Symposia
Improved Use of Research Evidence
Syed Aajmain, PhD
University at Albany, State University of New York
Albany, New York
Bethany Harris, PhD
Graduate Student
State University of New York (SUNY) at Albany
Albany, New York
Adela Scharff, MS
Graduate Student
University at Albany, SUNY
Albany, New York
James F. Boswell, Ph.D.
Associate Professor
University at Albany, SUNY
Albany, New York
Background: Disparities and inequities exist for racial/ethnic minority (REM) patients across the spectrum of mental health care. Despite attempts to eliminate disparities, in terms of improving access to services and increasing patient-centeredness in research and practice, it is unclear if such efforts are truly reaching REM patients. The COVID-19 pandemic triggered many community mental health centers (CMHCs) to pivot to telehealth. Although some have argued that shifting to telehealth lowers barriers to psychotherapy, others fear that providing exclusively tele-therapy could widen systemic REM disparities in care utilization and outcomes. The aim of this study was to explore differences in trajectories of change in depressive symptoms for CMHC patients as a function of REM background and whether they were seen before the pandemic (in person) and/or during the pandemic (via telehealth).
Method: This study used routinely collected data from treatment seeking adults presenting at a county CMHC (N = 2120). DSM diagnoses were assigned by treatment staff, and patients completed the Patient Health Questionnaire (PHQ-9) routinely throughout treatment. Trajectories of change in PHQ-9 scores were examined using multilevel models (Raudenbush & Bryk, 2002), with pre/post pandemic and REM status entered as predictors of treatment outcome. The interaction effects of time with pandemic status and REM status were also tested. Patients were 52% male; mean age = 46.6 yrs (SD = 14.2). The majority of patients identified as White (61%), followed by Black (33%), Hispanic (3%), multiracial (2%), and Asian (1%). 35% of patients had a primary psychotic spectrum disorder; 20% had a primary bipolar disorder; 16% had a primary unipolar major depressive disorder; and other common diagnoses included anxiety and trauma-related disorders.
Results: Overall, PHQ-9 severity significantly declined over the course of treatment. However, neither REM status (95% CI = -0.11:0.83) nor pre/post pandemic status (in person vs. telehealth; 95% CI = -0.34:0.25) emerged as a statistically significant moderator of outcome trajectories. The combined interaction effect was also not statistically significant (95% CI = -0.14:0.06).
Conclusion: Despite resistance to telehealth prior to pandemic onset and limited training in telehealth, we failed to observe significant decrements in patient outcomes after the move to telehealth. Patient outcomes, both pre- and post-pandemic onset, were also statistically similar among individuals with different racial/ethnic identities.