Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

FAMILY BONDING IN CONFINEMENT OF THE

COVID-19 PANDEMIC: A SYSTEMATIC REVIEW

Jonathan Martínez-Líbano

Universidad Andrés Bello, Santiago, Chile

Abstract

Introduction: Due to the demands of the COVID-19 pandemic, the family became the primary

setting in which people were confined. As a result, the family bond during confinement is an

important phenomenon to study.

Purpose: The purpose of this systematic review was to determine if the family bond would

influence the changes in mental health brought on by confinement and the COVID-19 pandemic.

Methodology: The methodological were a Systematic Review using the PRISMA model in the

search engines Web of Science, Scopus, PubMed, PSYINFO, Taylor and Francis, Sciendo,

Academic Search Ultimate, and Medline between September 2021 and April 2022. NOS

(Newcastle-Ottawa Scale) was utilized.

Results: Concerning the search results, it was possible to identify seven relevant studies for

analysis: four on the variables associated with psychological well-being during the pandemic and

two on the perceived changes in emotional state during the pandemic.

Conclusions: the effects of confinement on mental health are characterized by an increase in

negative emotions, heightened perceptions of stress, anxiety, and depression, and altered sleep

patterns. Concerning the influence of the family bond on mental health, it was discovered that

when the bond is perceived as positive and strong, that is, the individual perceives that their basic,

social, and affective needs are covered, it becomes a protective factor for mental health,

regulating the manifestation of stress, favoring the manifestation of positive emotions over

negative ones, and becoming emotionally supportive.

Keywords

mental health, family bonding, family relationships, confinement, pandemic, COVID-19

Address for correspondence:

Jonathan Martínez-Líbano, Universidad Andrés Bello, Santiago, Chile

Email: ps.jmartinez@gmail.com

This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International

License (CC BY-NC 4.0).

©Copyright: Martínez-Líbano, 2023

Publisher: Sciendo (De Gruyter)

DOI: https://doi.org/10.56508/mhgcj.v6i1.147

Submitted for publication: 29

August 2022

Revised: 20 November 2022

Accepted for publication: 10

February 2023

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Introduction

The COVID-19 pandemic is the most

dangerous threat to global health since the 1918

H1N1 pandemic, which caused millions of deaths

worldwide (Asmundson et al., 2020). In November

2019, the first outbreak would begin in Wuhan,

followed by the first case in Chile in March 2020

(Godoy Echibur & Badillo Vargas, 2021); eight

days later, the World Health Organization

declared a pandemic (Bendersky, 2020). This new

disease exhibits various unpredictable behaviors,

high levels of lethality, variations in the level of

contagion, and different strains throughout its

duration (Arteaga Herrera, 2020), which would

generate uncertainty and different problems in the

stability of the various social areas, primarily in

health, which would have resulted in the

implementation of multiple health measures

(Prada et al., 2021).

Primarily, Chile would have imparted all the

recommended sanitary measures, adopting in the

first instance the State of Constitutional Exception

of Catastrophe; additionally, it implements the

confinement based on the epidemiological

behavior of the various municipalities (Colihuinca

& Alejandra, 2021). The confinement caused by

the virus's contagion has had a significant impact

on various aspects of global stability, including the

economic situation. Considering the closure of

small and medium-sized businesses, the

reduction of employment and the time devoted to

working, the unemployment rates among informal

workers would have skyrocketed, resulting in

increases in poverty, food insecurity, or decreases

in family income, particularly among the most

vulnerable groups (Lizondo-Valencia et al., 2021;

Velasco, 2021)

Social isolation and confinement work as a

measure to prevent the spread of COVID-19

(Gonzalez-Bernal et al., 2021; Rodríguez-

Fernández et al., 2021; Seo, 2021) and its

variants, however it would have some effects, as

mentioned above, but they would also have

affected other areas, such as mental health, since

individuals mention experiencing adverse effects

on a psychological level (Martínez-Líbano, 2020;

Martínez-Líbano & Yeomans Cabrera, 2021;

Martínez-Libano & Yeomans, 2021), due directly

to the conditions of this confinement, and also to

the threat of contagion (Kirk & Rifkin, 2022); this

impact can produce psychological and psychiatric

disorders such as post-traumatic stress (Ashby et

al., 2022a; Nagarajan et al., 2022; Yunitri et al.,

2022), depression, anxiety (Ashby et al., 2022b;

Choi et al. , 2020), frustration (Jayabalan, 2020;

Muñoz-Fernández & Rodríguez-Meirinhos, 2021),

panic disorders (Muñoz-Navarro et al., 2021;

Nami et al., 2020) due to factors such as family

separation (McAdams , 2021; Montauk & Kuhl,

2020), pain, grief, loneliness, shame, guilt, anger,

fear, xenophobia, mass hysteria (Muorah, 2020;

Whitehead & Whitehead, 2010), misinformation

on social media (Buzzell, 2020; Tagliabue et al.,

2020), financial insecurity (Cheng et al., 2021),

stigmatization and other problems that would

affect psychological well-being (Fernández-

Abascal & Martín-Díaz, 2021; Nguyen et al.,

2021). Other research details that such

unprecedented isolation measures on social

distancing, which prevent access to social support

systems such as extended family, friends,

acquaintances, and community ties, can affect

mental well-being and cause a feeling of

loneliness, anxiety, and depression (Alfawaz et

al., 2021; Bzdok & Dunbar, 2020; Garcıa et al.,

2002; Long et al., 2022)

Family bonding is the inclusion of a member

within the family, with all that this encompasses:

admission, accommodation, and incorporation;

this inclusion implies the acceptance that this

member is part of the family structure; It is

relevant that all family members can turn to others

for support and support, especially in risky

situations such as the current context (Mateo et

al., 2018; Rodríguez Mateo et al., 2018). The

universal and characteristic concept of the family

is one of union, coexistence, and attachment

among its members; however, there are

circumstances in which these are not the main

factors that characterize any family going through

moments of stability and instability (Gough, 1959 ;

Seltzer, 2000; Tomaney, 2022; Traina, 2022).

From the systemic model, the different

relationships established within the family system

create relevance in the current context (Jamali &

Mirshak, 2007; Patterson, 2002), since depending

on the links formed, the effects mentioned above

could be more or less profound (Walsh, 2003); a

strong family leadership, defined by its upbringing,

guidance, and protection, would be essential for

the maintenance of stability (Committee, 2004;

Walsh, 2015), however, in times of stress and

uncertainty, the emotional affection and

exhaustion, exhaust the caregiver resources,

modifying parenting styles and weakening positive

leadership, triggering a strain on the parent-child

relationship (Prime et al., 2020; Wade et al.,

2020).

Purpose

The purpose of this systematic review was to

determine if the family bond would influence the

changes in mental health brought on by

confinement and the COVID-19 pandemic.

Methodology

A systematic review was conducted to identify

English and Spanish-written articles published

between September 2021 and April 2022 in the

databases Web of Science, Scopus, PubMed,

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

PSYINFO, Taylor and Francis, Scielo, Academic

Search Ultimate, and Medline.

Search Strategy

According to the PRISMA Preferred Reporting

Protocol for Systematic Reviews and Meta-

Analyses, a literature search was conducted

(Moher et al., 2009; Page et al., 2020). In each

database, the title, abstract, and keyword search

fields were examined. (["family bonding”] AND

["confinement" OR "confinements" OR

"enclosure"] AND ["COVID" OR "coronavirus" OR

"COVID-19])

Figure 1. Search strategy for the selection of

studies.

Selection Criteria and Study Eligibility

Each article's titles and abstracts were

screened, then the full text was evaluated for

eligibility. Studies were eligible for inclusion if the

following conditions were met: 1) the population

was adolescent or adult; and 2) the population

size was adequate. 2) with the use of clinical and

non-clinical instruments; 3) with both positive and

negative outcomes; 4) field studies. 5) texts in

English and Spanish; 6) studies that assess

family-related variables; 7) If the data for the

article was collected during the COVID-19

pandemic. 1) studies not related to the COVID-19

pandemic; 2) subjects living in isolation; 3)

academic notes, letters to the editor, or

reflections; and 4) systematic reviews were

excluded. 5) individuals with specific diseases.

Data extraction

Utilizing a data extraction form, pertinent

information was collected: (1) Principal author, (2)

Country, (3) Research design, (4) Sample size.

(6) Family bond incidence

Quality Assessment

The quality of the studies was evaluated using

a modified version of the Newcastle-Ottawa Scale

(NOS) for cross-sectional research. The NOS

evaluates quality on the basis of its content,

design, and interpretation with greater reliability

and validity than other scales (Cascaes da Silva

et al. al., 2013). The scale has three components:

selection, comparability, and outcome. There are

seven categories that evaluate the

representativeness of the sample, the rationale for

sample size, comparability between respondents

and non-respondents, exposure determinations,

comparability based on study design or analysis,

result evaluation, and statistical analysis

adequacy. Maximums of four stars for the

Selection dimension, two stars for the

Comparability dimension, and three stars for the

Comparability dimension can be awarded if a

study meets certain criteria (Epstein et al., 2018)

Results

Search results

Family Bonding during the confinement of the

COVID-19 pandemic was the subject of 46

publications in total. Five were eliminated due to

being duplicates. After reading the title and

abstract of 21 articles, the remaining 12 were

eliminated after reading the full text. Thus, six

articles that satisfied the inclusion criteria were

chosen for the systematic review.

Characteristics of the Study

Table 1 is a summary of the study's

characteristics and this review's findings. The

sample sizes of the six articles ranged from 208 to

3,960 family members, for a total of 9,343. Brazil

(n = 1), Peru (n = 1), the United States (n = 1),

Saudi Arabia (n = 1), Spain (n = 1), and Turkey (n

= 1) each conducted one of the six studies.

Table 1. Summary of the characteristics of the

study sample, study design, evaluation tools used

and incidence of family bound

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138

Authors

Country

Desing

Sample

Instrument

Measurement

Incidence of the family bond

Giannini

et al.,

2022

Brazil

Cross-

sectional

208

Own

questionnaire

Emotional state

Conflicting family relationships cause an

increase in emotional states of sadness and

anxiety.

Livia et

al., 2021

Peru

Cross-

sectional

3.960

Family APGAR

Family

functioning

Better family functioning predicts higher

positive emotions and lowers negative

emotions. Perception of family functionality as

support and emotional support. Family as

protector of the psychological impact

Tuason

et al.,

2021

EE. UU.

Cross-

sectional

938

Own

questionnaire

Family Time

Family relationships help cope with the stress

associated with the pandemic.

Alfawaz

et al.,

2021

Saudi

Arabia

Cross-

sectional

1.542

Own

questionnaire

Family Bonding

Better family bond less likely to be anxious

and depressed. Family ties are established as

a survival mechanism to preserve mental

well-being

López-

Núñez et

al., 2021

Spain

Cross-

sectional

1.656

Own

questionnaire

and CWRF

items

Family conflict

Family conflicts deteriorate mental health.

ŞENGÜN

TOPTAŞ,

2020

Turkey

Cross-

sectional

344

Own

questionnaire

Impact on

family

relationships

Family relationships have a positive effect on

exposure to COVID. Reduces anxiety and

generates a positive perception of stress.

Source: Own elaboration

Assessment of methodological quality

Table 2 presents the results of the evaluation of the methodological quality of the studies. The quality of the

included studies ranged from satisfactory to good, earning between 4 and 7 stars. There were two seven-star

studies (Livia et al., 2021; Tuason et al., 2021), two six-star studies (Alfawaz et al., 2021; López-Nez et al.,

2021), and two five-star studies (Giannini et al., 2022; ENGÜN & TOPTA, 2020).

Study

Total

Selection

Comparability

Results

Representativeness

of the sample

Size

Not

surveyed

Exposure

checks

Design

and

analysis

Evaluation

and

Results

Statistical

test

Quality

Sample

Giannini

et al

Good

Livia et al.

Good

Tuason

et al.

Satisfactory

Alfawaz

et al.

Satisfactory

López-

Núñez

et al.

Good

Şengün

Toptaş

Good

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Source: Own elaboration

Incidence of the family bond during

confinement by COVID-19

Among the effects that the family bond had on

the changes experienced during the confinement

of the COVID-19 pandemic, we discovered that

conflicting family relationships increase emotional

states of anxiety (n = 3); conflictive family

relationships increase emotional states of

sadness (n = 2); better family functioning

preserves mental well-being (n = 2); family

relationships regulate the perception of stress (n =

2); and better family functioning increases positive

emotions (n = 2)

Discussion

The systematic review carried out to explore

the incidence of family ties in the context of the

COVID-19 pandemic. At the end of this review, it

can be concluded that family bonding, when

perceived as good, tends to protect and improve

mental health. Particularly, confinement generates

a change in individuals. It is mentioned that 93.3%

of adolescents notice changes in their routine,

mentioning increased anxiety and depression

(Giannini et al., 2022), which oscillates with 92%

perception of the effects of psychological aspects

of the pandemic (ŞENGÜN & TOPTAŞ, 2020); it

is noted that there is a significant difference in the

appearance of negative emotions, exceeding the

average in relation to positive emotions (Livia et

al., 2021), considering, in turn, the loneliness and

the diminished sense of agency and generated by

psychological discomfort (Tuason et al. al., 2021),

the indicators associated with mental health

consider the presence of anxiety 58.1%,

depression 50.2%, insomnia 32.2% (Alfawaz et

al., 2021) and satisfaction with life 19% (López-

Núñez et al., 2021). This may be due to the fact

that, due to confinement, the members of a family

group have experienced radical changes that are

evidently perceptible in their usual routine, both at

the family level and in educational, work, and

social environment aspects, which has generated

an emotional and psychological impact,

depending on the stage of development in which

they are and the support they perceive from the

family environment (Cifuentes Carcelén & Navas

Cajamarca, 2021), which is complemented by

concern for their own health and that of people in

their social circle, considering, the fear of

becoming infected or infecting others; and in

addition, the vulnerability to economic problems

caused by confinement, job loss, and income

reduction, would generate uncertainty about

obtaining food and access to education, adding

stressors that put the mental health of individuals

at risk, which could even modify eating habits and

sleep (Vásquez et al., 2020).

Within the aspects influenced by the family

bond, present in the studies of the change

perceived during the confinement of the COVID-

19 pandemic, it is mentioned that when

considered, this bond as conflictive, would cause

an increase in the emotional states associated

with sadness and anxiety, this taking into account

that the increase in coexistence with family

members would have caused moments of greater

stress (Giannini et al., 2022), which is mentioned

in other studies, in which interpersonal conflicts

resulting from family life closest and limiting

privacy, would be associated with emotional

suffering, characterized by fear, anxiety, irritability,

sadness and stress (Brooks et al., 2020). On the

other hand, the consideration of difficult times

associated with the pandemic would have

provided opportunities to increase sharing time,

generating stronger ties and improving the

perception of the family relationship (Giannini et

al., 2022), which coincides with the influence that

the family bond had on the psychological impact

of confinement since better family functioning

would generate more positive emotions and fewer

negative emotions, becoming a protective factor

for the psychological well-being of the members

mainly, these positive emotions would be

associated with indicators of satisfaction

perceived with the response of the family to

expressions of affection and their response to

feelings of love and sadness (Livia et al., 2021);

therefore, it is pointed out that the family becomes

one of the most important environments, valuing

that it is the main environment in which one

interacts and receives support (Arias et al., 2013).

Among the studies cited, estrangement from

family members, that is, a member of the family

nucleus who had to endure confinement far from

the other family members, is considered a

precedent for elevated stress indices (Lukács,

2021). In light of the aforementioned, this is due to

the fact that the possibility that our health or that

of our family members will be affected is a natural

source of concern and anxiety (Valero-Cedeo

et al., 2020). Furthermore, emotional stress is

associated with the narrative ideas of the most

tragic situations experienced during the context of

the COVID-19 pandemic and the subsequent

confinement, which has resulted in the loss of

relatives without being able to say goodbye, along

with the loss of (Discua Cruz & Hamilton, 2022).

Regarding perceived stress in the context of

pandemic and confinement, according to

research, family bonding is presented as a coping

mechanism (Tuason et al., 2021) because, during

the pandemic, social loneliness and isolation are

associated with an increase in the stress

experienced, and that solid relationships should

be regarded as keys to mental health (van Bavel

Mental Health: Global Challenges Journal

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et al., 2022); In a similar vein, Lukács et al. (2002)

note that distancing oneself from one's family

would increase anxiety about contagion, thereby

heightening stress levels.

It is believed that strengthening family ties and

interactions would reduce the risk of presenting

anxious and depressive symptoms, with a higher

prevalence rate in women (Alfawaz et al., 2021).

Close relationships within the family nucleus and

the maintenance of strong ties with high resilience

capacities in unfavorable times would aid in

coping with the effects of changes in the risk

context that is experienced (Prime et al., 2020) In

contrast, it is stated that individuals would benefit

from living with their families during a pandemic

(ENGÜN & TOPTA, 2020).

Cross-sectional research would have

evaluated family bonding and mental health only

in a pandemic, closing the space to compare with

a pre-confinement state, consulting it only

retrospectively, or increasing the risk of recalling

more biases (Lukács, 2021). In addition, the

majority of the studies used online questionnaires

that were not standardized and were created with

specific purposes for each study, which could lead

to biases; this demonstrates the need to create

standardized surveys and use them on a larger

scale to add and validate findings (Alfawaz et al.,

2021)

All of the aforementioned should continue to

motivate us to continue studying the effects of the

containment of the COVID-19 pandemic on

mental health and how the family manages to

protect against negative effects or increase

positive emotions in the different social contexts

around the world and for the faithful, increase

state support for families, and promote family ties,

given that the family is a fundamental pillar of

society

Limitations and Strengths of the

Study

Strengths

This is the first systematic review that

examines and summarizes the existing literature

on the prevalence of family ties and the effects of

the COVID-19 pandemic's containment on the

adult and adolescent population.

Limitations

This systematic review has certain limitations,

as all of the reviewed studies relied on self-

reports, which can lead to responses that are

socially desirable. Similarly, as online studies

were conducted, it is possible that a portion of the

population could not access the evaluation. The

majority of studies were cross-sectional, meaning

that they were measured at a specific time,

making it difficult to extrapolate these results to

the general population and preventing causal

inferences; the longitudinal study does not provide

detailed information on the indicators prior to

confinement. Similarly, the majority of studies had

a larger proportion of women in their samples,

which could impede the data analysis. Regarding

this systematic review, the majority of the articles

utilized non-standardized questionnaires, which

could understate the data's reliability.

Furthermore, the articles did not provide specific

statistical data, such as prevalence, leaving a gap

in knowledge

Conclusions

We can conclude that a number of studies

include family bonding as one of their variables;

however, it is not examined in depth, especially in

terms of the factors that may interfere with it. In

contrast, there is a paucity of research on this

topic in Latin America and Chile. According to the

reviewed studies, the effects on mental health

caused by the containment of the COVID-19

pandemic would be associated with the

appearance of negative emotions, feelings of

stress, anxiety, depression, changes in sleep

hours, and uncertainty; these would have been

exacerbated by the above-mentioned health

situation. Regarding the influence of the family

bond on these changes, it has been observed that

when it is perceived as positive and strong, this

aspect becomes a protective factor for mental

health, regulating the manifestation of stress,

promoting the manifestation of positive emotions

and reducing the manifestation of negative

emotions, and serving as emotional support. It is

necessary to emphasize the significance of the

family unit in coping with high-risk situations like

the COVID-19 pandemic. The promotion of this

region must be the responsibility of social

institutions.

Conflict of interest

The author declares that he has no conflicts of

interest.

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