Couples and parenting dynamics during Covid-19 pandemic: A systematic review of the literature

TL;DR

This review explores how the pandemic affected couples and parenting, identifying stress sources, coping strategies, and mixed outcomes like lower well-being and changes in relationships.

Contribution

The study systematically integrates findings on family dynamics during the pandemic and highlights new research directions for clinical and academic practice.

Findings

Stress sources like gender inequalities and external pressures were consistently reported during the pandemic.

Coping strategies such as communication and dyadic support mediated pandemic-related stress effects.

No significant changes in relationship satisfaction or sexual frequency were found, but sexual satisfaction declined during the pandemic.

Abstract

The COVID-19 pandemic constituted a public health crisis bound to impact couples, parents, and families globally. However, the literature on the impacts of COVID-19 in families is not yet integrated. This systematic review aims to (1) provide an overview of how the COVID-19 pandemic potentially changed family systems, especially the couples and parenting dynamics, as well as (2) integrate inconsistent findings, and, finally, (3) define new avenues for research and clinical practice. Inclusion and exclusion criteria were defined for this review. The data was collected in bibliographic databases using a combination of keywords. The study includes empirical research published in English, Spanish, Italian, or Portuguese, appearing in peer-reviewed journals, focusing on the impact of the COVID-19 pandemic on the functioning of different-gender or same-gender couples, married or cohabitating, or cohabitating parents with children aged 2 to 18, between April 2020 and December 2023. Within 381 articles, 58 studies met the inclusion criteria, which 50 were quantitative, four qualitative, and four mixed methods studies. A qualitative thematic analysis of the reviewed articles identified 12 categories that were organized by stress sources, mediators, and outcomes. There is consistent evidence across the literature showing some sources of stress during COVID-19, such as Gender Inequalities (e.g., Unequal Division of Household Duties and Lack of Support for Mothers), and External Stress. Also, we identified some themes on the mediators such as Coping Strategies (e.g., Dyadic Support, Communication as a Mediator and Adaptation to New Daily Routines) and finally as outcomes, Lower Psychological Well-Being, and Relational Growth. However, some inconsistencies were found in Relationship (In) Satisfaction, Sexual Functioning and Communication as an Outcome. Explorations of moderators showed that these inconsistencies should be understood in reference to (1) quality assessment (2) coping and (3) income. After conducting a comprehensive analysis of inconsistencies, our study revealed no notable differences in either relationship satisfaction or sexual frequency before and after the COVID-19 pandemic. Notably, a decline in sexual satisfaction was observed during the COVID-19 period. No conclusive associations were identified between income, relationship satisfaction, sexual satisfaction, sexual frequency, and stress related to COVID-19. Nonetheless, our observations indicated that individuals with moderate or high income, in conjunction with the implementation of effective coping strategies, exhibited a diminished impact of COVID-19-related stress on both relationship satisfaction and sexual functioning. Future studies should focus on a dyadic perspective at various stages of the family cycle, including longitudinal perspectives, as well as studies focused on the role of dyadic coping during times of crises. Findings must be considered with caution because not all studies had equal methodological rigor.

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Introduction

On the 18th of March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic and a global public health emergency. Strict isolation measures were implemented worldwide to prevent the spread of the virus, resulting in lengthy lockdowns and social distancing measures impacting individuals, families, and society. Forced cohabitation led families to alter their dyadic and family-level dynamics. The objectives of this systematic review are to (a) describe relevant changes; (b) integrate inconsistent findings, and ultimately (c) define new avenues for both research and clinical practice.

The family system and stress

The family system is a self-regulating system, that maintains stability through negative feedback and enables change through positive feedback [1]. A family consists of subsystems with specific roles and boundaries [2], like conjugality or parenting, and that adapts continually to maintain stability and allow change [2], underlying the importance of communication between family members [3].

The classic family life cycle starts with single adults forming couples, progressing through stages such as families without children, families with young children, and families with adolescents [4–6].

Is this literature review, we will particularly focus on three of the life cycles: families without children, families with young children and families with adolescents, as differences in household type during the lockdowns show that couples with children and lone parents were described as more materially vulnerable and subjectively constrained [7]. Across time, the family undergoes distinct cycles, steered by expected challenges and specificities that are inherent in its growth, in which families with adolescents require more flexibility in the family boundaries to accommodate their children’s independence while caring for the older generation [6].

However, there are also changes that families must cope with that go beyond the expected developmental process, such as coping with external stressors. Ecological Systems Theory [8] helps to understand the complex and multisystemic interplay between family system and subsystems, the societal and chronological contexts. This theory includes the microsystem (immediate environment), mesosystem (interactions between microsystems), exosystem (indirectly affecting environments), macrosystem (cultural and societal context) and chronosystem (temporal context) [8].

Applying Bronfenbrenner’s framework aids to understanding the COVID-19 pandemic’s impact on families [9] on the living system that is a family [10]. This review starts by describing the specific contextual developments that took place during lockdowns in households composed of couples and families with children, living in forced cohabitation.

The pandemic context

China was the first country to declare confinement in late February 2020, followed by several Asian countries. In Europe, the first localized lockdown took place on late February in Italy, followed by several of other countries in March 2020. In the American continent, localized lockdown also started from the middle of March. Most confinement periods lasted until March 2021.

The pandemic exacerbated pre-existing inequalities in accessing healthcare [11–13], unemployment [14, 15], financial instability [16–19] and confinement stress [20–22].

Families were forced into prolonged cohabitation for long periods [23]. Emotional cohabitation, whether with partners or family of origin, became crucial, as pre-pandemic research indicated complex consequences during catastrophes [24]. Research on the pandemic’s impact on families focused on three areas: (a) identifying risks and challenges [7, 21, 25, 26], (b) factors enabling positive vs. negative adaptation to the crisis [27–30], (c) changes in mental health [31–37] and relationship dynamics [38–43].

The present research follows a similar structure: stressors, processes and outcomes. We start with level one, focusing on stressors–COVID-19 blurred boundaries between home and work [44], as well as limited global travel [45], affecting family and extended family contact, with increased risk of prolonged grief [46] and adolescents [47], as well as parents juggled remote work and homeschooling [45, 48, 49].

The second level explores the processes of family adaptation, that requires a complex interplay between stressors, available resources at individual, relational and family levels, and the family’s appraisal of these stressors [50, 51], influenced by coping models [50–53] and resources [54]. Research with families focused (a) not only on individual models [55] and individual strategies (e.g., problem solving or emotional coping), (b) but also on relational models [56–58] and on the dyadic strategies established by the couple (e.g., problem-focused, or emotion-focused dyadic support), c) and on community resources [59–61].

Finally, the third level encompasses a wide range of outcomes–family members experienced psychopathology [32], such as anxiety [35], depression [36, 37], post-traumatic stress, lower levels of quality of life and general stress [37], increased worry, lack of attention and irritability [31, 33, 34]. Additionally, evaluation of family relations [40–42], in which the literature we find highlights into family resilience with an increase of positive family dynamics [62] to negative consequences [40, 42], ranging from difficulty in eating behaviours or in physical activity [63], to accounts of interpersonal violence [64, 65].

Inconsistencies in data and insufficient literature integration were address by several reviewers, on psychological impact [66] and in specific groups [67]. This study identifies a gap in the literature on COVID-19’s impact on families, focusing on vulnerable households: couples and families in forced cohabitation.

Method

The present study is a systematic review of the literature that aims to [1] provide an overview of how the COVID-19 pandemic potentially changed family systems, especially the couples and parenting dynamics, as well as [2] integrate inconsistent findings, and, finally, [3] define new avenues for research and clinical practice. To explore the hypothesis of the study quality, we conducted a quality assessment (QuaDS) assessing the theorical framework, methodology, research design and sample characteristics. We undertook a systematic review of the literature that did not focus on meta-analysis results, given the unavailability of data and heterogeneity of design.

Inclusion and exclusion criteria

Following the systematic reviews guidelines outlined by CRD (2009), articles must satisfy the following inclusion criteria to qualify for this review: (a) published in English, Spanish, Italian or Portuguese, because it is the languages known by the research team; (b) published in a journal with peer review; (c) designed as empirical studies (either quantitative, qualitative or mixed methods); (d) targeting the impact of COVID-19 pandemic on couples functioning with different-gender couples or same-gender couples, married or living together; or with cohabitating parents (at least 90% of the sample) with children between 2 and 18 years old and (f) published between April 2020 to December 2023. The study excluded four types of studies: (a) those involving parents of children with chronic illnesses or prior conditions, due to the added stressors and unique dynamics; (b) parents of newborns born during the COVID-19 pandemic, as this does not align with the aim of comprehending the transition to parenthood; (c) studies with less than 10 participants, to ensure the accuracy and validity of data and its accuracy; and (d) studies that investigate the outcomes of family or couple therapy, as the aim is not to investigate the seeking of professional help by families and couples.

Procedure

To identify relevant literature for our review, we conducted a systematic literature search across four databases following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2020) [68–70] statement and the Centre for Reviews and Dissemination (CRD) (2009) protocol [71, 72]. Various strategies were utilized to retrieve applicable studies, ensuring a comprehensive review of the literature. First, a computerized search of bibliographic databases PubMed, EBSCO, Google Scholar, and Web of Science was conducted using the following search combinations for the title and abstract: "Couples" AND "COVID-19 Pandemic"; "Romantic Relationships" AND "COVID-19 Pandemic"; "Marital Satisfaction" AND "COVID-19 Pandemic"; "Parental Functioning" AND "COVID-19 Pandemic"; "Parenting" AND "COVID-19 Pandemic"; "Family" AND "COVID-19 Pandemic". In this review, specific journals were not directly consulted for literature related to the review. Instead, we utilized comprehensive databases described above to ensure a wide-ranging and unbiased collection of relevant studies.

A search query was conducted in the Web of Science (Clarivate, 2022) online database to identify relevant studies. This decision was based on a two-step approach. First, a review of similar literature revealed that using multiple databases is the most common practice to ensure comprehensive topic coverage. Second, during the query design phase, extensive trial tests were performed on both Scopus and Web of Science. Web of science consistently produced results that better matched our query criteria, making it a more suitable choice for our review. Therefore, we decided to focus exclusively on Web of science.

Study selection: Decision marking

The first step on the decision making involved entering the keywords into online data bases. Before screening, we removed the duplicate records. Subsequently, the titles of the articles were reviewed and based on their relevance, they were either advanced to the next stage or excluded. Following this title-based selection, the abstracts were thoroughly read to assess whether they met the inclusion criteria of our systematic review. After this dual stage screening process, which involved both title and abstract evaluation, the remaining articles were full to ensure they satisfied all the inclusion criteria for the study (See Fig 1 in S1 Fig). Articles were removed if including having less than 90% of couples living together or having divorced parents. Fifty-eight articles were selected for final comprehensive analysis after a careful review of all remaining articles and analysis of their full texts (See Fig 1 in S1 Fig).

Data collection process

Data extraction was performed by reviewing general study information (author name, article title, citation, type of publication, geographical area, and funding source), study characteristics (aim/objectives of the study, study design, study inclusion and exclusion criteria and recruitment procedures) and participant characteristics (age, gender, ethnicity, marital and cohabitation status, number of children). The method and instruments of each study were analysed for accuracy. After selecting the final articles, authors carefully reviewed the selected and relevant articles, extracted the data, and organised the relevant information. The final evidence table is presented in Table 1 - in this section, we present the author’s name and year of publication, the number of participants in each study, the study design, the geographical area, the data collection time and the main findings.

Table 1: Summary of baseline characteristics and outcomes of included studies.

Results

Overall mapping of the papers

We start this section by describing an outline map of the overall findings with respect to study methodology, location, and article quality. As for the design of the research, quantitative studies were the majority, but qualitative studies, and mixed-method studies were also included (See Table 1). Of the quantitative studies, the majority were cross-sectional, and few were longitudinal. As for the qualitative studies, all were cross-sectional [45, 92, 97, 99] and the data collection instruments used were mostly individual semi-structured interviews [92, 99], dyadic interviews [45] and open-ended questions [97]. Regarding mixed-method studies, on the qualitative section some authors used individual semi-structured interviews [90, 102, 121] and on the quantitative section questionnaires were the most common instruments [81, 90, 102, 121]. Studies were longitudinal [90, 121] and were cross-sectional [81, 102].

According to geographical distribution, most studies were conducted in Asia (n = 19) and America (n = 20), followed by Europe (n = 13), Oceania (n = 4) and Africa (n = 2). The total number of participants across all the studies were n = 45572.

Quality assessment results

Due to the novelty of couple and family research in association with COVID-19, studies were still scattered and showed great heterogeneity in terms of study design. Therefore, the Quality Assessment with Diverse Studies (QuADS) [128, 129] was applied to prevent bias and provide a clear indication of the strength of evidence and standards for future research. Studies were not excluded from this review based on quality, as there were no predefined inclusion and exclusion criteria. All studies were reported, and quality was assessed using 13 items and graded from zero to three.

Following Harrison and colleagues’ (2021) guidelines [128], the quality analysis of the articles was conducted in two phases. In the first phase, two authors performed an individual and independent quality analysis of the studies (n = 43) (See S1–S3 Tables). In this phase, the authors first selected five studies to perform the quality assessment independently and discussed the application of criteria. Once a common understanding was reached, authors independently reviewed all remaining articles. As the levels of agreement were found to be high, in a second phase, only the main author conducted the quality analysis of the studies (n = 15). The final percentage of study quality is presented, ranging from low quality to very good quality (See S1–S3 Tables).

Articles were analysed through NVIVO12, and 13 codes were identified, corresponding to each item and the subcodes according to the score (for example, if an article scored 1 on item 5, it would go to the subcode identified). Articles were evaluated as demonstrating very good (75% to 100%), good (50–75%), medium (25% to 50%) and low quality (0 to 25%). Finally, an interrater analysis was carried on using percent agreement index [129] which showed 91.48% of ratings between the two authors was the same. Most of the studies were classified as good, ten as very good and six as medium (See S1–S3 Tables).

Thematic analysis results

A qualitative analysis was conducted to identify main themes from key findings in the reviewed articles, following Braun and Clarke’s (2006) thematic analysis approach [130]. In a first moment, data was analysed through hierarchical organisation of initial codes. Initial codes were created inspired by Bronfenbrenner’s Ecological Systems Theory [8], depicting the systems affected by Covid-19—microsystem, mesosystem, macrosystem, exosystem and chronosystem. We also integrated the Stress Model Process [51] in the organization of themes, based on the three elements of stress: 1) sources, 2) mediators, and 3) outcomes. Each code was subdivided and organised into sub-codes. During the second round of data analysis, greater flexibility was enabled in generating the codes using open coding [131, 132]. This involves generating categories in an open and line-by-line manner based on the data, whilst constantly questioning the information presented [132]. After modifying the codes, an inter-categorical analysis was initiated, followed by axial coding involving continuous comparison between categories [132]. Furthermore, the interactions between category dimensions were explored, resulting in the renaming, and identification of new relationships, and even new categories. We also constructed cognitive maps to categorise and formulate new connections that became apparent. Ultimately, the systematic coding facilitated the identification of a range of categories and subcategories regarding the data, to address the research inquiries.

The thorough literature review allowed a categorization of the key domains that appear to have influenced parenting and couples functioning during the COVID-19 pandemic. Nine categories were identified through the thematic analysis. The classification of stress themes based on their sources, mediators, outcomes, and the corresponding systems in which they occurred (See S4 Table). In the following section, we describe the themes organized by stress elements, beginning with the themes that arose as stress sources. Subsequently, we outline the themes that acted as mediators and finally, the themes that surfaced as outcomes.

Themes on stress sources as result of COVID-19 pandemic

Two stress sources categories were identified—Gender Inequalities (n = 14) and External Stress (n = 15). The Gender Inequalities category is within the macrosystem of the couple, affected by domestic and parental duties and social norms, including two subcategories. The first subcategory named Unequal Division of Household Duties (n = 11), refers to an unequal sharing of household management tasks and parental responsibilities in providing primary care for children. The second subcategory named Lack of Support in Maternity (n = 3), defined as the absence of support, particularly with regards to childcare and social isolation. Regarding the External Stress (n = 15), emerged as well in the macrosystem and is known as the emotional strain and mental tension experienced by couples and parents in adverse and demanding circumstances such as the COVID-19 pandemic. The categories are detailed below.

Unequal division of household duties (n = 11)

The distribution of household duties during the COVID-19 pandemic was evaluated in eleven studies [65, 79, 83, 90, 93, 97, 99, 115, 119, 122, 126]. Since the onset of the COVID-19 pandemic crisis, a noticeable change in the division of housework and childcare [99] was observed. On the one hand, one of the emerging points within this category, as indicated by seven studies, was the gender differences between men and women in the allocation of household work during the COVID-19 outbreak [65, 79, 83, 90, 93, 115, 126]. While there was an increase in fathers’ involvement in domestic tasks, particularly in task allocation, mothers continued to provide more housework and childcare than fathers [65, 79, 83, 90, 93, 115, 122, 126]. The overwhelming domestic and parental burden, in both genders, was reflected in reduced satisfaction [126] and well-being, as well as in work performance [115]—We found an impact of working remotely [119] in family dynamics [99].

Lack of support for mothers (n = 3)

The lack of support for mothers during the pandemic led to feelings of loneliness, isolation, and inadequate support [89, 92, 99]. On one hand, the significance of support systems in parenting practices was evident [92, 99] and on the other hand, a link was observed with more hostile parenting practices and more negative attitudes towards the pandemic [89].

External stress (n = 15)

Elevated stress levels were identified and had a negative impact in dyadic dynamics [75, 81, 89, 91, 92, 94, 99, 101, 104, 117, 120], such as a decline in daily positive mood and an upswing in negative mood amongst couples [75]. The consequences of external stress were not exclusive to couples, as we will mention in the section after.

Focusing on parental stress [80, 82, 86, 89, 91, 92, 101, 109, 117], we identified some contributing factors: (a) household disorganization and chaos [117] and (b) the perception of the pandemic as overwhelming and burdensome [92]. The consequence of parental stress includes (a) a reduction on engagement in their children’s activities; (b) less attention and fewer time spent together; (c) more harsh parenting [82]; (d) less responsive parenting [117] and (e) more conflict in the intimate relationship [80]–those results in a decline in emotional regulation among children [86, 117], more work-family conflict and less balance [99] and parent depression [86].

Themes on the mediators during COVID-19 pandemic

Coping Strategies (n = 21) emerged in the mesosystem, as dyadic coping skills, such as Dyadic Support (n = 14), Communication as Mediator (n = 4) and Adaptation to New Daily Routines (n = 3). Dyadic Support is characterised by one partner helping the other to cope with and overcome problems or challenges, including those caused by COVID-19. Communication as a Mediator (n = 3) is defined as the process by which couples send and receive information, verbal or non-verbal, within the relationship. Adaptation to New Daily Routines (n = 3), that describes the main day-to-day changes and transformations in couple and parenting dynamics during the COVID-19 pandemic.

Coping strategies (n = 21)

As for the coping mechanisms recognized in the themes, we will first consider dyadic support, before turning our attention to communication and finally to strategies to adapt to new routines imposed by the COVID-19 pandemic.

Dyadic support (n = 14)

Dyadic support was considered a pivotal element in aiding families to cope with the demanding and precarious circumstances posed by the COVID-19 pandemic [111] whilst also proving to be vital for personal development throughout the pandemic period [121]. On the one hand, positive dyadic support reflected on less dyadic conflicts [61, 80], more relationship satisfaction [73, 76, 77, 124], increased gratitude within the relationship, and on more quality in the relationship through the reduction of reducing anxiety levels caused by confinement [95, 111], promoting psychological well-being [75]. On the contrary, negative dyadic coping had a negative impact on relational satisfaction [75, 91, 120] as it accentuated negative mood and had a greater impact on relationships compared to positive dyadic coping [84].

Communication as mediator (n = 3)

Communication emerged as pivotal for couples to handle challenges during the COVID-19 and as a tactic to manage conflict resolution [81, 85], defined as an inter-communication as a psychosocial strategy during conflict management, such as allocating sufficient time for enjoyable active learning [81], negotiating, accepting, and nurturing their relationship cultures [45].

Adaptation to new daily routines (n = 3)

Some changes imposed by the COVID-19 pandemic included the establishment of new routines at home [97, 99] as well as a change in family schedules [92]. Jones [97] found changes in dependency processes, such as the establishment of new routines at home. Kolo and colleagues [99] found that participants reported the impact of the COVID-19 pandemic in terms of daily routines, and Hood et al. [92] showed that family schedules changed.

Themes on outcomes effects because of COVID-19

Focusing on the outcomes from the COVID-19 pandemic, we found Lower Psychological Well-Being (n = 20), as particularly salient in the microsystem, as it reflects individual emotional distress. At the mesosystemic level of the couple, categories such as Relationship (In) Satisfaction (n = 21), Sexual Functioning (n = 10), and Communication as an Outcome (n = 4) have emerged. The Relationship (In) Satisfaction is referred interaction patterns exhibited by couples that affect their satisfaction. The Sexual Functioning category represents the perception of the couples on several sexual dynamics, such as frequency, intimacy, desire, satisfaction, arousal, pleasure, and individual practices (e.g., masturbation). Finally, Communication as a Process is defined as a dimension of the couple that was affected by the pandemic in both positive and negative ways. Relational Growth in the Chronosystem (n = 4) emerged as the ability of couples to bounce back and surmount challenges and obstacles during the COVID-19 pandemic.

Lower psychological well-being (n = 20)

Several studies demonstrated psychological difficulties during the COVID-19 crisis [65, 61, 74, 81, 84, 86, 89, 97–100, 102, 103, 108, 110, 111, 113–115, 126]. We also found gender differences in individual well-being, with women reporting inferior levels of well-being [65, 74, 98, 102, 108, 111, 126], especially in women with children [86, 102, 115, 126].

Furthermore, it became evident that these dynamics were reflected in relations, sexual dynamics, and parental interactions. Concerning to relationship dynamics, we found a positive relationship between individual well-being and relationship quality [74, 81], particularly among women [74], that highlight the importance of individual well-being in relation to relationship dynamics [110, 114].

Focusing on the interinfluences between personal well-being and sexual dynamics, some studies have found a negative impact of psychological distress on sexual dysfunctions [98], on pleasure, desire, and arousal [108]. Conversely, elevated levels of personal well-being were reflected in the quality, intimacy, and passion within sexual relationships [114]. Finally, some studies found higher maternal anxiety [89], less relational well-being [113], and poorer parenting behaviours, including those that are hostile [89], as well as parenting being the primary influence on individual and relational well-being [113].

Relationship (In) satisfaction (n = 21)

Several studies examined the levels of satisfaction among couples during the COVID-19 pandemic [73, 74, 77–78, 80, 85, 87, 88, 100, 102–104, 110, 112, 114, 116, 122–125], however the results were not consistent. Focusing on the studies that focused on relationship satisfaction before and after the pandemic, some studies suggested that the COVID-19 pandemic did not affect the satisfaction levels of couples [76, 78, 102, 104, 114, 123–125] and three studies found a decline in relationship satisfaction during the COVID-19 crisis [77, 112, 116]. Two studies found that changes in relationship satisfaction that varied according to relational processes [73] and to the perception of the pandemic as a source of conflict in the relationship [88]. Other studies found high levels of marital satisfaction, namely on relationship quality [103], although not comparing the pre- and post-pandemic periods [80, 85, 100, 110]. Others found that couples were moderately satisfied with their relationship [74, 120, 123]. Some factors were identified as moderators: sexual satisfaction, relationship validation, not having children, perception of fairness in the power dynamics on the relationship, social functioning, not having physical or sleep problems [74, 87], high levels of income [120] and doing activities together as a couple [103].

Sexual functioning (n = 10)

Ten studies analysed couples’ sexual experiences during the COVID-19 pandemic [74, 87, 97, 98, 105–108, 118, 127], but focused on different domains. At an individual level, there was an increase in individual sexual practices both in men and women, but higher in men [98].

At the relationship level, we found a positive impact of sexual satisfaction on relational satisfaction during the COVID-19 pandemic [74, 87]. One of the findings indicated a decrease in sexual satisfaction compared to the pre-pandemic period [98, 105, 106], particularly among women [108], because of the lower levels of well-being being associated with a higher risk of sexual difficulties [105, 118]. Factors contributing to moderate levels of sexual satisfaction included lower relationship invalidation, no children in the home and higher perceived fairness of relationship power [87].

In terms of sexual frequency, one study found a decrease [107] and two studies found no differences before and after the pandemic [74, 127] and one study found an increase on weekly sexual frequency [118]. Two studies reported no changes in sexual desire, arousal, and orgasm [108, 127] comparing to before the pandemic.

In terms of quality of sexual life, one study found a moderate level of quality reported in women and it was influenced by age, education of the spouse as well as the sexual frequency before and during the COVID-19 pandemic [107]. The study suggested that couples with university degrees and specifically women whose partner had a university degree had higher levels of quality of sexual life. Men with a nuclear family had higher levels of quality of sexual life.

Concerning intimacy, one study found both positive and negative changes in intimacy, in which participants described having both more and less time to connect [97] and other found no differences on emotional bonding during COVID-19 pandemic [127].

Communication as an outcome (n = 4)

Some studies have reported changes in the quality and frequency of communication in couples and families during the COVID-19 pandemic. On the one hand, two studies found a decrease in the communication quality, in a more and less communicative engagement with the partner, as well as more negative and more positive valence of conversations [97] such as severe irritation and less open and more aggressive communication, affected relationship quality over time [96]. On the other hand, other study found that communication improved during the COVID-19 pandemic [123], possibly due to fewer external demands such as commuting and travelling in couples with children. Another study found that COVID-19 pandemic concerns were reflected in couples’ stress communication, which was positively correlated with dyadic coping responses, but negatively correlated with psychological well-being [84].

Relational growth (n = 4)

During the COVID-19 pandemic, couples engaged in dynamic processes of negotiation and reconstruction [45], highlighting the importance of coping strategies as promoters of resilience, such as creating new rituals to express care towards their partner [45, 81]. One factor contributing to the relationship satisfaction was attributing any relationship issues to external factors [104]. This led to a decrease in spillover processes, resulting in higher levels of marital satisfaction and fewer negative behaviours.

Furthermore, Chakraborty et al. [81] discovered that psychological distress can have a beneficial effect on a couple’s adjustment during a crisis by promoting affection, emotional support, reliable alliance, satisfaction, approval, and companionship, thereby enhancing relational resilience [81]. More importantly, the study determined psycho-social methods for dealing with COVID-19 challenges, such as communication for conflict resolution, offering emotional support, and respecting personal space. Additionally, self-introspection through dialogue and self-realisation, along with inter-communication improvement through active listening and making time for leisure activities, were identified. Finally, Kolo et al. [99] highlighted the importance of prioritisation, scheduling and time management as crucial factors that aided couples in balancing work and life. These findings imply that these elements could offer valuable insights for interventions aimed at supporting couples during a family crisis [99].

Integrating inconsistent results

Given the aims of this literature review, the inconsistent findings are discussed in terms of the quality of the papers and the moderating variables. There are three categories where we describe inconsistent results, all of which are presented as outcomes of the process and included as part of the mesosystem: Relationship (In) Satisfaction, Sexual Functioning, and Communication as an Outcome.

Aim 1. Quality assessment

We first started by crossing the studies with different results against the quality matrix. From the studies reporting good or very good quality, we observed that some changes were identified in relationship (in) satisfaction. On the one hand, the studies reporting good quality found no disparities in relationship satisfaction before and after the COVID-19 pandemic (7 out of 8), fewer studies found a decrease in relationship satisfaction (3 out of 3), other studies found high levels of satisfaction (3 out of 5) and finally other studies found moderate levels (2 out of 2). A pattern was identified, with seven studies reporting both good methodological quality and no changes in relationship satisfaction during the pandemic (See Table 6 in S4 Table).

Despite different record of the changes on sexual functioning (both positive and negative changes), most of the studies were classified as of good quality. Several dimensions of sexual functioning have been identified, including sexual satisfaction and sexual frequency. We identified a pattern and observed that sexual satisfaction (3 out of 4) decreased during COVID-19, and that sexual frequency did not change (3 out of 5) (See Table 7 in S4 Table).

Finally, as to communication as an outcome, a pattern was identified, with the one study reporting a positive impact being of lower quality that the two that reported a decrease in communication ((See Table 8 in S4 Table). As observed during the pandemic there was a negative impact on the level of communication.

Aim 2. Moderators

To further explore underlying factors of the inconsistent of findings as to couple (in) satisfaction, sexual satisfaction, and communication as an output we will consider two possible hidden moderators. Considering social reports on the economic impact [133, 134] of the COVID-19 pandemic, we will explore the moderating effect of income—a macro variable of the pandemic—on these three categories of mesosystem outcomes. We will also consider the role of coping as a crucial process for crisis intervention at a secondary level.

As to relationship satisfaction, we identified several papers that have information of family income, coping strategies, or both (See Table 9 in S4 Table). We found no clear contribution of income in explaining variations in relationship satisfaction when couples were exposed to COVID-19 pandemic stress–some studies reported that income did not moderate slopes in relationship satisfaction [124], others identified financial problems as a stress factor [103], other did not report any changes in income during the pandemic [74, 80, 125] and further reported high- or average-income families [73, 102, 104]. Moving to our second moderator, seven studies showed that coping strategies (positive or negative) do moderate the relationship between pandemic stressors and relationship satisfaction, thus leading to different relationship outcomes. Finally, in three studies that included information on both coping and income [73, 80, 102], we find that the presence of moderate or high income and the development of coping strategies minimized the impact of COVID-19 stress on relationship satisfaction.

Next, we will present the studies with sexual functioning as a dependent variable which refer information on income, coping or both (See Table 10 in S4 Table). We found no clear relationship between income and sexual functioning. On the one hand, one study found that low levels of sexual satisfaction were linked to economic losses [98], but other study found no relationship between sexual satisfaction [105] and income. In contrast, moderate levels of sexual satisfaction have been associated with higher income [87]. On the other hand, when no differences in sexual frequency were observed, some studies found that couples tended to have a high income or no changes to the income, and high educational levels [74, 127], and one study found no significant differences [118]. Furthermore, three studies measured both coping, income, and sexual functioning. It appears that the presence of coping strategies and moderate to high income indeed moderated the impact of stress imposed by the pandemic and sexual dynamics [87, 97, 98].

Finally, as to the theme Communication as an Outcome, the only study that have an inconsistent and positive effect of COVID-19 pandemic on communication did not record income and/or coping strategies, so that we cannot move forward in our analysis (See Table 11 in S4 Table).

Discussion

To our knowledge, this is the first systematic review to explore the impact of Covid-19 pandemic on couples and parenting worldwide. From 58 studies across the world, there were 12 themes that interconnected challenges, coping strategies and the impact on parenting and couples during this moment of crisis.

This systematic review of the literature aimed to 1) describe and synthetize the main changes in individual, relationship, and family dynamics during the pandemic; 2) integrate the inconsistent findings and 3) define new routes for research and clinical practice.

Regarding our first goal (to describe the existing thematizes on couples and parenting dynamics during the COVID-19 pandemic), we identified Gender Inequalities and Lack of Support for Mothers relating to how domestic and childcare tasks are divided. This is of particular importance because gender inequalities arise from traditional family models that are structured and operate according to gender roles. This overload of domestic work for women has been described in the literature [135, 136], as a “gender care gap” [137], with repercussions not only on individual well-being [138, 139] but also on the quality of their relationships [140]. We suggest that clinicians should systematically address the division of labour and work-family balance, emphasizing that equitable sharing of responsibilities and improving communication can enhance relationship satisfaction. Additionally, it is important to develop appropriate interventions for mothers, who are a vulnerable group, to address the different dimensions of their overload and risk of mental health issues. This can be achieved by creating programs that offer parental support and reduce psychological distress, hopefully mitigating some of the negative effects of gender inequality. Future investigations should focus on the intersectionality of gender with other factors such as race, socioeconomic status, and single parenthood during crises to understand the unique challenges faced by these groups. This finding also highlights the urgency for the development of more effective support systems, including mental health services, workplace policies, social support networks and community resources. This multifaceted approach advocates for systemic change by targeting policy changes and promoting cultural shifts.

In addition to the stress caused by gender inequalities, external challenges led to high levels of stress in couples and families. Stress can corrode or strengthen relational bonds [141], depending on the resources available [142], on the perception of the situation and on the stress factors [143], that reflect either on maladaptation or relational growth and resilience [143]. In this sense, dyadic support is a significant and relevant aspect highlighted in this review due to existing reduced levels of wellbeing among participants. With effective resources, a period of crisis might carry the potential for positive transformation and present an opportunity for improvement in couples, by building resilience, problem-solving and adaptive skills. Couples can use a crisis as a catalyst for positive change and as a chance to address relational challenges. We believe that the interaction between stress, gender inequalities, and external challenges (e.g., the COVID-19 pandemic) within families depends on the resources available within the dyad. The outcome of this interaction is influenced by how effectively these resources are utilized.

Intimate relationships serve as a context for emotional support and space to alleviate psychological distress, consequently promoting mental and physical health for both family members and couples [144–146]. Also, it is considered a crucial mechanism for overcoming challenges [147] aiding in managing and dealing with stressful situations in a dynamic and reciprocal process [51]. By employing positive coping strategies, relational growth was achieved. We consider that family therapists and other family interventors focus on positive communication skills and assist couples in building an emotionally supportive relational context, which involves both support and stress communication. Since dyadic support becomes particularly important during times of stress, we also believe it is crucial to help couples develop stress management techniques that address both relational and individual stress. Additionally, dyadic support often includes problem-solving skills to address conflicts effectively. Relational growth can emerge from crises, such as the COVID-19 pandemic, when couples foster mutual support and recognize their progress together. Acknowledging families as competent is central to reinforcing positive behaviours and utilizing available resources within the family. Furthermore, since dyadic support is a modifiable dimension, it should be a focus of clinical intervention. Accordingly, therapists can work on changing patterns of dyadic support, communication, validation, and emotional regulation during stressful times. As mentioned before, we found low levels of psychological well-being. Extensive studies conducted during the pandemic have also reported psychological difficulties [31, 33–37]. In the absence of coping strategies and dyadic support, we found a bi-directional relationship between psychological difficulties and couple dynamics [148, 149], also described in the academic field, specifically in parenting [150–152] but also in sexuality [153, 154]. Conversely, insufficient relational satisfaction is reflected in an individual’s well-being [149, 155] and relationship dissatisfaction was found to be strongly linked with emotional distress in both genders [156]. A new aspect that comes to light in this analysis is the effect on work and performance, as previously explored in other research studies [157] and during the COVID-19 pandemic [158]. We believe that this result is a reflection on the gender inequalities and parental overload, as we identify gender-specific challenges, discussed before. Political measures include supportive workplace policies by targeting work-family balance to alleviate the pressure on women and mothers.

Concerning our second goal (integrate inconsistent findings), we found conclusive associations were identified between income, relationship satisfaction, sexual satisfaction, sexual frequency, and stress related to COVID-19. Nonetheless, our observations indicated that individuals with moderate or high income, in conjunction with the implementation of effective coping strategies, exhibited a diminished impact of COVID-19-related stress on both relationship satisfaction and sexual functioning. The effect of coping on the relationship between stressors and marital satisfaction, has been described in the literature as a strong predictor of marital satisfaction [159–161] that confirms our findings. The investigations about relationship between sexual functioning and dyadic coping found that positive dyadic coping has a positive effect on sexual outcomes [161–164].

Regarding income, although we did not find any clear relationship, some studies report that low income can reflect on more fluctuations in marital satisfaction [165], as middle-income couples report both more psychological well-being and dyadic adjustment [166], exerting an important role in marital satisfaction [167–169]. Some factors may contribute to the negative impact of low income on marital satisfaction, namely financial stress [170, 171], financial dependency and difficulties in managing daily life. One possible reason for not finding a moderating effect could be that the families in the study samples maintained their income during the pandemic and may have incurred fewer financial expenses due to lockdown measures, which could have reduced the pressure on the families. Additionally, it is important to note that the primary objective of the studies in this review was not to examine the relationship between income, relational variables, and pandemic-related stress. This socioeconomic vulnerability should be target by public policies to develop support for lower-income individuals and make mental health services available. This can be achieved with public health initiatives as well as workplace policies to improve better work-family balance, as described before, that can be beneficial regardless of income. In the future, academic research should examine how variations in income levels affect the efficacy of different coping strategies and their impact on relationship satisfaction and sexual functioning. Understanding these nuances should better inform targeted therapeutic interventions and policy measures.

Focusing on our third aim (to define new avenues for research and clinical practice), we identified relevant key points: 1) it is essential to identify sources of stress and resources available within families (e.g. coping strategies or socio-demographic characteristics); 2) it is crucial to assess and promote equal sharing of household tasks, as this promotes individual, relational and family well-being and adjustment [172] as well as work-family balance; 3) positive dyadic skills play a central role in the adjustment process and promote resilience and 4) individual well-being needs to be assessed and considered in couple and family therapy.

Regarding the methodological findings, our study included few qualitative studies, so we believe that is important to develop more qualitative studies to capture the perceptions, meanings, and construction of the COVID-19 pandemic experience as a couple and parent, using dyadic interviews. Future investigations should focus on the perspective of both members of the couple and parents at different stages of the family cycle, including longitudinal studies–as all the qualitative studies were cross-sectional. Also, dyadic qualitative studies are greatly needed to understand better the strategies developed to manage childcare demands, division of house duties, and work demands and their respective perception of impact on couple and family quality and satisfaction.

From our perspective, caution should be exercised when considering the findings of the current systematic literature review due to certain limitations. Initially, our study’s research criteria were confined to online databases in peer-reviewed journals as we believed that these publications are more trustworthy and have undergone a thorough review process. Consequently, only peer-reviewed articles were incorporated to ensure that the review’s quality was upheld. Secondly, it is important to recognize the findings while bearing in mind that not all studies had equal methodological rigor.

Conclusion

Couples and parents faced multiple challenges during this worldwide crisis, which varied according to their individual contexts and living conditions, affecting their individual, relational and family well-being. Our review explores the impact of COVID-19 on these dynamics, which are complex and multifaced. With appropriate resources and strategies, families can transform a period of crisis into an opportunity for growth and change. These resources constitute protective factors for the well-being of couples and families, mitigating difficulties and allowing couples to build new meaning, strategies and relational dynamics. It is necessary to reflect on the risk factors (e.g., unequal household duties, low psychological well-being or poor communication) and the urgent need for intervention and prevention in the future contexts of vulnerability and stress. This includes developing communication skills within dyadic support dynamics, establishing self-care routines, prioritizing mental health, and implementing measures to promote gender equality.

Besides identifying the negative and positive impact of COVID-19 pandemic on relational dynamics, we also identify that significant research gaps remain, particularly regarding marginalized groups. This review identifies strategies to help families cope with crises and prevent some of the relational and individual impacts. To our knowledge, this is the first systematic review that mapped the dynamics of cohabitating families during the COVID-19 pandemic. This review may serve to guide professionals intervening with couples and families, as it identified key areas of prevention and intervention.

Supporting information

S1 ChecklistPrisma statement checklist.(DOCX)

S1 FigFig 1. PRISMA flowchart for study selection.(PDF)

S1 TableTable 1. Quality assessment for selected studies—quality assessment for diverse studies.(DOCX)

S2 TableTable 2. Quality assessment for selected studies—Quality Assessment for Diverse Studies (QuADS) (2 judges).(DOCX)

S3 TableTable 3. Quality assessment judge 1 and Table 4. Quality Assessment Judge 2.(DOCX)

S4 TableTable 5. Thematic analysis categories by elements of stress and systems, Table 6. relationship satisfaction and quality assessment, Table 7. Sexual Functioning and Quality Assessment, Table 8. Communication as an Outcome and Quality Assessment, Table 9. Income and Coping on Relationship Satisfaction, Table 10. Income and Coping on Sexual Functioning and Table 11. Income and Coping on Communication as an Outcome.(DOCX)

S5 TableTable 12. Inclusion criteria for studies targeting couples and Table 13. Inclusion Criteria for Studies Targeting Parents.(DOCX)

S6 TableTable 14. Excluded reports for the systematic review of the literature.(DOCX)