The Impact of COVID-19 and an EF-4 Tornado in Coweta County, Georgia by Ann Kerlin

The Impact of COVID-19 and an EF-4 Tornado in Coweta County, Georgia

By Ann Kerlin, Ph.D1

Introduction

This paper describes the results of a study created to explore the impact of COVID-19 on

clients at One Roof Ecumenical Alliance Outreach, a faith-based charity located in Coweta

County, Georgia. About halfway through the data collection process, this county was struck by

an EF-4 tornado during the night of March 25-26, 2021. Many public buildings as well as 1,726

homes were damaged; of these, 99 homes were destroyed, and 174 received major damage. The

tornado struck an area that included many lower-income residents, displacing both renters and

homeowners, many of whom were without insurance. In fact, the Coweta County School System

declared that an additional 119 students were classified as homeless according to the McKinney-

Vento Homeless Assistance Act, 42 U.S.C. §11431 et seq. due to the tornado. The area was

declared a federal disaster site by President Biden. It is estimated that it will require 3 years to

physically recover from all the damage. Having experienced both a global pandemic and a very

destructive tornado, the implications for the mental health of the community are a concern..2,3

1 Ann Kerlin, PhD, Liberty University, 2013. Dr. Kerlin has an M.Div. from Luther Rice College & Seminary, and an MA in Human Services from Liberty University. She is a Licensed Professional Counselor who also enjoys research on trauma and addictions. She is the coordinator of the MABC program at LRCS.

2 Wei Shi and Brian J. Hall, “What Can We Do for People Exposed to Multiple Traumatic Events during the Coronavirus Pandemic?,” Asian Journal of Psychiatry 51 (June 1, 2020): 102-165, https://doi.org/10.1016/j.ajp.2020.102065.

3 Harris Hyun-Soo Kim and James Laurence, “COVID-19 Restrictions and Mental Distress among American Adults: Evidence from Corona Impact Survey (W1 and W2),” Journal

The Study Location

Coweta County, Georgia is situated in the west central portion of Georgia and is

considered part of Metro Atlanta. Per the 2019 U. S. Census data, the population is 148,509. The

median income in 2019 was $75,913, with 9.0% of the population living in poverty.

Demographic information indicates that 70.5% of the population is White, 18.4% is Black, 7.3%

is Hispanic or Latino, 2.2% is Asian, and 1.6% is other.4

This study began in January 2021 when several interns from the Human Services

department at the University of West Georgia joined One Roof for the semester. Designing a

survey project seemed in line with their work. The executive director of One Roof, who is also

the primary investigator of this project, is a Licensed Professional Counselor in Georgia. It

seemed that if there was a need for additional mental health support, One Roof should step up to

offer such care or advocate the need for it. One Roof’s clients typically are people living below

the federal poverty level, which tends to put them at higher risk for mental distress in times of

emergencies. COVID-19 impacted everyone, but those at the lowest economic levels were at

highest risk of losing jobs and wages, with the least financial margin.

5

of Public Health 42, no. 4 (November 23, 2020): 704–711, https://doi.org/10.1093/pubmed/ fdaa148.

4 “U.S. Census Bureau QuickFacts: Coweta County, Georgia,” U.S. Census Bureau, last modified 2019, accessed June 1, 2021, https://www.census.gov/quickfacts/cowetacountygeorgia.

5 Michael Karpman et al., “The COVID-19 Pandemic Is Straining Families’ Abilities to Afford Basic Needs: Low-Income and Hispanic Families the Hardest Hit,” The Urban Institute, April 28, 2020, https://www.urban.org/research/publication/covid-19-pandemic-strainingfamilies-abilities-afford-basic-needs.

Multiple researchers in a variety of disciplines have explored the impact of COVID-19.

Much was published in 2020 about the initial impact of social and health policies on current

mental health symptoms,6,7 and possible trajectories for an increase in mental health distress over

the long term.8 Much more research on the impact of COVID-19 is needed as new variants of the

virus enter communities and nations continue to adjust to changing health and economic

concerns.

Additionally, the United States has been through divisive political changes9 and civic

unrest due to racial strife. 10 Multiple factors have been influential in the mental distress of our

citizens, in addition to the global pandemic and the local tornado. It is impossible to isolate one

source of stress and link it to one particular outcome.

6 Calliope Holingue et al., “Mental Distress during the COVID-19 Pandemic among US Adults without a Pre-Existing Mental Health Condition: Findings from American Trend Panel Survey,” Preventive Medicine 139 (October 1, 2020): 106-231, https://doi.org/10.1016/j.ypmed. 2020.106231.

7 Emma E. McGinty et al., “Psychological Distress and COVID-19–Related Stressors Reported in a Longitudinal Cohort of US Adults in April and July 2020,” Journal of the American Medical Association 324, no. 24 (December 22, 2020): 2555-2557, https://doi.org/ 10.1001/jama.2020.21231.

8 Kira E. Riehm et al., “Trajectories of Mental Distress Among U.S. Adults During the COVID-19 Pandemic,” Annals of Behavioral Medicine 55, no. 2 (February 1, 2021): 93–102, https://doi.org/10.1093/abm/kaaa126.

9 Sameera S. Nayak et al., “Is Divisive Politics Making Americans Sick? Associations of Perceived Partisan Polarization with Physical and Mental Health Outcomes Among Adults in the United States,” Social Science & Medicine 284 (May 4, 2021): 113976, https://doi.org/10.1016/ j.socscimed.2021.113976.

10 Leonard E. Egede and Rebekah J. Walker, “Structural Racism, Social Risk Factors, and Covid-19 — A Dangerous Convergence for Black Americans,” New England Journal of Medicine 383, no. 12 (September 17, 2020): e77(1-3), https://doi.org/10.1056/NEJMp2023616.

Purposes and Goals of the Study

The primary investigator sought to determine whether the mental health symptoms

reported by participants visiting One Roof’s offices were higher than in prior years. To make

such a determination, the Kessler-6 screening assessment for serious mental health issues (SMI)

was selected.11 This instrument has been used in multiple epidemiological studies such as the

National Health Interview Study,12 the National Survey of Midlife Development, 13 and the

World Health Organization. 14 Because there are numerous analyses in large scale data

collections, some comparisons with this small study population were deemed feasible.

The purpose of the project was to learn more about One Roof’s clients and the impact of

COVID-19 in their lives. The hypothesis was that mental health distress is higher now in 2021

than in previous years.

11 R. C. Kessler et al., “Short Screening Scales to Monitor Population Prevalences and Trends in Non-Specific Psychological Distress,” Psychological Medicine 32, no. 6 (August 2002): 959–976, https://doi.org/10.1017/s0033291702006074.

12 Centers for Disease Control and Prevention, “Early Release of Selected Estimates Based on Data From the 2018 National Health Interview Survey,” May 30, 2019, https://www.cdc.gov/nchs/nhis/releases/released201905.htm#13.

13 Shinichiro Tomitaka et al., “Pattern Analysis of Total Item Score and Item Response of the Kessler Screening Scale for Psychological Distress (K6) in a Nationally Representative Sample of US Adults,” PeerJ 5, no. e2987 (February 9, 2017): 1-15, https://peerj.com/articles/ 2987/.

14 Ronald C. Kessler et al., “Screening for Serious Mental Illness in the General Population with the K6 Screening Scale: Results from the WHO World Mental Health (WMH) Survey Initiative,” International Journal of Methods in Psychiatric Research 19, no. Suppl 1 (May 31, 2010): 4-22, https://doi.org/10.1002/mpr.310.

Method

Study participants completed a survey prepared by the primary investigator, and

manually distributed to visitors at One Roof Ecumenical Alliance Outreach. The survey was

designed for manual self-administration, although some interns canvassed clients and helped

them complete it. Participation was voluntary, and no names were captured or tied to any request

made to our organization. The project was approved by the Institutional Review Board at Luther

Rice College and Seminary.

Measures

The Kessler-6 (K-6) is a short six-question survey rated on a 5-point Likert scale.

Responses are rated from 0 (None of the time) to 4 (All of the time), and total scores range from

0 to 24. Moderate mental distress is indicated when the K-6 ≥5; severe mental illness (SMI) is

indicated when the K-6 ≥ 13. Questions include: “During the past 30 days, about how often did

you feel… 1) nervous? 2) hopeless? 3) restless or fidgety? 4) so depressed that nothing could

cheer you up? 5) that everything was an effort? 6) worthless?” Cronbach’s alpha was .89 in the

original research15 and .90 in this study.

Several non-standard questions were included. The first was: “Thinking back to January

2020 and comparing it to today, what is true of your financial situation?” This was rated on a 5-

point Likert scale, rated from 0 to 4, beginning with 0 = “It’s much better”, “It’s a little better”,

“It’s about the same”, “It’s a little worse”, ending with 4 = “It’s much worse.”

15 Kessler et al., 969.

Participants were asked to check all the events related to COVID-19 that occurred in their

lives. Included on this list were “You had COVID-19”, “A family member had COVID-19”, “A

friend died from COVID-19”, “A family member died from COVID-19”, “You were

quarantined”, “You lost a job because of COVID-19”, and “Your hours were cut due to COVID-

19.”

A question about faith was included, and participants could select more than one answer:

“How would you describe your faith in God these days?” Answer choices were 1) I have drawn

closer to God lately, 2) I am praying and attending church more often 3) I am beginning to

wonder if God even hears my prayers, 4) I am angry at God and 5) I don’t really believe in God.

Basic demographic information was also collected which included gender, ethnicity, date

of birth, zip code, and income levels. Participants had to select an income level which were

ranked as follows 1) $0-$12,880, 2) $12,881-$18,000 3) $18,001-$30,000 or 4) $30,000 and up.

All statistical analyses were performed using SPSS Version 27.0 (IBM Corp., 2020).

Participants

Researchers collected 110 surveys from participants; 101 of them were completed and

available for use in the study. Results of the demographic information are displayed in Table 1.

Table 1: Demographics

N (%) Mean SD*

Female

White

Black

Hispanic 68 (67.3%) 43 (42.6%) 49 (48.5%) 1 (1.0%)

Other

8 (7.9%) Coweta County Resident 81 (80.2%) From another county or not specified 20 (19.8%) Age range 18-88 Income Levels** 50.3 15.6

1.79 1.08

1) $0-$12,880 2) $12,881 to $18000 3) $18,001 to $30,000

55 (54.5%) 15 (14.9%) 13 (12.9%) 4) $30,000 and up 11 (10.9%) * SD = standard deviation. ** Seven participants provided no response (7.3%). The mean score and frequencies from the K-6 assessment were rated on a 5-point Likert scale and results are displayed in Table 2. The mean score (the average of scores from all six questions shown below) was equal to 7.22 (SD = 6.7), which falls into the moderate mental distress category. A total of 54 participants (53.4%) indicated they were experiencing moderate or severe mental distress (K-6 ≥ 5). Overall, 34.7% (n = 35) indicated moderate psychological distress, falling between 5 and 13 on the K-6. An individual is deemed likely to have severe mental illness (SMI) when their K-6 score is greater than or equal to 13; 19 people met this criterion (18.8%).

Table 2: Results from the K-6

Nervous Hopeless Restless Depressed Effort Worthless Mean (SD) 1.55 (1.40) 0.95 (1.24) 1.43 (1.43) 0.95 (1.28) 1.54 (1.50) 0.79 (1.25)

Frequencies n (%)

0 = None of the time 1 = A Little of the time 2 = Some of the time 3 = Most of the time 4 = All of the time

32 (31.7%) 21 (20.8%) 21 (20.8%) 14 (13.9%) 13 (12.9%)

53 (52.5%) 19 (18.8%) 18 (17.8%) 3 (3.0%) 8 (8.0%)

38 (37.6%) 20 (19.8%) 19 (18.8%) 9 (9.0%) 15 (14.9%)

54 (53.5%) 18 (17.8%) 15 (14.9%) 5 (5.0%) 8 (8.0%)

39 (38.6%) 14 (13.9%) 19 (18.8%) 13 (12.9%) 16 (15.8%)

62 (61.4%) 18 (17.8%) 9 (9.0%) 4 (4.0%) 8 (8.0%)

For the question comparing one’s financial situation in 2021 to 2020, the mean score was

3.37 (SD = 1.36). This score is closest to the choice indicating “It’s about the same.”

When participants were asked about their experiences with COVID-19 (Yes = 1; No = 0),

the mean score for all participants was 1.55 (SD = 1.38), with 25 indicating none of these items

occurred in their lives (24.8%). Other frequencies worthy of note: 33 (32.7%) indicated 1 of

these categories impacted them, 19 checked 2 categories (18.8%), 15 checked 3 categories

(14.9%), 5 participants chose 4 categories (5%), while only 4 indicated that 6 or more events

impacted them (4%). Table 3 displays individual responses to this question.

Table 3: Effects of COVID-19 on Participants

Had COVID-19

Family had COVID-19 Friend died from COVID-19

Family died from COVID-19 Quarantined Lost a job due to COVID-19 Hours cut due to COVID-19 Yes (n = 10) Yes (n = 27) Yes (n = 23) Yes (n = 13) Yes (n = 28) Yes (n = 27) Yes (n = 29) 9.9%

26.7%

22.8%

12.9%

27.7%

26.7%

28.7%

Participants responded to the question “How would you describe your faith in God these

days?” as follows. 79 (78.2%) selected “I have drawn closer to God lately;” 32 (31.7%) selected

“I am praying and attending church more often;” 8 (7.9%) selected “I am beginning to wonder if

God even hears my prayers;” 2 (2.0%) selected “I am angry at God,” and 3 (3.0%) selected “I

don’t really believe in God.”

A chi-squared test of independence was performed to examine the relationship between

K-6 scores and the factors on the COVID-19 checklist. The relationship between “worthless” and the “Had COVID-19” was statistically significant. X2(8, N = 101) =19.389, p = .000. Those who

developed COVID-19 were more likely to select feeling “worthless” on the K-6. A second set of

chi-squared tests of independence was performed to examine the relationship between the

questions related to faith, the K-6, and the COVID-19 factors. The relationship between those

marking “worthless” and the selection, “I am beginning to wonder if God even hears my prayers” was significant; X2(8, N = 101) =26.148, p = .001. Those feeling worthless were more

likely to question the efficacy of their prayers. And the choice, “I am beginning to wonder if God

even hears my prayers” was also related to the K-6 selection, “everything is an effort” in a statistically significant manner; X2(6, N = 101) = 13.738, p = .033. Those who were questioning

the efficacy of their prayers were indicating more negative valence on this measure of emotion.

Discussion

An analysis of results using the K-6 in the National Health Interview Study (NHIS) from

2006 through 2018 indicates that between 2.7% and 3.9% of the general population scored 13 or

greater on the K-6 in nationally representative samples. 16 Clearly, the small sample in this study,

16 Centers for Disease Control and Prevention, “Early Release of Selected Estimates Based on Data From the 2018 National Health Interview Survey,” Figure 13.1, May 30, 2019, https://www.cdc.gov/nchs/nhis/releases/released201905.htm#13.

which was conducted in 2021, has an elevated level of stress with 18.8% (n = 19) indicating SMI

compared to results from NHIS of 3.9% as the highest score in the 12 year period reported. The

percentage of participants suffering from SMI in this study is 4.8 times greater than the

percentage reported by the NIHS in 2018.

During 2020, Twenge and Joiner compared a sample of 2,032 adults to the 2018 results

of the NHIS study and reported that 27.7% of their participants scored 13 or higher on the K-6

during the initial months of the pandemic.17 They also reported that 70.4% of their study

population indicated moderate or severe distress in 2020, while the 2018 NHIS sample was 22%.

In this study, by way of comparison, the results are higher than 2018, but lower than the findings

from 2020: a total of 44 participants (43.6%) reported moderate or severe mental distress in this

study.

In this study, the financial status of participants averaged somewhere between “it’s about

the same” and “it’s a little worse” on the question comparing their situation between 2019 and

2020. Despite the participants being in the lower income categories, and more likely to have felt

negative economic impact due to COVID-19 restrictions, federal financial stimulus programs

may have been supportive to this group.

Only 9.9% of participants reported having COVID-19 (n = 10), compared to statistics

from the Worldometer, which indicate 13.12% of Georgia’s population has tested positive.18 The

17 Jean Twenge and Thomas E. Joiner, “Mental Distress Among U.S. Adults During the COVID-19 Pandemic,” Journal of Clinical Psychology 76 (October 2020): 2170-2182, doi:10. 31234/osf.io/wc8ud.

18 “United States COVID: 39,957,521 Cases and 656,488 Deaths," Worldometer, accessed August 31, 2021, https://www.worldometers.info/coronavirus/country/us/.

demographics in this study are not representative of the entire state, making them less

comparable.

Results from the non-standardized question about religious beliefs and practices

somewhat align with findings by Pew Research conducted in 2020.19 Evangelical Protestants in

the U.S. were most likely to report stronger faith due to COVID-19 (49%), and 43% of them say

that the faith of Americans in general has grown: about one third of Catholics also report their

faith has grown. In this study, 78.2% of participants selected the option, “I have drawn closer to

God lately.” In times of crisis, people rely on religious and spiritual beliefs.

The relationship between selecting “worthless” on the K-6 and having had COVID-19 is

unclear. Having COVID-19 could include some feelings of stigma or have led to job loss or

income reductions, affecting one’s feelings of efficacy. Lingering side effects such as respiratory symptoms, particularly after COVID-19 pneumonia 20 and other long-term health concerns, may

have impacted participants’ health and wellbeing. 21

19 “How COVID-19 Has Strengthened Religious Faith,” Pew Research Center’s Religion & Public Life Project (blog), January 27, 2021, https://www.pewforum.org/2021/01/27/moreamericans-than-people-in-other-advanced-economies-say-covid-19-has-strengthened-religiousfaith/.

20 Piero L Olliaro, “An Integrated Understanding of Long-Term Sequelae after Acute COVID-19,” The Lancet Respiratory Medicine 9, no. 7 (July 2021): 679–80, https://doi.org/10.1016/S2213-2600(21)00206-X.

21 Sandra Lopez-Leon et al., “More than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis,” Scientific Reports 11, no. 1 (August 9, 2021): 16144, https://doi.org/10.1038/s41598-021-95565-8.

Religious practices and beliefs are often helpful to those coping with various forms of

stressors, but there are positive and negative aspects of religious belief.22 Those who selected “I

am beginning to wonder if God even hears my prayers” were more likely to select “worthless” or

“everything is an effort” on the K-6. This finding aligns with other research indicating that

religious struggles are often correlated with negative mental health symptoms.23 Those who are

already experiencing many stressors or traumatic experiences may suffer even more when they

also begin to question long-held religious beliefs. For Christians, perhaps the passage from

James 1:5-8 is most relevant: “If any of you lacks wisdom, let him ask God, who gives

generously to all without reproach, and it will be given him. But let him ask in faith, with no

doubting, for the one who doubts is like a wave of the sea that is driven and tossed by the wind.

For that person must not suppose that he will receive anything from the Lord; he is a double-

minded man, unstable in all his ways” (ESV).

Limitations

There are several limitations to this study. Our sample was small, the ethnicity and socio-

economic status of participants do not mirror the general population of the United States, and the

tornado damage was unique. Consequently, results of this study may not generalize to the

22 K Pargament, M. Feuille, and D. Burdzy, “The Brief RCOPE: Current Psychometric Status of a Short Measure of Religious Coping,” Religions 2, no. 1 (2011): 51–76, https://doi.org/10.3390/rel2010051.

23 Julie J. Exline et al., “The Religious and Spiritual Struggles Scale: Development and Initial Validation,” Psychology of Religion and Spirituality 6, no. 3 (2014): 208–22, https://doi.org/10.1037/a0036465.

broader U. S. population. Furthermore, several non-standard measures were used in the survey.

These measures require validation in further studies.

Implications to Practice

With the demonstrable increase in levels of anxiety and depression found in this study

and others, communities need to evaluate the availability of mental health care, perhaps

specifically targeting those in the lower income brackets. Providing mental health support is a

crucial part of the disaster recovery process being addressed in Coweta County.

Future Research

Many studies have examined the mental health outcomes related to COVID-19, and more

are needed. However, studies exploring ways to help ameliorate symptoms of depression,

anxiety, and social isolation, especially during health crises, may benefit society for the future.

One way that people cope with stressors is by turning to religious and spiritual beliefs and

practices. Further studies related to the impact of the restriction of church services during

COVID-19 are needed.