Date of Award

January 2023

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda M. Irwin


Coronavirus disease (COVID-19) has significant impact on people’s mental health. However, no nationwide study has investigated the mental health among rural residents during the COVID-19 outbreak in China. This study was aimed to investigate the impact of the COVID-19 outbreak on the mental health and public practices for controlling and preventing the COVID-19 in rural communities in China. An anonymous online survey was sent to participants through WeChat, the most widely used Chinese social-networking app, from March 2 to 11, 2020. We recruited 4607 individuals from 11 representative provinces in mainland China. The analytical sample was 2159 rural residents. The study analyzed generalized anxiety disorder (GAD) as the primary outcome and evaluated the public health practices performed in rural communities during the COVID-19 outbreak. Multiple logistic regression was conducted to explore risk factors that may contribute to heightened GAD. We found that the frequency of wearing masks, practicing physical distancing, and washing hands increased significantly after the COVID-19 outbreak (p<0.001). Conversely, there was a significant decrease in spitting (p=0.019) and going outside (p<0.001) after the COVID-19 outbreak. Nearly 39% of rural participants experienced mild to severe anxiety, which was correlated with poor self-perceived health status (aOR=1.69, p<0.01), living in Hubei province where the highest density of COVID-19 cases occurred (aOR=2.35, p<0.01), experiencing depression symptoms (aOR=8.33, p<0.01), having obsessive-compulsive disorder (aOR=4.75, p<0.01), and experiencing obvious disruption of work or schoolwork (aOR=1.88, p<0.01). Overall, the COVID-19 outbreak has significantly impacted the normal lives and mental health of rural populations in China, indicating the importance of improving mental health services in rural communities. Considering the fragile healthcare system in Chinese rural areas, it is urgently needed to develop targeted interventions to address mental health issues in rural communities. Such interventions are necessary for the preparation for future pandemic outbreak, which may have similar devastating effects like COVID-19 in rural settings.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2024