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Friday, January 17, 2025
Grand Ballroom C, Level 2 (Sheraton Grand Seattle)
* noted as presenting author
Background: Internet access is an important social determinant of health, as increased access to virtual, or “telehealth” appointments contributes to address the lack of mental health treatment options in the rural United States. However, in many rural areas, internet is unavailable or cannot support the needs of virtual visits. This study explores the current landscape with respect to internet access and rural mental health service utilization, examining the associations of rurality, internet access, and virtual appointments on mental health service utilization.
Data and samples: This study used the 2022 National Health Information Survey (NHIS) adult sample (n=27,651), a cross-sectional annual survey to monitor a variety of health topics on the representative civilian noninstitutionalized population. NHIS is collected continuously using geographically clustered sampling. The dependent variable is virtual appointments on mental health service utilization, measured by respondent self-report. Internet access is measured by respondent self-report. Rurality is measured using the 2013 NCHS Urban-Rural Classification Scheme of Counties. This analysis draws from Q3 and Q4 responses, which are the first to collect information regarding respondents’ internet access (n=13,879). All analyses are adjusted with survey weight and controlled for demographic and socioeconomic characteristics (including race, gender, insurance coverage, and income).
Results: Rural respondents comprise 14% of the weighted sample. Rural respondents’ internet access lagged behind their urban counterparts, with 11% lacking access to internet compared to 6% of urban respondents (p<.000). Rural respondents’ use of virtual healthcare appointments also lagged their urban counterparts by 10% (32% urban compared to 21% rural, p<.000). Ten percent of rural respondents accessed mental health services in the previous 12 months, compared to 13% of urban respondents (p<.000). Logistic regression demonstrated statistically significant relationships of virtual appointments with rural residence and internet access. Controlling for all other factors in the models, rural residents were 43% less likely to use virtual appointment options [OR .59, 95%CI 0.49- 0.69] while respondents with internet access were 85% more likely to use virtual appointments [OR 1.85, 95% CI 1.54-2.22, n=13,825 F=2.62 p=.006].
Conclusion: The data paint a limited but nuanced picture of the rural mental health access and utilization. This preliminary examination provides an early window into the role that internet access and virtual appointments may have on reducing rural mental health care access disparities. Many policy measures designed to decrease mental health access disparities in rural areas are focused on high-speed internet expansion and expansion of virtual visits for mental health treatment. Further research is needed to examine the impacts of telehealth and mental health telehealth offerings on rural populations as these services become more widely available.
Data and samples: This study used the 2022 National Health Information Survey (NHIS) adult sample (n=27,651), a cross-sectional annual survey to monitor a variety of health topics on the representative civilian noninstitutionalized population. NHIS is collected continuously using geographically clustered sampling. The dependent variable is virtual appointments on mental health service utilization, measured by respondent self-report. Internet access is measured by respondent self-report. Rurality is measured using the 2013 NCHS Urban-Rural Classification Scheme of Counties. This analysis draws from Q3 and Q4 responses, which are the first to collect information regarding respondents’ internet access (n=13,879). All analyses are adjusted with survey weight and controlled for demographic and socioeconomic characteristics (including race, gender, insurance coverage, and income).
Results: Rural respondents comprise 14% of the weighted sample. Rural respondents’ internet access lagged behind their urban counterparts, with 11% lacking access to internet compared to 6% of urban respondents (p<.000). Rural respondents’ use of virtual healthcare appointments also lagged their urban counterparts by 10% (32% urban compared to 21% rural, p<.000). Ten percent of rural respondents accessed mental health services in the previous 12 months, compared to 13% of urban respondents (p<.000). Logistic regression demonstrated statistically significant relationships of virtual appointments with rural residence and internet access. Controlling for all other factors in the models, rural residents were 43% less likely to use virtual appointment options [OR .59, 95%CI 0.49- 0.69] while respondents with internet access were 85% more likely to use virtual appointments [OR 1.85, 95% CI 1.54-2.22, n=13,825 F=2.62 p=.006].
Conclusion: The data paint a limited but nuanced picture of the rural mental health access and utilization. This preliminary examination provides an early window into the role that internet access and virtual appointments may have on reducing rural mental health care access disparities. Many policy measures designed to decrease mental health access disparities in rural areas are focused on high-speed internet expansion and expansion of virtual visits for mental health treatment. Further research is needed to examine the impacts of telehealth and mental health telehealth offerings on rural populations as these services become more widely available.