Patient and Provider Predictors of Telemental Health Use Prior to and During the COVID-19 Pandemic Within the Department of Veterans Affairs

The current study examined patient and provider differences in use of phone, video, and in-person mental health (MH) services. Participants included patients who completed >= 1 MH appointment within the Department of Veterans Affairs (VA) from 10/1/17-7/10/20 and providers who completed >= 100 VA MH appointments from 10/1/17-7/10/20. Adjusted odds ratios (aORs) are reported of patients and providers: (a) completing >= 1 video MH appointment in the pre-COVID (10/1/17-3/10/20) and COVID (3/11/20-7/10/20) periods; and (b) completing the majority of MH visits via phone, video, or in-person during COVID. The sample included 2,480,119 patients/31,971 providers in the pre-COVID period, and 1,054,670 patients/23,712 providers in the COVID period. During the pre-COVID and COVID periods, older patients had lower odds of completing >= 1 video visit (aORs < .65). During the COVID period, older age and low socioeconomic status predicted lower odds of having >= 50% of visits via video versus in-person or phone (aORs < .68); schizophrenia and MH hospitalization history predicted lower odds of having >= 50% of visits via video or phone versus in-person (aORs <. 64). During the pre-COVID and COVID periods, nonpsychologists (e.g., psychiatrists) had lower odds of completing video visits (aORs <. 44). Older providers had lower odds of completing >= 50% of visits via video during COVID (aORs <. 69). Findings demonstrate a digital divide, such that older and lower income patients, and older providers, engaged in less video care. Nonpsychologists also had lower video use. Barriers to use must be identified and strategies must be implemented to ensure equitable access to video MH services. Public Significance Statement This national study within the Department of Veterans Affairs found significant differences in the use of video, phone, and in-person mental health care both prior to and during the COVID-19 pandemic. Findings support the existence of a digital divide, such that older and lower income patients were less likely to receive video care. Older providers and nonpsychologists were less likely to provide video care.