COVID-19, Frontline Responders and Mental Health: A Playbook for Delivering Resilient Public Health Systems Post-Pandemic

ISBN: 978-1-80262-118-1, eISBN: 978-1-80262-115-0

Publication date: 23 January 2023


(2023), "Prelims", Horney, J.A. (Ed.) COVID-19, Frontline Responders and Mental Health: A Playbook for Delivering Resilient Public Health Systems Post-Pandemic, Emerald Publishing Limited, Leeds, pp. i-xviii.



Emerald Publishing Limited

Copyright © 2023 Jennifer A. Horney

Half Title Page


Endorsements Page

The impact of this global pandemic on mental wellness has been profound, and the consequences are still emerging. This book captures the direct and indirect psychological sequelae of surviving a collective trauma, along with critical lessons learned for congregant settings like long-term care facilities and prisons.

Robin Timme, Psy.D., ABPP (Forensic), CCHP-MH, CCHP-A, Senior Expert & Vice President at Falcon Inc.

Spotlighting the acute and lingering distress that the COVID-19 pandemic has heaped on responders, other essential workers, and the diverse communities they serve, this books make the compelling case as to why public health emergency management systems must demonstrate greater parity between mental health and physical health going forward.

Monica Schoch-Spana, PhD Senior Scholar, Johns Hopkins Center for Health Security. Senior Scientist, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health.

Title Page


A Playbook for Delivering Resilient Public Health Systems Post-Pandemic

Edited by

Jennifer A. Horney

University of Delaware, USA

United Kingdom – North America – Japan – India – Malaysia – China

Copyright Page

Emerald Publishing Limited

Howard House, Wagon Lane, Bingley BD16 1WA, UK

First edition 2023

Editorial matter and selection © 2023 Jennifer A. Horney.

Individual chapters © 2023 the authors.

Published under exclusive licence by Emerald Publishing Limited.

Reprints and permissions service


No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters’ suitability and application and disclaims any warranties, express or implied, to their use.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-1-80262-118-1 (Print)

ISBN: 978-1-80262-115-0 (Online)

ISBN: 978-1-80262-117-4 (Epub)

Dedication Page

To my husband, Michael, and my children, Ian and Lila, and to all of those whose lives have been impacted by this pandemic and our response to it.


About the Contributors xi
Acknowledgments xviii
Introduction: Mental Health Impacts of Disasters and Emergencies 1
Jennifer A. Horney
1. Older Adults’ Behavioral Health During the COVID-19 Pandemic 9
Vanessa Parks, Grace Hindmarch, Sonny S. Patel and Aaron Clark-Ginsberg
2. COVID-19 and Women 23
Sarah E. Scales and Jennifer A. Horney
3. Impacts of COVID-19 on Children and Adolescent Well-Being 43
Yulissa Rodriguez and Rita V. Burke
4. Mental Health Among LGBTQ+ Communities in the Context of COVID-19 55
Gregory Phillips II, Dylan Felt, Megan M. Ruprecht and Lauren B. Beach
5. Impacts of the COVID-19 Response on Populations with Chronic Conditions and Developmental Disabilities 79
Jennifer Trivedi and Megan Stevens
Box 1: Being Immunocompromised, Accessing Care, and Coping with Mental Health in COVID-19, Jennifer Trivedi 81
Box 2: A Qualitative Study of Parents of Disabled Children, Megan Stevens 86
6. Mental Health and Quality of Life in Long-Term Care During the Pandemic 97
Caitlin McArthur, Reem T. Mulla, Luke A. Turcotte, Jessica Chi-Yen Chu, Micaela Jantzi and John P. Hirdes
7. Mental Health in Rural America During COVID-19 and Beyond 119
J. Tom Mueller and Alexis A. Merdjanoff
Box 1: COVID-19 in the Rural American West, J. Tom Mueller and Alexis A. Merdjanoff 126
8. Impacts of the COVID-19 Response on Frontline Healthcare Workers 135
Mari Fischer and Jennifer A. Horney
Box 1: COVID-19 and EMS Workers, Maria Mendez Garza 140
Box 2: Mental Health Impacts of COVID-19 in Veterinary Medicine, Danielle Lecce 141
9. Impacts of the COVID-19 Response on the Governmental Public Health Workforce 153
Kahler W. Stone
Box 1: A Voice from the Field: A California COVID-19 Epidemiologist, Jake M. Pry 164
10. Impacts of the COVID-19 Response on the Academic Public Health Workforce 177
Kristina W. Kintziger and Jennifer A. Horney
11. Mental Health Impacts on Other Essential Workers 199
Jennifer A. Horney
Box 1: Dieticians as Frontline Responders, Denine Stracker 200
Box 2: Unintended Consequences of COVID-19 Policies on the Mental Health of Emergency Services Workers, Ashleigh Bothwell 204
12. Inequities in the Mental Health Impacts on Frontline Responders and Essential Workers 211
Ibraheem M. Karaye
13. Lessons from the Response 227
Jennifer A. Horney
Box 1: Responding to the Overdose Epidemic During COVID-19 in North Carolina: Trends, Challenges, and Recommendations for Surveillance and Response, Mary E. Cox, Amy Ising, Mike Dolan Fliss, and Scott Proescholdbell 229
Box 2: Hope in the First State, Joshua L. Kelly and Erin N. Norris 234
Conclusions and Common Themes 243
Jennifer A. Horney
Index 249

About the Contributors

Lauren B. Beach, JD/PhD, (they/she) is a Research Assistant Professor within the Department of Medical Social Sciences and Department of Preventive Medicine in the Feinberg School of Medicine at Northwestern University. She is also the Interim Director of the EDIT Program within NU’s ISGMH. Dr Beach investigates the epidemiology of chronic health conditions over the life course among diverse SGM populations and people with HIV. They also study how multilevel health and identity related stigmas affect chronic condition management and health outcomes of minoritized populations. Dr Beach is active in community engaged, evidence informed advocacy efforts to improve the health of sexual and gender minority populations – in particular bisexual populations. They are nationally active in bisexual health policy leadership circles and have spoken at the White House, CDC, and NIH to present recommendations for improving bisexual health.

Rita V. Burke, PhD, MPH, is an Associate Professor of Clinical Population and Public Health Sciences at the Keck School of Medicine at the University of Southern California. She also holds a joint appointment in the Department of Pediatrics. She has over 70 peer-reviewed publications, over 50 abstracts and book chapters. She is the former co-chair of the Research Committee for the Pediatric Trauma Society, co-chair of the Disaster and Emergency Response sub-committee of the American Public Health Association, and current co-chair of the Los Angeles Children in Disasters Working Group. She is the Deputy Editor for the peer-reviewed journal Disaster Medicine and Public Health Preparedness and co-author of Landesman’s Public Health Management of Disasters.

Jessica Chi-Yen Chu is an undergraduate student pursuing a Bachelors in Honours Public Health at the University of Waterloo, expecting to graduate in June 2022. She is working on her honours thesis, researching COVID-19, mental health and QoL in long-term care homes. She is interested in mental health and health policy among this population.

Aaron Clark-Ginsberg, MSc, PhD, is a Social Scientist at RAND who has been researching disasters for more than 10 years. His PhD took him to 10 developing countries to conduct field research on the governance of community-based disaster risk reduction. His more recent work spans the disasters gambit, with a focus on three primary areas of inquiry: disasters and community, disasters and health, and disasters and measurement. As outputs of these projects he has contributed chapters to several disaster-related books including Critical Disaster Studies (2021), External Interventions for Disaster Risk Reduction (2020), The Humanitarian Challenge (2015), and Climate Crisis: Examining the Health Equity and Justice Implications (forthcoming).

Dylan Felt, MPH, is a Research Project Manager and Assistant Director for Community Engagement with the EDIT Program at NU’s ISGMH and the Department of Medical Social Sciences. She received her Masters of Public Health from Northwestern University in 2022, and her B.A. in Psychology from Brown University in 2016. She has worked with Drs Phillips and Beach since 2017, providing support, coordination, and leadership across numerous public health research and program evaluation initiatives. Her research leverages a variety of social science theories to investigate, explicate, and propose solutions to health inequities rooted in social structures, with an emphasis on the health of transgender people. Broadly, her work emphasizes using research as a tool for meaningful praxis and social change, and prioritizes community leadership in public health work and the pursuit of health equity.

Mari Fischer, MSN, RN-BC, is the Manager of Clinical Coordinator and External Relations in the School of Nursing at the University of Delaware. She is a board certified psychiatric mental health nurse and a member of Sigma Theta Tau International Honor Society of Nursing.

Grace Hindmarch, BSPH, is a Research Assistant at the RAND Corporation. Her research projects include implementing collaborative care for opioid use disorder and co-occurring depression and/or PTSD, comparing financing strategies for sustainment of an evidenced-based practice for adolescent substance use, evaluation of organizations supporting minor victims of sex trafficking, and measure development for incident management of health-related events. Prior to RAND, she received a BSPH with honors in public health and anthropology from Tulane University.

John P. Hirdes, PhD, is a Professor in the School of Public Health Sciences, University of Waterloo and a Fellow of the Balsillie School of International Affairs. In addition, he is the Senior Canadian Fellow and a Board Member of interRAI (, an international consortium of researchers from over 35 countries. He chairs interRAI’s Network for Mental Health and the interRAI Network of Canada.

Jennifer A. Horney is Professor and Founding Director of the Epidemiology Program and Core Faculty at the Disaster Research Center at the University of Delaware, Newark, Delaware, USA. Her work focuses on measuring the health impacts of disasters. She was part of the public health response to Hurricanes Isabel, Charley, Katrina, Wilma, Irene, and Harvey, where she conducted rapid assessments of disaster impacts on individual and community health. She has also provided technical assistance to public health agencies globally around disasters, emerging infectious disease outbreaks, and pandemic influenza planning and response. She is currently leading an interdisciplinary project exploring the impacts of public health control measures implemented during the COVID-19 pandemic on the provision of services and advocacy to domestic violence victims and survivors.

Micaela Jantzi is the Data Manager for the interRAI Canada Research Group at the University of Waterloo. She provides analytic support for research projects and management of large data holdings across the full spectrum of interRAI assessments.

Ibraheem M. Karaye, MD, DrPH is an Assistant Professor of Population Health at Hofstra University. Previously, he was a Postdoctoral Researcher and an Adjunct Assistant Professor in the Epidemiology Program at the University of Delaware. His research broadly examines the physical and mental health impacts of disasters, mass trauma, and injuries on socially vulnerable populations, including racial and ethnic minorities and older adults. His work also examines health disparities and assesses the distribution of health outcomes globally and in the United States. His approach has been to study social variables using large secondary data sets and novel statistical and spatial analytic methods.

Kristina W. Kintziger is an environmental and infectious disease Epidemiologist with experience in both academia and public health practice. She received her Master’s degree in Epidemiology from Emory University and her Doctorate in Epidemiology from the University of South Carolina. She conducts translational research that focuses on improving public health practice in areas that include infectious diseases, disaster response, and climate and health. She worked in public health practice as an Epidemiologist at the Florida Department of Health prior to her career in academic public health.

Caitlin McArthur, PhD, is an Assistant Professor in the School of Physiotherapy at Dalhousie University. Her research focuses on improving the effectiveness of and access to rehabilitation for people living with chronic health conditions across the continuum of care, particularly home and long-term care. She is interested in fall and fracture prevention and improving functional mobility.

Alexis A. Merdjanoff, PhD, is an Assistant Professor Social and Behavioral Sciences at New York University’s School of Global Public Health. She is a public health sociologist who explores how population health is affected by exposure to natural hazards, including hurricanes, floods, extreme heat and wildfires. She is particularly interested in how social inequalities shape the impact of hazards on health, recovery, and resilience for vulnerable populations. By focusing on the long-term effects of disasters, she has been able to determine why some survivors are able to recover quickly while others remain mired for months or years.

J. Tom Mueller is a Research Assistant Professor of Geography and Environmental Sustainability and a Faculty Affiliate in Sociology at the University of Oklahoma. He holds a PhD in Rural Sociology and Human Dimensions of Natural Resources and the Environment from Penn State. As a rural sociologist and demographer, his research program focuses on spatial inequality, health, well-being, and environmental injustice in the United States. Using a variety of quantitative methods, his research focuses on understanding why some places are persistently worse off than others, and what needs to be done to remedy these inequalities.

Reem T. Mulla is a PhD candidate at the School of Public Health Sciences at the University of Waterloo. Her research focuses on the impact of COVID-19 on mood and cognition among residents of long-term care facilities. She is interested on the effect of infectious diseases and vaccination uptake among this population.

Vanessa Parks, PhD, is a Sociologist at RAND where she studies how individuals and communities respond to disasters. Much of her research focuses on the health and social impacts of disasters, particularly among communities that are historically marginalized, rural, or closely tied to natural resources. In 2020, she founded the SSEER, CONVERGE, and NSF-supported COVID-19 Impacts to the Deep South working group. Prior to joining RAND, she was a Postdoctoral Researcher at the University of Mississippi’s Center for Population Studies and received her PhD from Louisiana State University. Her work has been published in Rural Sociology, Natural Hazards, Society and Natural Resources, and many other outlets.

Sonny S. Patel, MPH, MPhil, is an award-winning researcher and Public Health Executive who serves on advisory committees and boards of directors of organizations looking to create positive social and community impact. He is a Presidential Fellow in Transcultural Conflict and Violence Initiative at Georgia State University and a Visiting Scientist at Harvard Humanitarian Initiative, Harvard University. He was a former National Institutes of Health Fogarty Global Health Scholar, an Emerald Publishing Literati Award winner, and a top 40 under 40 Public Health Catalyst awardee by the Boston Congress of Public Health. He was recognized in 2020 by USAID in India as one of the top DevDistruptors in Mental Health. He is the author of the book, Community Resilience When Disaster Strikes: Security and Community Health in UK Flood Zones, published by Springer Nature and contributed to the textbook, Service-Learning for Disaster Resilience: Partnerships for Social Good, published by Routledge.

Gregory Phillips II, PhD, MS, is an Assistant Professor in the Departments of Medical Social Sciences and Preventive Medicine at Northwestern University (NU), and the Founder of the Evaluation, Data Integration, and Technical Assistance (EDIT) Program within NU’s Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH). He is an infectious diseases epidemiologist whose career spans over a decade of exploring the complex factors that disproportionately impact the health of minoritized individuals. He uses a community-led approach in all his work, and has been one of the leading developers of several new program evaluation frameworks, including LGBTQ + Evaluation and Systems-Informed Empowerment Evaluation. He also currently leads the Youth and Young Adults (YYA) COVID-19 Study, funded under the NIH RADx-UP Initiative.

Yulissa Rodriguez recently received her Masters in Public Health from the University of Southern California, where her research focused on a variety of public health issues including breastfeeding disparities among farmworkers in Monterey County, the use of green space in the City of Pomona to address adolescent mental health, restoration of the Los Angeles River, and COVID-19 vaccine hesitancy and misinformation in Los Angeles. She attended California Polytechnic State University, San Luis Obispo, where she earned a Bachelor’s of Science in Nutrition. She spent her childhood in a farming community. Her goal is to blend her backgrounds to find creative solutions to systemic societal challenges.

Megan M. Ruprecht is a Research Project Coordinator with the EDIT Program at Northwestern University. She oversees the YYA COVID-19 Study, which endeavors to better understand how the COVID-19 pandemic has impacted the mental, social, and physical health of marginalized young people. She has published and presented on the disproportionate impacts of COVID-19 on minoritized populations, with a focus on the structural causes of health disparities both locally and nationwide. She is especially interested in the power of community-engaged research to reduce health disparities among LGBTQ populations and is currently a student in the Masters of Public Health program at Northwestern University.

Sarah E. Scales is a doctoral student at the University of Delaware, Newark, Delaware, USA. Her work focuses on using epidemiology to understand the human health impacts of disasters and complex emergencies. She has worked on projects assessing the health impacts of extreme heat exposure, measuring excess mortality and under-five mortality in the Yemen Civil War, and describing the mental health impacts of the COVID-19 pandemic on the public health workforce.

Megan Stevens is a PhD student in the Department of Sociology and Criminal Justice at the University of Delaware. Her research focuses on health, disabilities, and resilience.

Kahler W. Stone is an Assistant Professor at Middle Tennessee State University in Murfreesboro, Tennessee, USA. His current activities involve teaching and researching disaster epidemiology, public health capacity, and opioid use disorder. He previously worked as a local governmental epidemiologist before his academic appointment. Prior to that, he worked internationally in Zambia with HIV/AIDS prevention trials. He has published work on epidemiologic capacity, public health surveillance, and workforce challenges. He is currently involved in mixed methods research assessing the long-term mental health impacts of the COVID-19 response on public health workers.

Jennifer Trivedi is an Assistant Professor in the Department of Anthropology and a Core Faculty member at the Disaster Research Center at the University of Delaware. Her work focuses on the historical and cultural contexts surrounding disaster vulnerability, response, recovery, resilience, and decision-making. Her ongoing research examines the impacts of the COVID-19 pandemic on different groups in the United States, hurricane evacuation decision making and timing as part of an interdisciplinary team, varied cultural aspects of disasters, and long-term recovery processes.

Luke A. Turcotte, PhD, is a Health Systems Researcher and Data Scientist working jointly with the University of Waterloo, Canadian Institute for Health Information, and Bruyère Research Institute. He is also affiliated with interRAI, an international collaborative that develops clinical health assessment instruments and decision-support tools. His research is focused on the development and application of health information systems to support clinical decision-making and improve the quality of care for older adults with complex health conditions across the continuum of care.


The COVID-19 pandemic has impacted the physical and mental health of millions in both direct and indirect ways. Stress, anxiety, and loneliness associated with fears about contracting COVID-19 and the experiences of loss, financial insecurity, and social isolation have worsened our mental health generally, with more adults reporting symptoms of mental health disorders during the pandemic compared with the pre-pandemic period. We also know there are highly vulnerable subpopulations for whom the mental health impacts of the COVID-19 pandemic can be more severe, including children, caregivers, minority populations, and those with limited access to care. Frontline responders – healthcare providers, public health practitioners, and other essential workers are also at higher risk. The goal of this book is to hear their voices and to consider their recommendations for the critical and necessary changes that will help to build our resilience to the mental health impacts of disasters prior to the next public health emergency. This book would not have been possible without the contributions of many people, working within their own areas of expertise to address the impacts of the COVID-19 pandemic – and our response to it – on mental health.