Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022.

Importance: Although telehealth services expanded rapidly during the COVID-19 pandemic, the association between state policies and telehealth availability has been insufficiently characterized. Objective: To investigate the associations between 4 state policies and telehealth availability at outpatient mental health treatment facilities throughout the US. Design, Setting, and Participants: This cohort study measured whether mental health treatment facilities offered telehealth services each quarter from April 2019 through September 2022. The sample comprised facilities with outpatient services that were not part of the US Department of Veterans Affairs system. Four state policies were identified from 4 different sources. Data were analyzed in January 2023. Exposures: For each quarter, implementation of the following policies was indexed by state: (1) payment parity for telehealth services among private insurers; (2) authorization of audio-only telehealth services for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries; (3) participation in the Interstate Medical Licensure Compact (IMLC), permitting psychiatrists to provide telehealth services across state lines; and (4) participation in the Psychology Interjurisdictional Compact (PSYPACT), permitting clinical psychologists to provide telehealth services across state lines. Main Outcome and Measures: The primary outcome was the probability of a mental health treatment facility offering telehealth services in each quarter for each study year (2019-2022). Information on the facilities was obtained from the Mental Health and Addiction Treatment Tracking Repository based on the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Service Locator. Separate multivariable fixed-effects regression models were used to estimate the difference in the probability of offering telehealth services after vs before policy implementation, adjusting for characteristics of the facility and county in which the facility was located. Results: A total of 12 828 mental health treatment facilities were included. Overall, 88.1% of facilities offered telehealth services in September 2022 compared with 39.4% of facilities in April 2019. All 4 policies were associated with increased odds of telehealth availability: payment parity for telehealth services (adjusted odds ratio [AOR], 1.11; 95% CI, 1.03-1.19), reimbursement for audio-only telehealth services (AOR, 1.73; 95% CI, 1.64-1.81), IMLC participation (AOR, 1.40, 95% CI, 1.24-1.59), and PSYPACT participation (AOR, 1.21, 95% CI, 1.12-1.31). Facilities that accepted Medicaid as a form of payment had lower odds of offering telehealth services (AOR, 0.75; 95% CI, 0.65-0.86) over the study period, as did facilities in counties with a higher proportion (>20%) of Black residents (AOR, 0.58; 95% CI, 0.50-0.68). Facilities in rural counties had higher odds of offering telehealth services (AOR, 1.67; 95% CI, 1.48-1.88). Conclusion and Relevance: Results of this study suggest that 4 state policies that were introduced during the COVID-19 pandemic were associated with marked expansion of telehealth availability for mental health care at mental health treatment facilities throughout the US. Despite these policies, telehealth services were less likely to be offered in counties with a greater proportion of Black residents and in facilities that accepted Medicaid and CHIP.

A longitudinal study of predictors of serious psychological distress during COVID-19 pandemic.

BACKGROUND: The prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined. METHODS: A probability-based sample (N = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD. RESULTS: At T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4-3.8) and health care (OR 3.2, 95% CI 1.4-7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5-23.3), low household income at T1 (OR 2.6, 95% CI 1.1-6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4-7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5-7.2) were all significantly associated with elevated risk for SPD at T3. CONCLUSIONS: Elevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.

Nationally Representative Sample Shows an Increase in Domestic Conflict Early in the COVID-19 Pandemic.

OBJECTIVE: The coronavirus disease (COVID-19) pandemic and associated social distancing increased stressors related to risk for domestic conflict, but increases in domestic conflict early in the pandemic have yet to be studied in community samples. METHODS: Increase in domestic conflict (verbal or physical fights) since the beginning of the pandemic was assessed in 1196 partnered and cohabitating respondents, drawn from a nationally representative sample, in May 2020. Chi-square tests and logistic regression analyses were used to estimate associations of demographic characteristics and financial worry with domestic conflict. RESULTS: An increase in domestic conflict was reported by 10.6% (95% CI: 7.7-13.4) of the sample. Domestic conflict increase was significantly associated with younger age, lower education, and financial worry. CONCLUSION: Increases in domestic conflict were seen in certain vulnerable groups and in those who report financial worry. Policies ensuring financial stability, particularly early in the disaster conditions, could reduce domestic conflict during continued COVID-19 conditions or other disasters.

The effect of COVID-19 vaccinations on self-reported depression and anxiety during February 2021

Using the COVID-19 Trends and Impact Survey, we find that COVID-19 vaccinations reduced the prevalence of self-reported feelings of depression and anxiety, isolation, and worries about health among vaccine-accepting respondents in February 2021 by 3.7, 3.3, and 4.3 percentage points, respectively, with particularly large reductions among respondents aged 18 and 24 years old. We show that interventions targeting social isolation account for 39.1% of the total effect of COVID-19 vaccinations on depression, while interventions targeting worries about health account for 8.3%. This suggests that social isolation is a stronger mediator of the effect of COVID-19 vaccinations on depression than worries about health. We caution that these causal interpretations rely on strong assumptions. [ABSTRACT FROM AUTHOR] Copyright of Statistics & Public Policy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic.

Importance: The COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US. Objective: To examine mental health service use among US adults from January through December 2020. Design, Setting, and Participants: This cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021. Main Outcomes and Measures: Per-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group. Results: The study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (ß, -6.44; 95% CI, -8.33 to -4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; ß, -5.28; 95% CI, -7.50 to -3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; ß, -1.81; 95% CI, -2.75 to -0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; ß, -6.78; 95% CI, -8.51 to -5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; ß, -2.00; 95% CI, -3.98 to -0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; ß, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; ß, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period. Conclusions and Relevance: In this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.

Availability and Accessibility of Mental Health Services in New York City.

Mental health services are critical components of public health infrastructure that provide essential supports to people living with psychiatric disorders. In a typical year, about 20 percent of people will have a psychiatric disorder, and about 5 percent will experience serious psychological distress, indicating a potentially serious mental illness. Nationally, the use of mental health services is low, and the use of care is not equitably distributed. In the United States as a whole and in New York City (NYC), non-Hispanic white individuals are more likely to use mental health services than non-Hispanic black individuals or Hispanic individuals. The challenges of ensuring the availability of mental health services for all groups in NYC are particularly acute, given the size of the population and its diversity in income, culture, ethnicity, and language. Adding to these underlying challenges, the coronavirus disease 2019 (COVID-19) pandemic has disrupted established patterns of care. To advance policy strategy for addressing gaps in the mental health services system, RAND researchers investigate the availability and accessibility of mental health services in NYC. The RAND team used two complementary approaches to address these issues. First, the team conducted interviews with a broad group of professionals and patients in the mental health system to identify barriers to care and potential strategies for improving access and availability. Second, the team investigated geographic variations in the availability of mental health services by compiling and mapping data on the locations and service characteristics of mental health treatment facilities in NYC.

Assessment of Patient Preferences for Telehealth in Post-COVID-19 Pandemic Health Care.

Importance: Telehealth use greatly increased in 2020 during the first year of the COVID-19 pandemic. Patient preferences for telehealth or in-person care are an important factor in defining the role of telehealth in the postpandemic world. Objective: To ascertain patient preferences for video visits after the ongoing COVID-19 public health emergency and to identify patient perceptions of the value of video visits and the role of out-of-pocket cost in changing patient preference for each visit modality. Design, Setting, and Participants: This survey study was conducted using a nationally representative sample of adult members of the RAND American Life Panel. The data were obtained from the American Life Panel Omnibus Survey, which was fielded between March 8 and 19, 2021. Main Outcomes and Measures: Preferences for video visits vs in-person care were analyzed in the survey. The first question was about participants' baseline preference for an in-person or a video visit for a nonemergency health issue. The second question entailed choosing between the preferred visit modality with a cost of $30 and another modality with a cost of $10. Questions also involved demographic characteristics, experience with video visits, willingness to use video visits, and preferences for the amount of telehealth use after the COVID-19 pandemic. Results: A total of 2080 of 3391 sampled panel members completed the survey (participation rate, 61.3%). Participants in the weighted sample had a mean (SE) age of 51.1 (0.67) years and were primarily women (1079 [51.9%]). Most participants (66.5%) preferred at least some video visits in the future, but when faced with a choice between an in-person or a video visit for a health care encounter that could be conducted either way, more than half of respondents (53.0%) preferred an in-person visit. Among those who initially preferred an in-person visit when out-of-pocket costs were not a factor, 49.8% still preferred in-person care and 23.5% switched to a video visit when confronted with higher relative costs for in-person care. In contrast, among those who initially preferred a video visit, only 18.9% still preferred a video visit and 61.7% switched to in-person visit when confronted with higher relative costs for video visits. Conclusions and Relevance: This survey study found that participants were generally willing to use video visits but preferred in-person care, and those who preferred video visits were more sensitive to paying out-of-pocket cost. These results suggest that understanding patient preferences will help identify telehealth's role in future health care delivery.

Perceived Need for Mental Health Treatment and the Mental Health Response to the COVID-19 Pandemic in the United States.

Objective: Population-based information on the extent of perceived need for mental health treatment and clinically significant psychological distress can help inform strategies for responding to the mental health impact of the COVID-19 pandemic.Methods: A representative sample of U.S. adults, age 20 and over (N = 1,957), completed surveys in May and June 2020. Potential target populations were distinguished based on perceived need for mental health treatment and psychological distress, assessed by the Kessler-6, among those without perceived need. Populations were characterized with respect to demographic characteristics and prior mental health treatment history using logistic regression models.Results: The prevalence of perceived need for mental health treatment was 21%. Perceived need was strongly associated with pre-pandemic treatment history; compared to those with no treatment history, perceived need was dramatically higher among those in treatment when the pandemic began (OR = 53.8 95% CI 28.2-102.8) and those with pre-pandemic treatment history (OR = 9.3, 95% CI 5.1-16.8). Among the 79% who did not perceive need, moderate or greater distress was reported by 19% and was associated with younger age and Hispanic ethnicity (OR = 2.1, 95% CI 1.2-3.6).Conclusions: In the U.S., where mental health treatment is relatively common, mental health treatment response during the pandemic, and perhaps other crises, should target people with a history of mental health treatment. Outreach to people less likely to seek care on their own despite clinically significant distress should target Hispanic populations.

A longitudinal study of psychological distress in the United States before and during the COVID-19 pandemic.

The COVID-19 pandemic has caused financial stress and disrupted daily life more quickly than any prior economic downturn and on a scale beyond any prior natural disaster. This study aimed to assess the impact of the pandemic on psychological distress and identify vulnerable groups using longitudinal data to account for pre-pandemic mental health status. Clinically significant psychological distress was assessed with the Kessler-6 in a national probability sample of adults in the United States at two time points, February 2019 (T1) and May 2020 (T2). To identify increases in distress, psychological distress during the worst month of the past year at T1 was compared with psychological distress over the past 30-days at T2. Survey adjusted logistic regression was used to estimate associations of demographic characteristics at T1 (gender, age, race, and income) and census region at T2 with within-person increases in psychological distress. The past-month prevalence of serious psychological distress at T2 was as high as the past-year prevalence at T1 (10.9% vs. 10.2%). Psychological distress was strongly associated across assessments (X2(4) = 174.6, p < .0001). Increase in psychological distress above T1 was associated with gender, age, household income, and census region. Equal numbers of people experienced serious psychological distress in 30-days during the pandemic as did over an entire year prior to the pandemic. Mental health services and research efforts should be targeted to those with a history of mental health conditions and groups identified as at high risk for increases in distress above pre-pandemic levels.