Abstract
To investigate associations between parent-child relationships, children's externalizing and internalizing symptoms, and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of a random, representative sample of residents with children aged 3-17 years during mid-March 2020 in Wuhan and Shanghai, China. A total of 1655 parents and children were surveyed with a response rate of 80.1% in the survey. During the epidemic, the frequency of children enquiring about the epidemic (AOR = 1.46, 95% CI: 1.04, 2.06), parents explaining the epidemic to them (AOR = 2.87, 95% CI: 1.80, 4.58), parents expressing negative emotions in front of them (AOR = 2.62; 95% CI = 2.08-3.30), and parents with more irritable attitudes (AOR = 1.93; 95% CI = 1.33-2.81) were significantly associated with children's externalizing symptoms. For internalizing symptoms, significant associations were found with worse parent-child closeness (AOR = 2.93; 95% CI = 1.80-4.79), the frequency of parents expressing negative emotions in front of them (AOR = 2.64; 95% CI = 1.68, 4.12), and more irritable attitudes (AOR = 2.24; 95% CI = 1.42-3.55). We also found that each indicator of parent-child relationships had the significantly similar associations with children's lifestyle behaviors. These findings suggest that improving parents' attitudes towards their children and parent-child closeness during the epidemic, especially among parents with lower educational levels, are important to ensure the wellbeing of children.