Physical, Mental, and Financial Stress Impacts of COVID-19 on Early Childhood Educators

We developed an anonymous, self-administered online survey using validated measurement tools. The survey was advertised through email and social media sites geared toward early childhood educators in Indiana asking for volunteers to take the survey. This study was deemed as an exempt study by the Institutional Review Board because it was voluntary, anonymous and had minimal risk. Notices were posted from June-mid-August, 2020. The governor of Indiana enacted a “Stay-at-Home” order effective March 25, 2020—respondents were asked about each set of items before the governor’s order and then after the shutdown order. 145 respondents completed at least the first section of the survey. The respondents were from 94 different Indiana zip codes. The mean age of the respondents was 46.8 years (median = 47); 98% were female; 16% were black, non-Hispanic, 72.4% White, non-Hispanic, 8.6% Hispanic and 2.1% Asian. 23.6% of respondents were employees, 30.6% were directors and 45.8% were owners. 23.6% worked in Ministry childcare, 38.9% in family / home, 31.9% in center-based, 2.8% Head Start and 2.1% were classified as exempt. Physical health was measured using a single item, “In general, how would you rate your overall health”? with 5 response categories ranging from excellent to poor. Emotional stress was measured in two ways. The first used the Kessler 6 item mental health index (Prochaska et al., 2012 ). Respondents were asked “how often did you feel…” Items included sad, restless or fidgety, worthless, nervous, everything was an effort and hopeless. There were 5 response categories ranging from all to none. The second emotional stress measure asked for a series of yes/no to “Did worry or stress cause…”. Items included trouble with sleep, poor appetite or overeating, headaches or stomachaches, alcohol or drug use, difficulty controlling temper, and worsening chronic condition. Financial stress was measured in two ways—both adapted from the Consumer Financial Protection Bureau Financial Wellbeing Scale. The first item asked whether they had money left over at the end of the month and the second asked whether they had concern that their money wouldn’t last. Response categories were always, often, sometimes, rarely or never. Financial stress was also measured using 6 yes or no response items from the Kaiser Family Foundation’s (KFF) Health Tracking Poll (Kirzinger et al., 2020 ). Response items included whether they had: fallen behind on rent or mortgage, problems paying for food, problems paying for utilities, fallen behind on credit cards or bills, problems affording health insurance and problems affording prescription medications. Items with 5 response categories were recoded from 1 to 5 with 5 being the highest response and 1 being the lowest response. Items with yes/no responses were recoded as 1 or 0 respectively. Paired t-tests were then used to test whether there was a significant difference between before or after COVID-19. Chi-square was used to test the difference in categorial variables. For the Kessler 6, the items were then converted to an index and individual’s scores were categorized as moderate or severe mental stress based on a cutoff of 13. All analyses were performed using SPSS v22. General health rating was rated as very good or excellent in 70% of the respondents prior to the pandemic, whereas only 37% rated their health as very good or excellent during the shutdown period. Those rating their health as only fair or poor increased 3.5-fold. (Fig. 1 ). Self-reported health rating before and after Indiana’s COVID-19 stay-at-home order On individual items of the Kessler 6 Scale of Mental Stress, there were statistically significant increases in sadness, being restless or fidgety, feelings of worthlessness, nervousness, feeling everything was an effort and hopeless between before and after the COVID-19 Stay at Home order. Between 1/8 and 1/13 early childhood educators felt sad, worthless or hopeless most or all of the time. Even more (1/3 to 1/4) early childhood educators endorsed feeling restless, nervous or that everything was an effort most or all of the time (Table 1 ). The Kessler 6 Index (Prochaska et al., 2012 ) can be further analyzed to determine whether an individual has moderate or severe stress. Even before COVID-19, a third (32.8%) of early childhood educators reported feeling moderate personal stress and 4% had severe stress. Those portions rose significantly (p < 0.001) after COVID-19 with 63% reporting either moderate (46%) or severe personal stress (17.5%). Emotional Stress was also measured by changes in psychosomatic symptoms (Kirzinger et al., 2020 ). All these symptoms significantly increased with many symptoms doubling (sleep, poor appetite or overeating, headaches or stomachaches) or tripling (alcohol or drug use and difficulty controlling temper) in frequency (Fig. 2 ). Psychosomatic symptoms before and after the pandemic stay-at-home order—response to “Did worry or stress cause…”? Items adapted from the CFPB financial well-being scale showed that a large portion of early childhood educators (1 out of 5) rarely or never had money left over at the end of the month even before COVID-19. That portion more than doubled with nearly half reporting they rarely or never had money left at the end of the month after COVID-19. 33% of early childhood educators always or often worried their money wouldn’t last prior to COVID-19 while 50% reported always or often having this concern after COVID-19. (Table 2 ). The early childhood educators also reported doubling to quadrupling on most of the other measures of financial stress from the KFF Health Tracking poll (Kirzinger et al., 2020 ). The largest increases were in problems paying for food, paying for utilities and falling behind on rent/mortgage. (Fig. 3 ). Personal financial stressors before and after the pandemic stay-at-home order