A recent investigation by researchers at the Johns Hopkins Bloomberg School of Public Health has uncovered significant disparities in telehealth usage for mental health care between high-wealth and low-wealth neighborhoods in Maryland. The study, which spanned from mid-2016 to mid-2024, analyzed electronic health records and found that patients from wealthier areas were considerably more likely to utilize telehealth services for depression treatment compared to those from less affluent regions. This trend became particularly pronounced during and after the COVID-19 pandemic when telehealth adoption surged. The findings highlight the potential limitations of telehealth in bridging access gaps for underserved populations.

The rise of telehealth during the pandemic was a transformative shift in healthcare delivery. As in-person visits were curtailed, telehealth emerged as a viable alternative. Researchers focused on how this change affected mental health care, especially for individuals diagnosed with depression. By analyzing deidentified data from the Johns Hopkins Health System, they categorized patients based on neighborhood wealth using the Area Deprivation Index (ADI). This index evaluates socioeconomic factors such as income, education, employment, and housing quality at the Census-block-group level.

From mid-2016 to mid-2019, telehealth visits were relatively rare. However, the situation changed dramatically during the pandemic. In mid-2020, telehealth usage peaked and remained a substantial component of mental health care through mid-2024. Specifically, 65% of psychiatry visits and 24% of primary care visits for mental health were conducted via telehealth from mid-2021 to mid-2024. The disparity between high-wealth and low-wealth neighborhoods became evident: patients from wealthier areas were approximately 1.62 times more likely to use telehealth for primary care and 1.67 times more likely for psychiatry visits compared to their counterparts in deprived areas.

One of the key challenges identified was the infrastructure required for effective telehealth use. Video consultations typically necessitate a personal computer, reliable internet access, privacy, and some technical know-how. These requirements may pose barriers for residents in low-wealth/high-deprivation neighborhoods, limiting their ability to fully benefit from telehealth services. The study also noted that while telehealth can enhance access for some, it does not uniformly improve access for all patient groups.

The research underscores the importance of addressing these disparities to ensure equitable access to mental health care. By understanding the factors that contribute to higher telehealth adoption in wealthier areas, healthcare providers can develop strategies to support underserved populations. The findings suggest that targeted interventions are necessary to bridge the gap and provide comprehensive mental health services to all, regardless of socioeconomic status. Catherine Ettman, the lead author, emphasized the need to consider how telehealth can be optimized to reach those who stand to benefit most from improved access.