Telehealth During COVID-19—Does Everyone Have Equal Access?

Nadkarni, Ashwini; Hasler, Victoria Choate; AhnAllen, Christopher G.; Amonoo, Hermioni L.; Green, David W.; Levy‐Carrick, Nomi; Mittal, Leena

doi:10.1176/appi.ajp.2020.20060867

Cited by 37 publications

(14 citation statements)

References 3 publications

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“…As telehealth delivery is as effective as in-person delivery of evidence-based anxiety, depression, and PTSD treatments (Morland et al, 2020 ; Tuerk, Keller, & Acierno, 2018 ), expansion of these services is warranted. Resources to provide smart tablets, as successfully piloted by the Department of Veterans Affairs (Zulman et al, 2019 ), could expand access to low-income households where smart phone and laptop ownership are not universal (Nadkarni et al, 2020 ). Brief video interventions that boost treatment-seeking intentions may also be helpful (Amsalem et al, 2021 ), as many veterans even with severe psychological symptoms are not engaged in treatment (Nichter, Hill, Norman, Haller, & Pietrzak, 2020b ).…”

Section: Discussionmentioning

confidence: 99%

Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

Hill

Nichter

et al. 2021

Psychol. Med.

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Background: The coronavirus disease-2019 (COVID-19) pandemic has caused myriad health, social, and economic stressors. To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3,078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress. Results: The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre-to peri-pandemic (7.1% to 9.4%; p<0.001) and was driven by an increase among veterans aged 45-64 years (8.2% to 13.5%; p<0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean=1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress.Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above prepandemic factors. Conclusions: Although most U.S. veterans showed resilience to mental health problems nearly one year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and 1-of-7 veterans experienced increased distress.Clinical implications of these findings are discussed.

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Section: Discussionmentioning

confidence: 99%

Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

Hill

Nichter

et al. 2021

Psychol. Med.

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“…A patient's presence in an EMR database was not random; rather, it signified that the patient had a need for a healthcare visit [58]. Access to healthcare also could have changed over the time periods of the pandemic (pre-, early, and peak COVID-19), which may have influenced the profile of patients being seen [59,60]; however, healthcare providers at the VA San Diego remained accessible to patients due to the availability of both telephone and video visits. Another limitation of the study was that the use of existing data assumed that components of each visit were relatively uniform and did not affect answers to the standard tobacco use status question stated above (Materials and Methods, paragraph 1).…”

Section: Discussionmentioning

confidence: 99%

Changes in Tobacco Use Patterns among Veterans in San Diego during the Recent Peak of the COVID-19 Pandemic

Fatollahi

Bentley

Doran

et al. 2021

IJERPH

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The prevalence of tobacco use increases in times of stress; however, during the initial stage of the COVID-19 pandemic, tobacco use rates stayed the same in most populations. Previous work focused on the initial months of the pandemic, while this study examined the changes in tobacco use during a later peak period of the pandemic. We used data from 61,852 visits to the VA San Diego Healthcare System from November 2019 to February 2021, divided into pre-, early, and peak pandemic periods. Multinomial logistic regression was used to test whether the odds of being a daily or non-daily tobacco user varied over time, by demographic group, or with the presence of specific psychiatric diagnoses. Younger Veterans had a greater reduction in the prevalence of non-daily tobacco use between the early and peak periods, while older Veterans had a rise in daily use from pre- to the early pandemic, which returned to baseline during the peak. Individuals with substance use disorder and serious mental illness diagnoses were more likely to report tobacco use, but psychiatric diagnoses did not predict change over time. These findings demonstrate factors that potentially contribute to changes in tobacco use during a public health crisis and may help guide future targeted cessation efforts.

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“…This applies for both patients and care providers, requires investment and time to implement. Nevertheless, the economic and technologic inequities must be taken into account, as they limit the access of online interventions for elder, children, people of low-income, with disabilities and with cognitive impairment (Nadkarni et al, 2020). As a public health perspective, we strongly recommend that mental health services should receive investments to implement telehealth and to adapt the setting to meet biosafety regulations, to keep face-to-face attendance for those people without digital accessibility.…”

Section: Discussionmentioning

confidence: 99%

Closed Doors: Predictors of Stress, Anxiety, Depression, and PTSD During the Onset of COVID-19 Pandemic in Brazil

Calegaro

Ramos-Lima

Hoffmann

et al. 2021

Preprint

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Background: The SARS-CoV-2 pandemic first reached Brazil in late February 2020. Since then, it is one of the most affected countries globally. The rise of mental health problems in the population directly or indirectly affected is now a major concern. In the present study, we show the results of the first wave of the COVIDPsiq cohort study, which started early on (April 2020). The aim of this study was to investigate and compare independent predictors of symptoms of stress, anxiety, depression, and post-traumatic stress disorder (PTSD) in Brazilians one month after social distancing measures were implemented. Methods: Depression, Anxiety, and Stress Scale (DASS-21) and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) were the two self-report instruments used to assess the symptoms. Variables related to demographics, social distancing, exposure to the news of coronavirus pandemic, substance use, and traumatic situations were also analyzed. Data was gathered through a web-based survey. Multivariate analyses were performed through hierarchical multiple linear regression models (HMLR). Result: A sample of 3,587 participants completed the questionnaire, among which approximately two-thirds considered that their mental health worsened after the beginning of the social restriction measures. Stress, anxiety, depression, and PTSD levels were highly correlated with this self-perception. The five most important predictors of psychological distress were the distress related to pandemic news, younger age, current psychiatric diagnosis, trouble sleeping, and emotional abuse or violence. Limitations: This is an internet survey-based study in which convenience sample bias may limit its external validity. It does not represent the northern regions of the country and most participants are white wealthier females. It was not possible to evaluate if symptoms are clinically relevant to infer an increased incidence of mental illness. Conclusions: These results confirm the hypothesis that a pandemic would have important impacts on the mental health of the population and indicate the level of distress related to the media as an important predictor of mental symptoms.

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Telehealth During COVID-19—Does Everyone Have Equal Access?

Cited by 37 publications

References 3 publications

Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

Changes in Tobacco Use Patterns among Veterans in San Diego during the Recent Peak of the COVID-19 Pandemic

Closed Doors: Predictors of Stress, Anxiety, Depression, and PTSD During the Onset of COVID-19 Pandemic in Brazil

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