Term of Award

Fall 2022

Degree Name

Doctor of Public Health in Epidemiology (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Biostatistics, Epidemiology, and Environmental Health Sciences

Committee Chair

Kelly Sullivan

Committee Member 1

Jessica Schwind

Committee Member 2

Stacy Smallwood


Background. The COVID-19 pandemic was an unprecedented global health crisis that challenged the general public. Vulnerable populations with pre-existing mental illness have been disproportionately burdened by the SARS-CoV-2 (COVID-19) pandemic. As a result, they may experience more adverse mental health outcomes related to COVID-19 infection than other groups. Methods. First, we conducted a retrospective chart review using electronic health records for patients who visited an urban community health center in metropolitan Georgia between 2/1/2019 and 3/11/2021. We examined the prevalence of mental health diagnostic patterns and depression symptoms before and during the COVID-19 pandemic. Second, in a cross-sectional study, we further explored the psychological challenges of adults with severe mental illness during the COVID-19 pandemic using the BPRS, PHQ-9, and K-6 scales. We also examined the association between social connectedness and mental health status. Results. The chart review indicated that patients had higher odds of a primary diagnosis of severe mental disorders, such as schizophrenia, schizotypal personality disorder, schizoid personality disorder, schizoaffective disorder, and schizophrenia) (OR = 3.44, 95% CI: 1.59 –7.43); and affective mood disorders, such as major depressive and bipolar disorders (11%) (OR = 2.11, 95% CI: 1.47 –3.01) during the pandemic compared to the year before the pandemic. The cross-sectional analysis indicated that adults diagnosed with COVID-19 experienced more severe psychological distress (OR=2.48, 95% CI: 1.02–6.28) compared to those not diagnosed with COVID-19. After adjusting for sex and age, adults with SMI who sheltered in place during the lockdown experienced higher psychological distress than those who did not shelter in place in place (aOR=2.52, 95% CI: 1.02-6.48). Women experienced significantly higher SMI severity (BPRS scores (x̄ ± SD) for women = 56.7±24.4 vs. men = 48.5±19.1; (p=0.039) and higher odds of depression (OR=2.74, 95% CI: 1.22­­–6.13) during the pandemic than men. Furthermore, adults with SMI with high social support experienced higher psychological distress than those with low social support (aOR = 4.60, 95% CI: 1.82 –11.8). Conclusions. The findings of this study emphasize the need to incorporate infectious disease responses with mental health interventions during a public health crisis.

INDEX WORDS: COVID-19 pandemic, Mental health, Severe mental illness, African American minorities, Urban setting, Psychological distress, Shelter in place, Social support.

OCLC Number


Research Data and Supplementary Material


Available for download on Monday, November 15, 2027