Differential Impact of COVID-19 on the Use of Tele–mental Health Among Veterans Living in Urban or Rural Areas

Hogan, Julianna; Amspoker, Amber B.; Walder, Annette; Hamer, Joshua; Lindsay, Jan A.; Ecker, Anthony H.

doi:10.1176/appi.ps.202100363

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…Black veteran subgroup analyses showed that those with greater VTH use were more likely to be Hispanic, younger, female, and living in an urban setting. These data are consistent with other studies demonstrating higher VTH rates among veterans who are Hispanic, younger, female, and living in urban settings (Guajardo et al, 2023; Hogan et al, 2022; Lindsay et al, 2022; Weldon & Hagemann, 2022).…”

Section: Discussionsupporting

confidence: 92%

“…As is the case across all races, veterans living in urban settings have surpassed veterans living in rural settings in adopting and using VTH due to the pandemic (Hogan et al, 2022;Rush et al, 2022). Rural populations have grown to be more racially diverse, as Black Americans make up the largest minority group in the rural, deep South (Johnson & Lichter, 2022).…”

Section: Ruralitymentioning

confidence: 99%

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Black veteran use of video telehealth for mental health care.

Day,

Ecker,

Amspoker

et al. 2024

Psychological Services

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Black veterans experience disparities in mental health (MH) care access and are disproportionately affected by COVID-19. Video telehealth to home (VTH) may reduce disparities by addressing barriers, particularly with pandemic-related shifts to remotely delivered care. Considering potential needs for tailored implementation across racial/ethnic groups, we examined differences in VTH use by non-Hispanic Black veterans versus all other races/ethnicities and among Black (Hispanic and non-Hispanic) veterans by age, rurality, and gender during the pandemic. We extracted a cohort of Veterans Health Administration-enrolled veterans receiving at least one MH encounter between October 2019 and September 2020 (n = 1,627,791) from electronic health records. Multilevel linear growth curve models examined the percentage of VTH use for non-Hispanic Black versus other races/ethnicities before and after pandemic onset. Black veteran-only subgroup analyses examined differences by ethnicity in percentage of VTH MH encounters since pandemic onset by age, rurality, and gender, using regression and analysis of covariance models. Despite significant increases in VTH during the pandemic, on average, VTH use was consistently lower for non-Hispanic Black veterans across both periods. During the pandemic, differences in VTH use between non-Hispanic Black and non-Black veterans accelerated over time. VTH use was greater during the pandemic for Black veterans who were Hispanic, younger, urban, and female. Adoption of VTH for MH was low for non-Hispanic Black veterans before COVID-19 and during COVID-19 compared to non-Black groups. Future VTH research and implementation efforts should question why adoption remains low, work to meet cultural needs, and promote equitable adoption for Black veterans. Impact StatementThis study suggests that video telehealth is essential in providing equitable access to mental health care. However, the rapid virtualization of health care demonstrates that non-Hispanic Black veterans are at continued risk of not benefitting from this care modality. Black veterans may benefit from community outreach or tailored approaches to increase video telehealth to home (VTH).

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Section: Discussionsupporting

confidence: 92%

Section: Ruralitymentioning

confidence: 99%

Black veteran use of video telehealth for mental health care.

Day,

Ecker,

Amspoker

et al. 2024

Psychological Services

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“…Earlier studies demonstrated that telemental health could effectively improve patients' mental symptoms 6,[10][11][12] . Telemental health services are not restricted by distance and are easy to access, even by residents of rural areas 6,[13][14][15] . Such remote services appear to be increasing in rural areas (partially influenced by the COVID-19 pandemic) 13,15) .…”

Section: Introductionmentioning

confidence: 99%

“…Telemental health services are not restricted by distance and are easy to access, even by residents of rural areas 6,[13][14][15] . Such remote services appear to be increasing in rural areas (partially influenced by the COVID-19 pandemic) 13,15) . Thus, telemental health services should be investigated in a study population limited to residents of rural areas.…”

Section: Introductionmentioning

confidence: 99%

Telemental health in rural areas: a systematic review

et al. 2023

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Objective: Despite the high prevalence of mental disorders in rural areas, mental health services are lacking because of shortages of resources and difficulty in accessing such services. Telemental health services can be beneficial for these patients. This study summarizes the efficacy of telemental health in managing mental disorders in rural areas. Materials and Methods:The MEDLINE and Cochrane Central Register of Controlled Trials databases were searched to identify randomized controlled trials on telemental health for mental disorders in rural areas until June 2022. The reviewers independently screened, extracted, and assessed study quality using the Risk of Bias 2 tool. Results: Six eligible studies were identified on mental health symptoms, insomnia, depression, and schizophrenia. The quality of all the studies was moderate, and they all reported that telemental health effectively improved the symptoms of mental disorders. One study reported a reduction in relapse and rehospitalization rates in young individuals. Another study reported that it was effective in improving the symptoms of depression and anxiety in older individuals. Conclusions: Although further studies are warranted, telemental health services could effectively improve the symptoms of mental disorders in rural areas.

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“…Similarly, 53% of US urban households, compared with 46% of rural households, used virtual care during the pandemic, though this difference was not statistically significant [ 19 ]. In their US study of rural and urban living veterans, Hogan and colleagues [ 20 ] found higher use of virtual mental health care pre-COVID-19 among rural than among urban living veterans and increased use by both groups during the first 7 months into COVID-19 but with urban veterans surpassing rural veterans’ usage. Researchers have suggested that barriers to a rapid transition to telehealth delivery may have affected rural areas more than urban areas particularly due to their lack of access to broadband internet, limited device ownership (smartphone, tablet, laptop), and lower digital literacy [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults

Rush¹,

Seaton²,

Corman³

et al. 2022

JMIR Form Res

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Background To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored. Objective The 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs. Methods This study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis. Results Overall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants’ perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options. Conclusions The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents.

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Differential Impact of COVID-19 on the Use of Tele–mental Health Among Veterans Living in Urban or Rural Areas

Cited by 11 publications

References 11 publications

Black veteran use of video telehealth for mental health care.

Black veteran use of video telehealth for mental health care.

Telemental health in rural areas: a systematic review

Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults

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