Introduction

Global dispersion of the coronavirus type 2, which causes a severe acute respiratory syndrome (SARS-CoV-2), has led to worldwide measures being taken to prevent massive infections and reduce demands on healthcare systems. Two of the most important measures has been social distancing and the decree of voluntary social isolation at home (^{World Health Organization [WHO], 2020}).

There are no precedents for a health related phenomenon of this magnitude and its psychological and economic impact that allows predicting the effects on human behavior, particularly on sociofamily behavior (SFB), including child-related connivance (CRC). Outbreak family clusters began to appear during 2019 presenting a series of respiratory symptoms (^{Luo, Xiong, Tang, & Zhou, 2020}). Self-isolation can generate secondary uncertainty due to limited knowledge of COVID-19 and overexposure to related news that can cause or increase fear and anxiety reactions among the population. Furthermore, isolation by itself causes other well-known psychological effects, like boredom, frustration, and irritability (^{Li et al., 2020}; ^{Wang, Zhang, Zhao, Zhang, & Jiang, 2020a}).

^{Wang et al. (2020b)} reported the results of an online survey of 1304 people living in 194 cities in China with the aim of exploring the psychological consequences of social isolation as a preventive measure for the contagion of COVID-19. They found that around 26% of the people obtained scores on the scales that classified them within some level of depression, 36% scored with clinical levels of anxiety, and 32% with stress symptoms.

SFB is vulnerable to different intrapersonal and external factors, which directly influence its stability. The closure of schools and businesses as a preventive measure for contagion increases the experience of negative emotions, such as parents’ concerns about its impact on their children’s education and anxiety about childcare at home when they must continue to face economical sustainability (^{Brooks et al., 2020}; ^{Wang et al., 2020a}).

Childhood, from birth to the onset of puberty, is a period in which significant physical, cognitive, social, and emotional changes occur. These changes depend both on genetic and environmental factors; within the latter, the family context has been pointed out as a relevant factor since it acts as a protective and introductory entity for the child to his/her cultural environment. Parents have an integral role in stimulating or inhibiting child development (^{Arranz et al., 2004}). The relationship between factors such as socioeconomic status and parent-child interactions prove that family welfare is a highly sensitive system. It has been shown that parents’ conflict-solving abilities, educational, and socializing practices correlate with disruptive behavior in children (^{Fegert, Vitiello, Plener, & Clemens, 2020}; ^{Flouri, Narayanan, & Nærde, 2018}; ^{Lee, Kang, Cho, Kim, & Park, 2018}; ^{Luby et al., 2013}; ^{Masten & Osofsky, 2010}). According to this evidence, adverse childhood events, such as natural or health-related disasters, war, confinement, poverty, and acute or chronic stress, can compromise infant neurodevelopment. Therefore, children are considered to be a vulnerable group during infectious disease outbreaks.

For example, those experienced in 2006 in India with the Chinkungunya outbreak and, in 2014, with the Ebola epidemic in West Africa. Given these scenarios, it became evident that the families’ economy was affected in a way that all members, including children, had limited access to medical care and food availability (^{Gopalan & Das, 2009}). In these conditions, the families went through a period of uncertainty, in which feelings of sadness, anxiety, and frustration were exacerbated. All of these situations put the family at disadvantage due to the social and health impacts suffered by the main caregivers. In agreement with the Alliance for Child Protection in Humanitarian Action, Technical Note: Protection of Children during the Cornonavirus Pandemic (2019), a pandemic may result restructuring in family dynamics, since on several occasions, older siblings are the ones who provide basic diet and parenting care to younger children. Talking about young children specifically, they can present anguish about the disease, even if they do not understand its gravity, or the possible death of beloved ones. Also, they can show higher levels of stress due to the isolation of a relative in a healthcare center or mandatory confinement at home, since these measures grow fear by not clearly understanding what is happening.

The ^{Alliance for Child Protection in Humanitarian Action (2019)} has reported that certain factors such as family situation, irresponsible child care, and absence of family or community support can cause negative consequences on child development that may reflect stress and insufficient attention to basic needs. Following this line, the possible absence of parents due to illness or work, school burden, and daily responsibilities at home, can lead to emotionally intense environmental experiences (^{Svedin, 2008}).

As previously mentioned, the current situation caused by the COVID-19 pandemic is affecting children and families in an exceptional way. Novelty stressors like homework, homeschooling, the closure of recreational centers, the absence of leisure activities, the constant fear for relative’s health and deaths, and the economic impact can generate a series of mental health-related problems such as stress, depression, and family violence (^{Fegert et al., 2020}; ^{Flouri et al., 2018}; ^{Vieira, Garcia, & Maciel, 2020}).

Mental health risk factors associated with COVID-19 may disproportionately affect children in vulnerable conditions, so special attention should be given to these groups in order to prevent exacerbating previous disadvantages (^{Fegert et al., 2020}).

According to all of the aforementioned, exploring people’s perception of changes in family behavior, including children’s, and the different social, economic, and personal characteristics during voluntary isolation will make possible, for health professionals, to identify primary care needs in vulnerable populations, and develop early interventions.

Due to the lack of instruments for measuring sociofamily behavioral changes during an outbreak derived self-isolation period and its effects on children’s behavior, the aim of this study is divided in three parts. First, to analyze the reliability of an ad-hoc designed questionnaire to measure some variables from this experience. Second, to characterize effects of voluntary social isolation in sociofamily behavior, at a personal level and over children’s activities at home. And third, to determine vulnerability predictors for a negative experience by isolation itself in a sample of parents of children from one to twelve years old under voluntary social isolation by COVID-19.

Method

Results

Discussion and conclusion

Behavioral factors could present variations in how different demographic and socioeconomic status groups face an outbreak and resolve upcoming psychological, healthrelated, economic and security problems, among others. This study presents a comparison of sociofamily behavior, including perception of changes, under voluntary social isolation due to the COVID-19 outbreak, among different demographic groups in Mexican population, and the reliability of the designed instrument to specifically measure sociofamily behavior changes perceived by parents during this isolation period. Although recent studies have shown some negative psychological effects of voluntary isolation by COVID-19, this is the first study focusing on sociofamily behavior in Mexican population that reports a correlation between sleep changes, anger and emotional reactions in sociofamily dimensions. This report explicitly emphasizes the effects of isolation and vulnerabilities in sociofamily behavior with a consequent increase in the global negative effects, specifically loss of motivation and hopes for the future, and more frequent anger reactions.

Play is a normal and expected behavior in childhood, so it can be highly sensitive to constant stress or traumatic events. Previous studies have reported changes in play patterns of children who were exposed to adverse events such as natural disasters, diseases, or war-related situations (^{Wolmer, Hamiel, Pardo-Aviv, & Laor, 2017}; ^{Stenman et al., 2019}). In our study, parents reported a greater presence of active, fantasy-themed, pretend play focusing on the current situation, and a preference for playing with adults. It has been suggested that play can be seen as a psychological mechanism that allows processing and adaptive coping with stress. It is a way for emotional expression that facilitates organizing memories, integrating sensory experiences, and better understanding of situations. There are several neurobiological correlates of play, with better regulation of levels of alertness and fear (^{Cohen & Gadassi, 2018}). Fantasy play allows children to take a more active role in a given situation; it is also noted that play involving the child parents contributes to resilience when faced with continuously stressful events (^{Cohen & Gadassi, 2018}; ^{Wolmer et al., 2017}).

In previous studies, predictors of psychological impact had demonstrated contradictory evidence as to whether population’s characteristics and demographics could describe and predict the psychological impact of quarantine (^{Brooks et al., 2020}). The results of this study support the idea that there is not a unique linear demographic feature that may anticipate sociofamily behavior changes for negative effects of the voluntary social isolation, but possibly a complex profile of features including, at least, some of those analyzed in this report: socioeconomic status, income source, and family composition.

It has been reported that health related disasters reaction of parents and children can reach traumatic levels due to the experience of stress responses during the disease containment (^{Sprang & Silman, 2013}). While the response to health related disasters has been widely reported as a stress factor causing negative effects on people’s mental health (^{Maunder et al., 2008}; ^{Perrin, McCabe, Everly, & Links, 2009}; ^{Wong et al., 2008}), this report concludes that there are specific family groups of higher vulnerability that may not be detected or attended during a pandemic disaster. These groups include low socioeconomic status individuals who particularly perceive greater negative changes and effects within sociofamily behavior, such as emotions, habits, home activities organization, and self-perception by parents. Low socioeconomic status has a statistical inverse relation with direct medical diseases contagion including neurological (^{Ghaffari-Rafi, Ghaffari-Rafi, & Leon-Rojas, 2020}), respiratory (^{Cakmak, Hebbern, Cakmak, & Vanos, 2016}; ^{Reyes et al., 2018}), and mood disorders (^{Chen et al., 2019}). Data from this study suggests that socioeconomic status is also a predictor for personal or other possible family dysfunctional behaviors, including sleep patterns, homeschooling, and diet.

Marital status has also been considered a relevant factor for presenting a higher symptomatology of psychiatric disorders, including depression and anxiety, and there have been specific increases during the COVID-19 pandemic for divorced, separated or widowed (^{Tan et al., 2020}). In this study, a particular effect was observed on sociofamily parental behavior for the families with children group, showing increased negative effects on their ability to solve conflicts between parents and children, behavioral control, and stress perception by the infants. The COVID-19 outbreak significantly degrades emotional well-being (^{Yang & Ma, 2020}).

In the present study, the income source demonstrated to be a factor that significantly affects perception of changes in sociofamily behavior during voluntary isolation. This was particularly observed in the group of families who stopped working due to the outbreak, and therefore, stopped receiving economic income, with negative effects on habits and parental self-perceived abilities to solve child-related conflicts at home.

Once it is reported that psychiatric symptoms may be reduced if prevention measures are carefully taken when returning to normal activities (^{Tan et al., 2020}), future studies should consider the sociofamily effects after returning to prior regular activities as protective measures taking into account family habits reorganization. This study highlights the importance to acknowledge the sociofamily changes caused by the voluntary social isolation during an outbreak as prolonged, as this in order to identify and prevent negative outcomes, and design proper interventions to solve or minimize consequent family conflicts. Undoubtedly, this unprecedented health related phenomenon is not only disrupting economic stability in most of the countries in the world, but also coexistence within households. The findings of this report also present a valid instrument to measure the perception of changes in sociofamily behavior that can be remotely administered and interpreted by mental health specialists.

The present investigation presents several strengths and limitations. Non-probabilistic convenience sampling permitted to gather information about the groups of interest (families under voluntary isolation with children from one to 12 years old), but leads to difficulties to generalize these findings to other groups of families with different ages, compositions, or by the number of children living with the same family. Further studies are also needed to describe the particular influence of anxiety and depression on the SFB.