Author ORCID Identifier

Date of Award

Fall 1-6-2023

Degree Type


Degree Name

Master of Public Health (MPH)

First Advisor

Dr. Emily Graybill

Second Advisor

Dr. Brian Barger



INTRODUCTION: As a result of COVID-19, new mandates such as donning a mask while indoors as well as hybrid learning models emerged and disrupted children’s normal routine. Budding research suggests that these changes in routine as well as anxiety surrounding the virus may have caused an increase in negative mental health challenges. Fear of viral infection and death as well as economic and educational setbacks plague the minds of youth and families alike.

AIM: In this study, we aim to assess internalizing problems before and during the pandemic with data from the Strengths and Difficulties Questionnaire (SDQ).

METHODS: To test this hypothesis, a repeated measures analysis of variance (ANOVA) was conducted on child externalizing problems scores captured by the SDQ. The season year was the repeated (within subject) factor and internalizing/externalizing was the between subject factor; child gender and racial ethnicity (White, Black, Hispanic) were included as covariates. Due to missing data, we used imputation methods to create complete data sets from the incomplete data by imputing the missing data 5 times.

RESULTS: Results show slightly elevated internalizing problems (based on SDQ) and little to no change in externalizing problems amongst students. Overall, the levels stabilized or decreased over the course of the pandemic. Attention is warranted to investigate what long-term effects this may cause and to monitor if internalizing problems stabilize similar to pre-pandemic levels or if they become more elevated post-pandemic.

DISCUSSION: This study was conducted to answer the question “is there an increase in internalizing and/or externalizing behaviors post COVID-19?”. The limited research that exists shows increases in adolescent internalizing and decreases in externalizing behaviors, however did not find these results in our study. Current literature shows that school behavioral health programs yield the best results when they are tailored to meet the needs of schools by using representative data of the entire student population. An important first step in implementation of a successful behavioral health program is to evaluate all students in a school or district on behavioral and emotional criteria using a universal screening procedure such as SDQ, which we have examined in this study.


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