Rural tele-mental health use during the pandemic for adjustment disorders, anxiety, and depression.

The author's affiliation with The MITRE Corporation is provided for identification purposes only and is not intended to convey or imply MITRE's concurrence with, or support for, the positions, opinions, or viewpoints expressed by the author.The coronavirus disease (COVID-19) pandemic contributed to widespread distress across the U.S., with a growing incidence of adjustment disorders, anxiety, and depression across the population. The use of tele-mental health services is a critical resource for reaching individuals who need access to mental health services, whether due to challenges with distance, lack of local provider access, or a result of stay-at-home orders due to COVID-19. This study compared the use and type of tele-mental health services (medical vs. nonmedical) administered for the three mental health diagnosis sets by rural versus urban geography. A retrospective study was conducted during a 16-month study period (November 2019-February 2021) using a large health system database to examine the use of tele-mental health services for three mental health diagnosis sets: adjustment disorder, anxiety, and depression. The utilization of tele-mental health services was evaluated across urban and rural lines, by medical versus nonmedical visit type, and additionally by broadband availability. After a brief initial rise, rural communities saw a steeper decline in tele-mental health service utilization relative to their urban counterparts, even as rural communities experienced a surge in COVID-19 cases. This is potentially an indication that rural areas may be slower to adapt to tele-mental health delivery of care relative to their urban counterparts. Consistent with the evidence base on rural-urban health and socioeconomic disparity, the study team found that rural areas lag compared to their urban counterparts in accommodating tele-mental health technology for health emergencies. It is important for health services researchers to investigate the technological as well as nontechnological factors related to sustained tele-mental health utilization. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement This study suggests that there are disparities in adoption of tele-mental health services between rural and urban areas. Although rural populations initially embraced tele-mental health services, even when rural communities had highest surges of COVID-19 cases those areas showed a significant decline in services compared to urban areas, which suggests additional ways are needed to improve rural health engagement for use of tele-mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)