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Published Online: 13 December 2023

Sociodemographic Differences in the Impacts of Video-Enabled Tablets on Psychotherapy Usage Among Veterans

Kritee Gujral, Ph.D. [email protected], James Van Campen, M.S., Josephine Jacobs, Ph.D., Jeanie Lo, M.P.H., Rachel Kimerling, Ph.D., Daniel M. Blonigen, Ph.D., Todd H. Wagner, Ph.D., and Donna M. Zulman, M.D., M.S.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 5
https://doi.org/10.1176/appi.ps.20230134
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Abstract

Objective:

To examine potential health disparities due to a broad reliance on telehealth during the COVID-19 pandemic, the authors studied the impact of video-enabled tablets provided by the U.S. Department of Veterans Affairs (VA) on psychotherapy usage among rural versus urban, Black versus White, and female versus male veterans.

Methods:

Psychotherapy usage trends before and after onset of the COVID-19 pandemic were examined among veterans with at least one mental health visit in 2019 (63,764 tablet recipients and 1,414,636 nonrecipients). Adjusted difference-in-differences and event study analyses were conducted to compare psychotherapy usage among tablet recipients and nonrecipients (March 15, 2020–December 31, 2021) 10 months before and after tablet issuance. Analyses were stratified by rurality, sex, and race.

Results:

Adjusted analyses demonstrated that tablet receipt was associated with increases in psychotherapy visit frequency in every patient group studied (rural, 27.4%; urban, 24.6%; women, 30.5%; men, 24.4%; Black, 20.8%; White, 28.1%), compared with visits before tablet receipt. Compared with men, women had statistically significant tablet-associated psychotherapy visit increases (video visits, 1.2 per year; all modalities, 1.0 per year).

Conclusions:

VA-issued tablets led to increased psychotherapy usage for all groups examined, with similar increases found for rural versus urban and Black versus White veterans and higher increases for women versus men. Eliminating barriers to Internet access or device ownership may improve mental health care access among underserved or historically disadvantaged populations. VA’s tablet program offers insights to inform policy makers’ and health systems’ efforts to bridge the digital divide.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 5 • May 01, 2024
Pages: 434 - 443
PubMed: 38088041

History

Received: 16 March 2023
Revision received: 8 September 2023
Accepted: 22 September 2023
Published online: 13 December 2023
Published in print: May 01, 2024

Keywords

  1. Psychotherapy
  2. Disparities
  3. Telehealth
  4. Gender
  5. Race
  6. Rurality

Authors

Details

Kritee Gujral, Ph.D. [email protected]
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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James Van Campen, M.S.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Josephine Jacobs, Ph.D.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Jeanie Lo, M.P.H.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Rachel Kimerling, Ph.D.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Daniel M. Blonigen, Ph.D.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Todd H. Wagner, Ph.D.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Donna M. Zulman, M.D., M.S.
Center for Innovation to Implementation (Gujral, Van Campen, Jacobs, Kimerling, Blonigen, Zulman), Health Economics Resource Center (Gujral, Jacobs, Lo, Wagner), and National Center for Posttraumatic Stress Disorder (Kimerling), U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences (Blonigen), Department of Surgery (Wagner), and Department of Medicine (Zulman), Stanford University School of Medicine, Stanford.
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Notes

Send correspondence to Dr. Gujral ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

This work was supported by a VA Quality Enhancement Research Initiative grant (PEI 18–205) and by the Veterans Rural Health Resource Center–Portland (PROJ-03676), VA Office of Rural Health. Dr. Jacobs is supported by a Career Development Award (19-120) from the VA Health Services Research and Development Service. Dr. Wagner is supported by a Research Career Scientist Award (RCS-17-154) funded by the VA.These views represent the opinions of the authors and not necessarily those of the VA or the U.S. government.

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