Wealthier patients more likely to use telehealth for mental health care, study finds

Telehealth mental health © okrasiuk - stock.adobe.com

A recent study from the Johns Hopkins Bloomberg School of Public Health suggests that patients with depression from wealthier neighborhoods in Maryland were significantly more likely to receive mental health care via telehealth compared to those from lower-income areas, raising concerns that telehealth may be widening disparities in mental health care access.

The peer-reviewed study, published in PNAS Nexus, analyzed electronic health records (EHRs) from the Johns Hopkins Health System between 2016 and 2024, focusing on patients diagnosed with depression. Researchers assessed telehealth utilization based on the Area Deprivation Index (ADI), a socioeconomic measure that accounts for income, education, employment, and housing quality.

Patients in the wealthiest quartile were 1.62 times more likely to use telehealth for primary care visits and 1.67 times more likely to do so for psychiatry visits compared to those in the most deprived quartile.

A divide in mental health care access

Telehealth visits surged during the COVID-19 pandemic as in-person care was limited. By mid-2020, virtual appointments accounted for a substantial share of mental health visits, peaking at 65% in psychiatry and 24% in primary care between 2021 and 2024.

Although telehealth was initially seen as a tool for expanding access to mental health care, the study’s findings suggest that those who benefit most are already in a better position to access care.

“Telehealth for mental health may reduce barriers to accessing care for some, but our findings suggest that telehealth may not be improving access to care for all patients, especially those living in low-wealth/high-deprivation areas,” said lead author, Catherine Ettman, PhD, an assistant professor in the Bloomberg School’s Department of Health Policy and Management.

One possible reason for the disparity is that video-based telehealth visits require access to reliable high-speed internet, a private space and digital literacy — resources that may be insufficient in high-deprivation areas.

Post-pandemic trends

The study also tracked overall mental health visit trends from mid-2016 to mid-2024. Prior to the COVID-19 pandemic, visit rates in psychiatry were increasing for both high- and low-income groups — though at a faster rate for wealthier patients.

After Maryland lifted COVID-19 restrictions in July 2021, telehealth usage declined across the board. However, wealthier patients continued to use telehealth at levels above pre-pandemic rates, while lower-income patients reverted to in-person care at pre-pandemic levels.

The study identified significant concerns about disparities in mental health care access, highlighting the need for policies that address inequities in telehealth access and availability.

“It is important to consider how telehealth may improve access to care and what we can learn from the groups it has helped most so that we can adjust and support patients who may need more mental health care services,” Ettman said.