaquis CP, Reynolds K, Protudjer JLP, Roos LE. Maternal psychological distress & mental health service use during the COVID-19 pandemic. J Affect Disord. 2020; 276:765–74.

Kansal K. Qualitative Analysis of Covid-19 on Working Women. Int J Sci Res Publ. 2020; 10(6):41–4.

Hosna AU, Sazali P, Wahab A, Hamid M, Hasanat MW, Haque A, et al. Impact of Mental Pressure and Coronavirus ( Covid-19 ) on the Work Performance of Working Mothers of Bangladesh. Am Int J Bus Manag. 2020; 3(12):63–9.

Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents’ Stress and Children’s Psychological Problems in Families Facing the COVID-19 Outbreak in Italy. Front Psychol. 2020; 11:1713.

Petrocchi S, Levante A, Bianco F, Castelli I, Lecciso F. Maternal Distress/Coping and Children’s Adaptive Behaviors During the Covid-19 Lockdown: Mediation Through Children’s Emotional Experience. Front. Public Heal. 2020; 8: 587833.

Meltzer H, Ford T, Goodman R, Vostanis P. The Burden of Caring for Children with Emotional or Conduct Disorders. Int J Family Med. 2011; 2011:801203.

Cantiani C, Dondena C, Capelli E, Riboldi EM, Molteni M, Riva V. Effects of COVID-19 lockdown on the emotional and behavioral profiles of preschool Italian children with and without familial risk for neurodevelopmental disorders. Brain Sci. 2021; 11(4):477.

Takahashi F, Honda H. Prevalence of clinical‐level emotional/behavioral problems in schoolchildren during the coronavirus disease 2019 pandemic in Japan: A prospective cohort study. JCPP Adv. 2021; 1:e12007.

Marsh S, Dobson R, Maddison R. The relationship between household chaos and child, parent, and family outcomes: A systematic scoping review. BMC Public Health. 2020; 20:513.

Noh JW, Kim KB, Park J, Hong J, Kwon YD. Relationship between the number of family members and stress by gender: Cross-sectional analysis of the fifth Korea National Health and Nutrition Examination Survey. PLoS One. 2017; 12(9):e0184235.

Nye FI, Carlson J, Garrett G. Family Size, Interaction, Affect and Stress. J Marriage Fam. 1970; 32(2):216-26.

Goux D, Maurin E. The Effect of Overcrowded Housing on Children’s Performance at School. Assessment. 2004;(March):1–35.

Solari CD, Mare RD. Housing Crowding Effects on Children;s Wellbeing. Soc Sci Res. 2012; 41(2):464–76.

Thibaut F, van Wijngaarden-Cremers PJM. Women’s Mental Health in the Time of Covid-19 Pandemic. Front. Glob Women’s Heal. 2020; 1:588372.

Gomez R, Suhaimi AF. Incidence rates of emotional and behavioural problems in Malaysian children as measured by parent ratings of the Strengths and Difficulties Questionnaire. Asian J Psychiatr. 2013; 6(6):528–31.

Musa R, Fadzil MA, Zain Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN J Psychiatry. 2007; 8(2):82–9.

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories Behav Res Ther. 1995; 33(3):335–43.

Horng WB, Lee CP, Chen CW. Classification of age groups based on facial features. Tamkang J Sci Eng. 2001; 4(3):183–92.

Department of Statistics Malaysia. Household Income & Basic Amenities Survey Report 2019. Press Release. 2020.

United Nations. Household size and composition around the world. Vol. 2, Economic & Social Affairs. 2017.

International Labour Office. International Standard Classifi cation of Occupations: Structure, group definitions and correspondence tables. Vol. I. Geneva; 2012.

Imran N, Zeshan M, Pervaiz Z. Mental health considerations for children & adolescents in covid-19 pandemic. Pakistan J Med Sci. 2020; 36(COVID19-S4):S67–72.

Jeharsae R, Jae-noh M, Jae-a-lee H, Waeteh S, Nimu N, Chewae C, et al. Associations between Stress and Child Verbal Abuse and Corporal Punishment during the COVID-19 Pandemic and Potential Effect Modification by Lockdown Measures. medRxiv. 2021.

Morelli M, Cattelino E, Baiocco R, Trumello C, Babore A, Candelori C, et al. Parents and Children During the COVID-19 Lockdown: The Influence of Parenting Distress and Parenting Self-Efficacy on Children’s Emotional Well-Being. Front Psychol. 2020; 11:584645.

Sundarasen S, Chinna K, Kamaludin K, Nurunnabi M, Baloch GM, Khoshaim HB, et al. Psychological Impact of COVID-19 and Lockdown among University Students in Malaysia: Implications and Policy Recommendations. Int J Environ Res Public Health. 2020; 17(17):1–13.

Adadms EL, Smith D, Caccavale LJ, Bean MK, Adams EL. Parents are stressed ! Patterns of parent stress across COVID-19. Research Square. 2020;

Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020; 17(5):1729.

Mangrio E, Zdravkovic S. Crowded living and its association with mental ill-health among recently-arrived migrants in Sweden: A quantitative study. BMC Res Notes. 2018; 11: 609.

Mariu KR, Merry SN, Robinson EM, Watson PD. Seeking professional help for mental health problems, among New Zealand secondary school students. Clin Child Psychol Psychiatry. 2012; 17(2):284–97.

Riva M, Plusquellec P, Juster RP, Laouan-Sidi EA, Abdous B, Lucas M, et al. Household crowding is associated with higher allostatic load among the Inuit. J Epidemiol Community Health. 2014; 68(4):363–9.

Rader B, Scarpino S V., Nande A, Hill AL, Adlam B, Reiner RC, et al. Crowding and the shape of COVID-19 epidemics. Nat Med. 2020; 26:1829–34.

Fukuda Y, Hiyoshi A. Influences of income and employment on psychological distress and depression treatment in Japanese adults. Environ Health Prev Med. 2012; 17(1):10–7.

Yan S, Xu R, Stratton TD, Kavcic V, Luo D, Hou F, et al. Sex differences and psychological stress : responses to the COVID-19 pandemic in China. BMC Public Health. 2021; 21(79):1–8.

Yoo KB, Park EC, Jang SY, Kwon JA, Kim SJ, Cho KH, et al. Association between employment status change and depression in Korean adults. BMJ Open. 2016; 6(3):1–8.

Ismail MK, Vikniswari Vija Kumaran, Siti Nurul Munawwarah. COVID-19 Outbreak: An Analysis of Malaysian Household Income Class During Movement Control Orders (MCO). Asia Proc Soc Sci. 2021; 7(1):26–9.

Lim LL. The socioeconomic impacts of COVID-19 in Malaysia : Policy review and guidance for protecting the most vulnerable and supporting enterprises. International Labour Organization. 2020.

Coiro MJ. Depressive symptoms among women receiving welfare. Women Heal. 2001; 32(1–2):1–23.

Roy D, Tripathy S, Kumar S, Sharma N, Vermaa SK, Kaushal V. Study of knowledge , attitude , anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatry J. 2020; 51:1–7.

Arora A, Kumar AJ, Alat P, Das SS. Understanding coronaphobia. Asian J Psychiatr. 2020; 54:102384.

Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. J Anxiety Disord. 2020; 74(April):102258.

Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020; 395(10228):945–7.

Bloomfield L, Kendall S. Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme. Prim Health Care Res Dev. 2012; 13(4):364–72.

Xue A, Oros V, La Marca-Ghaemmaghami P, Scholkmann F, Righini-Grunder F, Natalucci G, et al. New Parents Experienced Lower Parenting Self-Efficacy during the COVID-19 Pandemic Lockdown. Children. 2021;8(2):79.

Johnston C, Mash EJ. A Measure of Parenting Satisfaction and Efficacy. Journal of Clinical Child Psychology. 1989; 18:167–75.

Kendall S, Bloomfield L, Kendall S. Developing and validating a tool to measure parenting self-efficacy. J Adv Nurs. 2005;51(2):174–81.

Etikan I. Comparison of Convenience Sampling and Purposive Sampling. Am J Theor Appl Stat. 2016; 5(1):1-4.

Harris M, Andrews K, Gonzalez A, Prime H, Atkinson L. Technology-Assisted Parenting Interventions for Families Experiencing Social Disadvantage: a Meta-Analysis. Prev Sci. 2020; 21(5):714–27.

How to Cite
Masiran, R., Ibrahim, N., Awang, H., & Lim, P. Y. (2022). PSYCHOLOGICAL DISTRESS AMONG MOTHERS OF CHILDREN WITH EMOTIONAL AND BEHAVIORAL PROBLEMS DURING COVID-19 PANDEMIC IN MALAYSIA. Malaysian Journal of Public Health Medicine, 22(1), 56-67.