Digital mental health interventions for college students of color: Understanding uptake and enhancing engagement

College students of color have significant mental health needs, but they are less likely to receive treatment than their white counterparts (Lin et al., 2022). Given students of color are a high need, understudied, and underserved group, increased attention to their mental health and strategies targeting mental health equity are imperative. Digital mental health interventions (DMHI) have been proposed as mechanisms for disparity reduction, and research indicates DMHI are effective in college student populations (Lattie et al., 2019). However, less is known about DMHI preferences, needs, and usage among students of color. Addressing pertinent questions about DMHI reach and uptake for this population can support efforts to advance health equity. This dissertation comprised two studies that explored the following research questions: Can DMHI enhance racial/ethnic equity in college student mental health treatment receipt? (Study 1) What are key barriers to DMHI uptake for college students of color and what strategies might enhance DMHI uptake in this population? (Study 2). Study 1 evaluated racial/ethnic differences in mental health problems and treatment enrollment within a largescale screening and treatment research initiative on a diverse college campus. Results illustrated racial/ethnic differences in student depression, anxiety, and suicidality. Students of color were less likely to have received prior mental health treatment compared to white students but were no less likely to initiate digital and face-to-face treatment through the research initiative. DMHI uptake rates were comparable to prior studies, with just 8.7% of those eligible initiating use of the DMHI. Given these findings, Study 2 employed a modified Delphi design to generate expert consensus on barriers to DMHI uptake and strategies to improve uptake among college students of color. Cross-disciplinary experts (n=35) participated in a three-round survey. Results revealed important barriers to uptake, including factors associated with the user, program, technology, and environment. Strategies were coded within four implementation levels, including DMHI design, marketing and outreach, orientation and onboarding, and campus/community-level efforts. Analyses yielded a subset of promising strategies rated highly important and feasible. These findings provide guidance for future efforts focused on tailoring and implementing DMHI uptake strategies through co-creation with students of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Disparities in mental health access before and after transitioning to telehealth

Telehealth implementation has potential to reduce disparities in access to mental health care. We examined the number of mental health visits accessed and the visit format used (office, phone, or virtual) by patient demographics before and after a large health system's shift to telehealth during the COVID-19 pandemic. Patients ages 6-17 accessed relatively fewer and female patients accessed relatively more mental health visits after the telehealth transition. Demographic variables were associated with visit format used, with rural residents, older adults, females, and White and Black/African American patients using a higher proportion of phone visits. Implications are discussed for the future implementation of telehealth. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement This study found changes in the gender and age of patients accessing mental health services before and after a large health system began providing services remotely in response to the COVID-19 pandemic. It also found that phone calls were relatively preferred by certain demographic groups. These groups may be adversely affected by limitations on reimbursement for mental health services provided by phone. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic.

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.