ABSTRACT
It is essential for mental health services to be equitably accessible and utilized. The literature on mental health service utilization has, to date, been focused largely on in-person care. This quality assurance project evaluated telemental health (TMH) utilization rates among Veterans by race and ethnicity. Following the rapid expansion of TMH in response to the COVID-19 pandemic, we also explored whether TMH use across racial and ethnic Veteran groups changed after the onset of the pandemic. Using chi-square analyses, we compared the observed race and ethnicity of Veterans receiving TMH to the expected race and ethnicity of Veterans receiving TMH, controlling for rurality. We found that TMH was not being utilized by all racial and ethnic groups within the Veteran population as would be expected, both before and during the pandemic. Improvements were noted during the pandemic when much of outpatient mental health care was converted to telehealth. The strengths and limitations of this project, recommendations for TMH, and potential future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
ABSTRACT
Introduction: Telemental health (TMH) has increased substantially. However, health care systems have found it challenging to implement TMH ubiquitously. A quality improvement project guided by implementation science methodology was used to design and implement a TMH training program. Materials and Methods: Implementation science methodology (Promoting Access to Research Implementation in Health Services, Reach-Effectiveness-Adoption-Implementation-Maintenance, Implementation/Facilitation) provided the framework to design and implement the training program. A total of 100 interdisciplinary mental health providers from outpatient mental health clinics participated. Results: Providers reported satisfaction with the training program. Results indicated that the training increased providers' TMH knowledge and competence. The number of providers using TMH and patients who received TMH nearly doubled. Conclusions: Implementation science methodology was important in creating an organizational framework at this facility to design, evaluate, and implement an innovative TMH training program.
ABSTRACT
Past studies of the expression of depression in people of Asian descent have not considered whether observed ethnic differences in somatization or psychologization are a function of differences in the expression of the disorder or of group differences in the degree of depressive symptomatology. In the present study, we carried out χ(2) and Item Response Theory (IRT) analyses to examine ethnic differences in symptoms of Major Depressive Disorder in a nationally representative community sample of noninstitutionalized Asian Americans (n = 310) and European Americans (n = 1,763). IRT analyses were included because they can help discern whether there are differences in the expression of depressive symptoms, regardless of ethnic differences in the degree of depressive symptomatology. In general, although we found that Asian Americans have lower rates of depression than European Americans, when examining specific symptoms, there were more similarities (i.e., symptoms with no ethnic differences) than differences. An examination of the differences using both χ(2) and IRT analyses revealed that when there were differences, Asian Americans were less likely to endorse specific somatic and psychological symptoms than European Americans, even when matched in degree of depressive symptomatology. Together, these community-based findings indicate that depression among Asian Americans is more similar than different to that of European Americans. When differences do occur, they are not an artifact of the degree of depressive symptomatology but instead a true difference in the expression of the disorder, specifically a lesser likelihood of expressing specific somatic and psychological symptoms in Asian Americans compared with European Americans.
