Abstract
BACKGROUND: COVID-19 is a significant threat to people's mental health and social well-being. The research examined the effects of social determinants of health on COVID-19 related stress, family's stress and discord, and personal diagnosis of COVID-19. METHODS: In November 2020, the data collection was conducted from 97 counties in North Carolina (N = 1500). Adult residents in North Carolina completed an online COVID-19 impact survey conducted using quota-based sampling on race, income, and county to provide a rapid quasi-representative assessment of COVID impact. The study investigated the variables in a structural model through structural equation modeling. For data analysis, IBM SPSS 26 and AMOS 27 were deployed. RESULTS: Social determinants of health had direct effects on COVID-19 related stress (β = 0.66, p < 0.001, r (2) = 0.43), family's stress and discord (β = 0.73, p < 0.001, r (2) = 0.53), and personal diagnosis of COVID-19 (β = 0.52, p < 0.001, r (2) = 0.27). These findings indicate that underserved populations experienced higher stress and discord at both individual and family levels and more severe COVID-19 symptoms. Moreover, black participants, whose family income and food access declined significantly more, had worse stress, discord, and COVID-19 symptoms than white participants. CONCLUSIONS: The study suggests that the government and health professionals enhance mental health and family support service accessibility for underprivileged populations through telehealth and community health programs to prevent associated social and health issues such as suicide, violence, and cancer.