Studies exploring the influence of COVID-19 on family well-being were reviewed using the scoping review method of Arksey and O’Malley [11]. We also followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) [12].

A literature search was conducted on MEDLINE and CINAHL using controlled vocabulary terms (i.e., Mesh for MEDLINE and CINAHL Subject Headings for CINAHL). The literature search was conducted in MEDLINE and CINAHL in order to obtain specific suggestions to nursing care. We identified the literature published between January 1, 2020 and August 19, 2021. The terms regarding COVID-19 were “COVID-19” or “SARS-CoV-2” in both MEDLINE and CINAHL. The terms about family were “Family,” “Family Characteristics,” “Family Relations,” “Family Conflict,” “Family Health,” or “Family Nursing” in MEDLINE; and “Family,” “Family Relations,” “Family Attitudes,” “Patient-Family Relations,” “Dysfunctional Family,” or “Family Nursing” in CINAHL. Subsequently, the search results of the COVID-19 pandemic were combined with those of family well-being.

Based on previous systematic reviews [13] [14] [15], family well-being included not only family health, happiness, and relations such as couple and parent-child relationships, intimate partner violence (IPV), child abuse and neglect (CAN), and family functioning, but also physical, mental, and social health, and quality of life (QOL) among family members such as family caregivers of patients, children, and older adults. Therefore, this study included the outcomes of both a family as a collective system and its individual members. The titles or abstracts of the relevant studies were screened, following which the full publications of the potentially eligible studies were considered. Studies were excluded if they met the following criteria: 1) not including an abstract, 2) published in non-English, 3) not focusing on the COVID-19 pandemic, 4) not focusing on family well-being, and 5) reviews, recommendations, comments, and editorials. The reference lists of the excluded review articles were inspected to identify additional studies. According to the scoping review methods of Arksey and O’Malley [11] and PRISMA-ScR [12], this review did not assess the methodological quality of the included studies.

A total of 923 articles were retrieved from MEDLINE and CINAHL databases (Figure 1). Of these, 11 duplicates were excluded. The titles and abstracts of the remaining 902 articles were screened for eligibility, and 783 articles were excluded for the following reasons: 237 articles included no abstract, 39 were published in non-English, 25 did not focus on the COVID-19 pandemic, 465 did not focus on family well-being, and 17 were reviews, recommendations, comments, and editorials. The full publication of the remaining 119 articles was assessed for eligibility, and 94 articles were excluded for the following reasons: one did not focus on the COVID-19 pandemic, 81 did not focus on family well-being, and 12 were reviews, recommendations, comments, and editorials. There was no additional article found through screening the reference lists of the excluded review articles. Finally, 25 articles were included in this scoping review.

Twelve of the 25 identified studies targeted families of individuals with no diseases and disabilities [16] [27], four targeted families of COVID-19 patients and survivors [28] [29] [30] [31], four involved families of individuals with disabilities [32] [33] [34] [35], three included families of children with chronic diseases [36] [37] [38], and two targeted families of workers involved with COVID-19 patients [39] [40] (Table 1). Of the 25 identified studies, 17 used a cross-sectional quantitative design [16] [18] [19] [20] [21] [23] [25] [26] [31] - [36] [38] [39] [40], four used a longitudinal quantitative design [22] [27] [28] [37], two used a qualitative design [29] [30], and two involved mixed methods [17] [24]. Five of the studies were conducted in China [18] [27] [38] [39] [40], three each in the United States of America (USA) [20] [33] [34] and Hong Kong [23] [25] [26], two each in Iran [29] [30] and Switzerland [28] [37], and one each in Albania [21], Bangladesh [19], Brazil [36], Canada [16], Greece [35], Japan [22], Netherlands [24], Saudi Arabia [32], and Spain [17]. One study conducted an online survey around the world, mainly in Europe and North America [31].

Three studies focused on family health [23] [25] [26], two on family happiness [25] [26], eight on family relations [16] [17] [18] [23] [25] [26] [29] [30], two on family functioning [27] [37], and two on IPV and/or CAN [19] [24]. In addition, five studies focused on family caregivers’ physical health [20] [27] [30] [33] [39], 16 on family caregivers’ mental health [16] [19] [21] [22] [27] [28] [29] [30] [32] [33] [34] [35] [36] [38] [39] [40], three on family caregivers’ social health [29] [30] [33], and one on family caregivers’ QOL [31].

All studies exploring family health and happiness were conducted in Hong Kong [23] [25] [26]. In the study by Wong et al. [25], families perceived certain benefits of COVID-19 in terms of physical health (e.g., improved family hygiene and improved family physical health), and harm to mental health (e.g., increased family negative emotion and decreased family happiness). In the studies by Sit et al. and Wong et al. that used the same items about family health and happiness, fear of COVID-19 was negatively associated [23], and personal preventive behaviors such as washing hands and wearing masks were positively associated with perceived family health and happiness among family members in Hong Kong [26].

Families reported that while family and parent-child relationships worsened during the COVID-19 pandemic, they also improved in certain instances [16] [17] [18] [25], with families reporting improved family relationships rather than worsened ones in some studies [16] [25]. Members of families that engaged in personal preventive behaviors perceived that their families were more harmonious than those who did not [26]. Telecommuting was associated with couple relationships in Spanish families [17]. In contrast, job loss and financial concerns caused by the COVID-19 pandemic, fear of infection with COVID-19, and stress that the pandemic exacerbates an existing mental health problem, worsened couple, parent-child, and family relationships (e.g., increased harsh words, conflicts and yelling/shouting) [16] [23].

Two qualitative studies exploring family relationships among families of Covid-19 patients were conducted in Iran [29] [30]. When family caregivers lived with and provided care to COVID-19 patients, they became more interested in and appreciative of each other [30]. Family members described that the death of a member, especially a father, had a very adverse effect on the stability of their family [29].

Compared to before the pandemic, Chinese pregnant women reported less family cohesion and more family conflicts and independence during COVID-19 [27]. Similarly, family cohesion and expressiveness during the COVID-19 pandemic was lower than before among parents with typically developing children, children born very preterm, or children with congenital heart diseases in Switzerland [37].

No difference was found in the frequencies and severities of IPV and CAN before and during the lockdown among families with high risk of IPV and/or CAN in the Netherlands, but half of them reported frequent and serious violence during the containment [24]. Compared to before the lockdown, more than half of Bangladeshi mothers with experiences of IPV reported that emotional, sexual, and physical (moderate and severe) violence increased during the confinement [19].

Chinese pregnant women reported sleep disturbance more frequently during the COVID-19 pandemic than before it [27]. Household chaos and stress related to the lockdown were negatively related to sleep time and physical activities among parents of preschoolers in the USA [20].

Family members providing care for COVID-19 patients at home reported sleep disturbance and fatigue as the most common physical problems [30]. Family caregivers of individuals with disabilities had more fatigue and sleep disturbance than non-family caregivers, and these symptoms worsened with increased caregiving burden related to COVID-19 [33].

More than half of the Chinese family members of front-line rescue workers had sleep disturbance with increased worry regarding the workers’ physical condition and access to of supplies; a greater impact of front-line work on their daily lives was associated with more sleep disturbance [39].

The COVID-19 pandemic and the subsequent lockdown increased psychological problems such as depression, anxiety, and somatic symptoms among pregnant women, and parents with infants or children aged < 18 years at home [16] [19] [27]. Among family members with nursing students, 26% indicated moderate to severe symptoms of depression after the first 10 days of lockdown associated with COVID-19 [21]. Eight percent of parents with children aged < 18 years at home reported suicidal ideation or self-harm during the pandemic, which was at a higher proportion than for parents without children at home (2%) [16]. Parenting for children, alongside caregiving and its increased burden for older adults during COVID-19 aggravated parents’ and family caregivers’ mental health [16] [22]. The belief that COVID-19 and the lockdown phase increased health problems influenced the worsening of depression among family members of nursing students [21]. Family cohesion perceived by pregnant women decreased their anxiety, depression, and somatization symptoms, while family conflict increased the perception of these symptoms [27].

Qualitative studies found that family members who had COVID-19 patients or experienced their deaths, described COVID-19 as difficult and terrifying, feeling fear, anxiety, worry, sadness, and hopelessness; they also reported negative preoccupation about patients’ progress, feeling powerless to manage their symptoms and guilt that they may have transmitted the virus to their families, causing their deaths [29] [30]. Sixteen percent of family members with COVID-19 patients had anxiety, and 15% had depression [28]. The burden associated with COVID-19, such as the risk of infection and isolation from patients, and their death increased depression and anxiety [28].

Family members of individuals with disabilities reported aggravation of depression, anxiety, parenting stress, and psychological distress due to the COVID-19 pandemic and its subsequent lockdown [32] [33] [34] [35]. Increased severity of disabilities [32] [34], caregiving burden [33], and lack of support [32] for individuals with disabilities were negatively related to mental health. In addition, during the COVID-19 pandemic and its subsequent lockdown, family caregivers of children with type 1 diabetes or kidney failure reported depression, anxiety, and pandemic-related emotional burden (e.g., feeling worried and afraid of being infected with the virus) [36] [38].

Among family members of workers involved with COVID-19 patients, 34% - 49% reported anxiety, 12% - 29% reported depression, 10% reported posttraumatic stress, and 8% reported suicidal ideation [39]. Worries about the safety and physical condition of workers, lack of supplies for workers, a greater impact of their job on their daily life, more time spent thinking about COVID-19, and longer working time of workers deteriorated psychological problems among family members [39] [40].

Family caregivers who had COVID-19 patients or experienced their deaths described that healthy people in the community were terrified of interacting with them, and would rather stay away from them, making them feel socially rejected and lonely [29] [30].

During the pandemic, family caregivers of individuals with disabilities reported less ability to participate in social activities than non-family caregivers. Those who reported a greater impact of COVID-19 on their caregiving also had less social participation than family caregivers who reported less impact [33].

Partners and family members of COVID-19 survivors reported that the poor dimension of the Family Reported Outcome Measure measuring their QOL was feeling worried, followed by the dimension of family activities, frustration, holiday, and sex life [31]. Partners and family members with a COVID-19 history experienced a greater impact on eating habits, work and study, family activities, holiday, sex life, and sleep than those with no history.