Objective: To examine the effect of delivering telemental health services on mental health service utilization rates in Federally Qualified Health Centers (FQHCs).
Method: A quasi-experimental study utilizing two-way fixed effects estimator (FQHC and year fixed effects) with lagged explanatory variables and FQHC- and county-level controls was employed to test the effect of offering telemental health service on mental health visits and percentage of patients screened and followed up for depression. FQHC-level data was obtained from Uniform Data Systems (UDS) annual performance data (N=8185 FQHC-years) and county-level data on population demographics, health status, and provider characteristics from Small Area Income and Poverty Estimates, Bureau of Labor Statistics, and American Community Survey for the calendar year 2016 to 2021.
Findings: FQHCs that offer telemental health services have incident rate ratios (IRRs) of 1.05 (95% CI= 1.02,1.07), 1.04 (95% CI= 1.01,1.06), and 1.05 (95% CI= 1.01,1.09) indicating significantly higher visit rates for depression, anxiety, and attention deficit disorder (ADD), respectively compared to FQHCs that do not. Urban FQHCs that offered telemental health services showed IRRs of 1.07 (95% CI= 1.03,1.10), 1.06 (95% CI= 1.04,1.09), and 1.04 (95% CI= 1.00,1.07) demonstrating higher mental health service utilization rates for depression, anxiety, and other mental health visit rates than rural. Also, FQHCs with a telemental health service serving higher proportion of low-income, uninsured, and Medicaid-insured individuals had higher mental health services utilization rates.
Conclusion: The study suggests that having a telemental health service significantly increases mental health visit rates for high burden mental health conditions like depression and anxiety. The findings underscore the importance of extending pandemic-driven telehealth policies that reduce hurdles faced by FQHCs to offer telemental health services. Based on the study finding, telehealth policies need to be tailored to sustain the increased utilization rates in low-income, uninsured, and Medicaid-insured populations and reducing rural-urban, and racial disparities in telemental health service utilization in FQHCs.

Background: Telehealth became widely used at the height of the COVID-19 pandemic, and its use continued afterwards. Telehealth may be perceived and received differently by different patient groups, especially those with mental health conditions. Little is known about the utilization of telehealth by patients with depression or anxiety disorder; this study aims to explore their patterns of telehealth use.

Methods: Data were from the Health Information National Trends Survey (HINTS) cycle 6 collected in 2022 by the National Cancer Institute. Weighted Chi-square tests were conducted to identify factors associated with the use of telehealth. Weighted logistic regression models were estimated to test if depression/anxiety disorder was associated with telehealth use and with specific reasons of using/not using telehealth.

Results: A total of 4,952 participants were included, among whom 2,887 (weighted percentage: 39.36%) had used telehealth in the past 12 months. Participants with depression/anxiety disorder (n=1,360, weighted percentage: 28.32%) had a higher proportion of telehealth users than those without (57% vs. 32%, p<0.0001). After controlling for other covariates, having depression/anxiety disorder was significantly associated with higher use of telehealth (OR=2.65, 95% CI: (2.04, 3.43)). Other significant factors included female (OR=1.36, CI: (1.08, 1.73)), being married (OR=1.25, CI: (1.03, 1.52)), lack of transportation (OR=2.44, CI: (1.51, 3.93)), and having healthcare insurance (OR=2.12, CI: (1.26, 3.37)). Factors not associated with telehealth use were rurality of residence, income and educational levels. Regarding reasons for using telehealth, participants with depression/anxiety disorder, compared to those without, were more likely to select the reason as avoiding COVID-19 infection (OR=1.36, 95% CI: (1.04, 1.79)) or as convenience (OR=1.70 , 95% CI: (1.17, 2.49)). Regarding reasons for not using telehealth, there was no difference between the depression/anxiety disorder group and others, in terms of preference for in-person visits, concern for privacy or technical difficulty.

Conclusion: Patients with depression/anxiety disorder were more likely to use telehealth, and more likely to consider reasons of convenience and avoiding infection in choosing telehealth, compared to those without depression/anxiety disorder. Among those who did not use telehealth, those with depression/anxiety disorder were not different from those without regarding reasons for not choosing telehealth.

Background. Healthcare workers (HCW) face high levels of burnout related to demanding schedules, high patient volume, and the added pressures of the COVID-19 pandemic. There is a pressing need for low-intensity, self-paced stress management interventions that promote resilience and combat burnout in HCW. Biofeedback is a promising approach to deliver these interventions. Little is known about how users interpret and respond to biofeedback data, and if the data produced via wearable sensors is influential in behavior modification, stress management, and self-care.

Methods. To address this gap, a randomized cross-over study was implemented to test the utility of the biometric data recorded via wearable sensor in changing self-care behaviors among 80 HCW. Participants completed a pre-and-posttest survey including standardized self-report measures of depression, anxiety, burnout, and questions regarding self-care. Participants wore a wrist worn sensor for six weeks and answered a daily “check-in” survey to assess self-reported stress and self-care. The cross-over design included two arms: immediate biofeedback in which participants viewed biometric data in real time; and delayed biofeedback in which participants were blind to sensor data.

Results. Eighty HCW were recruited to the study with 91% retention over 6 weeks. Of those retained, 80% (59/73) completed ≥75% of monitoring days. Of the 14 with <75% of day monitored, 64% (9/14) were missing data during the delayed feedback phase, suggesting that adherence may have been impacted by the visibility of the biometric data from the sensor. Analysis of patterns of missing data, and dropout will be explored by sex, race, burnout, and professional role.

Implications. The high levels of retention in this data indicates a preliminary acceptance of wearable sensor use with HCW and the feasibly of collecting data over a 6-week period using a technology enabled protocol. A better understanding of the salience and interpretability of biometric data for participants enhances our understanding of how, and when, participants respond to data provided via wearable sensor. This foundational knowledge is critical to maximizing the use of biometric sensor data as a tool that may enhance behavior modification, improve mental health symptom management, and promote burnout resilience and wellbeing in HCW.

Background: Social media use in younger people has shown mixed associations with mental health. We hypothesized that communication types during social media use might alter the relationship between social media dependence and anxiety. We aimed to identify how four dimensions of communication influence the link between social media addiction (SMA) and anxiety.

Methods: We recruited undergraduate students aged 18-26 to participate in daily surveys over two weeks using a diary method. Participants' self-reported daily social media use, SMA measures, anxiety symptoms, and four dimensions of communication: Consumption, Broadness, Online Exclusivity, and Parasociality. Lagged logistic regression models with generalized estimation equations (GEE) evaluated the influence of daily SMA and communication type on ensuing anxiety symptoms.

Findings: Out of 79 participants, 1009 daily records were analyzed. SMA positively correlated with anxiety (Kendall rank correlation coef. = 0.30). Interaction analysis indicated that levels of parasociality and consumption moderated the association between SMA components and anxiety outcomes. In young adults with high levels of consumption or parasociality, a 1-standard-deviation rise in SMA’s social conflict component led to an 11%-13% increase in next-day anxiety scores. This association was absent for those with low to moderate communication levels of parasociality and consumption.

Interpretation: Elevated levels of passive consumption and one-sided interactions amplify the anxiety risk associated with social media dependence. Further longitudinal evidence can elucidate the connections between communication types, social media exposure, and anxiety, guiding the development of a model for healthy social media use.

Background: The COVID-19 pandemic exposed significant gaps in public health response to individual/collective health and emotional/social functioning. Disparities in depression screening are evident. African Americans with depression are less likely to seek treatment, become more disabled, and suffer longer illness course. The overall aim of this study is to train Church Health Workers (CHWs) to screen for depression among COVID-19 survivors in a Black church comparing the effectiveness of Screening, Brief Intervention, and Referral to Treatment (SBIRT; Intervention arm) to individuals as Referral As Usual (RAU; Control arm/Usual Care arm) on treatment engagement for depression.

Methods: A 2-arm, single-blinded, mixed-methods Randomized Controlled Trial among COVID-19 survivors within a Black church is currently ongoing. CHWs screen their fellow church members with the Patient Health Questionnaire (PHQ-9) and depression score ≥ 10 will be included in the study. Screening of 200 individuals is expected to yield a pool of 70 participants.

Results: 84 subjects were screened and 8(9.5%) were in moderate and 17 (20.2%) were in mild depression. Descriptive statistics, the mean and standard deviation will be used to describe continuous variables and analyzed at baseline, 3 mos. and 6 mos. after intervention. Simple linear and multiple regression models will be used to estimate the relationship between variables.

Conclusion: We hypothesize that CHWs deployed for church-based depression screening and intervention can help overcome cognitive barriers and increase treatment engagement, defined as attending a depression-related clinical visit for which the subject reports receiving information, referral, counseling, or medication for depression.

Background: Evidence suggests that mental health (MH) service recipients and clinicians value shared decision-making (SDM), but observational research indicates it rarely occurs. Using qualitative data, we explored MH services recipient perspectives on what impacts shared decision-making.

Methods: New York State’s Office of Mental Health administered the Shared Decision-Making Questionnaire (SDMQ) to service recipients (N=1,123) between May–June 2022. We conducted a thematic analysis using an inductive approach and achieved thematic saturation with 33% of 821 recipients responding to two open-ended questions in the SDMQ related to the recipient’s most recent mental health visit (identifying health complaint and decision made), and an additional question eliciting advice on managing MH stigma.

Results: Three coders identified the following four themes that seemed to influence recipient perspectives on shared decision-making: (1) Trust/mistrust in MH providers referred to degrees of fear of being discredited and receiving poor quality care based on their diagnosis (“Be very careful when disclosing (or don't disclose) your own mental health issues”). (2) Empowerment referred to asserting one’s agency and expressing one’s treatment preferences (“Don’t allow others [to] make your decisions. Your opinion matters”). (3) Decisional inclusion/exclusion referred to degrees of being included in treatment decisions (“A dx and treatment plan that was imposed on me, instead of constructively and appropriately designed in coordination with me.” or “We did my objective together and I thought that was awesome”). (4) Provider or system competence referred to degrees of clinician or system efficacy ("Providers are rarely up to date on the most current forms of therapy” “You are in control of your own mental healthcare. Any provider who does not treat you as such does not deserve your business"). Anticipated and/or experienced stigma, was often associated with reports of greater mistrust, decisional exclusion, and criticism of provider/system competence, undermining shared decision-making. However, stigma exposure also seemed to empower some of the recipients.

Conclusions: According to recipients, trust in clinicians, being empowered to assert one’s preferences, inclusion in treatment decisions, and seeing providers/system as competent promotes SDM. The role of stigma on SDM requires future investigation. These findings have implications for advancing SDM.

Background: Mindfulness-Based Resilience Training (MBRT) is an evidence-based approach to address the need of effective interventions for resilience inherent to stress-inducing occupations. However, little is known about how to best measure the development of mindfulness practice. This study investigated a mindfulness practice measure (MPM)’s ability to capture participant mindfulness practice within the context of a larger MBRT intervention among a sample of healthcare professionals and public safety workers. MBRT was designed to build practical knowledge and tactical skills around trauma to enhance one’s ability to skillfully encounter occupational stress and trauma, perform well, and to carefully work with the consequences.

Methods: A total of 162 participants were recruited into 10 cohorts from February-June 2022. Each cohort received a two-day MBRT training followed by four weekly online trainings. Participants completed questionnaires, including MPM, at baseline (T0), immediately following the training (T1), and 30 (T2) and 180 days post-training (T3). The MPM queried participants on 1) days during the past week mindfulness was practiced and 2) average minutes practiced when practicing during the past week. Questions were combined and converted to minutes practiced per week and assessed using linear mixed models against the outcomes of perceived mindfulness, difficulties regulating emotions, and emotional intelligence across time points.

Results: Models adjusted for race, gender, and education revealed significant increases in mindfulness practice minutes from baseline at T1 (Est = 23.73(6.97), p =.0008), T2 (Est = 19.73(8.53), p =.022), and T3 (Est = 37.57(11.81), p=.001). Further, amount of practice was associated with statistically significant improvements in perceived mindfulness (Est = 0.01(0.004), p =.007). Further analyses suggest individuals with mindfulness practice experience at baseline with 10 or more minutes (61%) displayed the greatest improvement in mindfulness (Est =7.21(1.60), p <.0001), difficulties regulating emotions (Est =-9.91(3.06), p =.0015), and emotional intelligence (Est = 5.31(1.08), p <.0001).

Conclusions: Preliminary results suggest the MPM demonstrated significant improvements in average mindfulness minutes practiced each week across the intervention, and that these improvements were associated with greater perceived mindfulness. Participants with experience in mindfulness practice showed the most improvement in perceived mindfulness, difficulties regulating emotions, and emotional intelligence.

Background: With this scoping review, we map the current state in peer-reviewed publications of quantitative findings regarding promotora-led preventative mental health interventions among Hispanic/Latinxs in the U.S. To meet the multiple needs related to mental health of Hispanic/Latinx communities around the country, there has been an expansion of working with promotores, also known as lay or community health workers, to reach vulnerable communities, expand mental health care infrastructure, and adapt mental health promotion programs to make them culturally and linguistically appropriate for these communities. However, the peer-reviewed literature regarding the impact of these preventative mental health programs for this community is still scattered and quantitative findings are dispersed. Because this is a growing area working with a vulnerable population, there are neither standard interventions nor measures used in all the studies. Research groups have rightfully prioritized adapting their methods to the needs of their target communities, which in turn has impacted their study design and replicability, as well as produced inconsistent findings across studies. Our objective is to identify the measures, quantitative findings, and design interventions of these preventative mental health projects.

Methods: To develop this scoping review, we followed relevant items of the PRISMA-ScR checklist, searched for relevant articles in the PubMed database (n=387), and identified 30 peer reviewed studies, grouped in 21 research projects, that met our eligibility criteria.

Results: Of the 21 identified projects, 9 (43%) had a control group, 5 (24%) had a delayed control group, 7 (33%) had a pre-post design, and 12 (57%) randomized their participants. All the projects showed significant results in the pre-post analysis of at least one mental disorder within the experimental group. Nine out of 14 (64%) projects with control or delayed control groups showed significant results in the intervention effect over at least one mental disorder. The most used measures for depression were the Patient Health Questionnaire-9 (PHQ-9, 6 times) and the Center for Epidemiological Studies–Depression (CES-D) (5 times).

Recommendations for future studies: (1) the use of experimental designs, when possible, (2) converge in the use of similar measures to compare results across studies and for replicability.

Background: Implementation support practitioners play a pivotal role in bridging the research to practice gap and facilitating the adoption of evidence-based psychotherapies (EBPs) in community mental health agencies (CMHA). Despite the vital role of trust and relationship-building as an implementation strategy, there is a gap in operationalizing trust (Metz 2021). This gap is particularly apparent in the context of implementing rigorous EBPs, such as Parent-Child Interaction Therapy (PCIT), within CMHAs serving diverse populations. Effective implementation strategies grounded in trust are important when balancing EBP fidelity and provider priorities throughout EBP implementation and sustainability.

Description: In a PCIT Learning Collaborative (LC), four CMHAs nationwide received comprehensive clinical training and implementation support. This support included a needs assessment, three learning sessions, biweekly coordinator consultation, and monthly senior leader consultation, all guided by principles of co-creation, ongoing improvement, and sustaining change from Metz’s Practice Guide to Supporting Implementation. Relational strategies, centered in authenticity and empathy, intersected with technical approaches, emphasizing the importance of prioritizing relationships to overcome implementation barriers.

Lessons Learned: Frequent communication focused on reflective listening with various members of CMHA teams, routinely requesting feedback on the implementation process, and approaching CMHA team members as experts in their context facilitated the development of trust. Through this trust, we were able to co-create strategies to meet site-specific needs while maintaining fidelity to the model. Creative solutions were devised to address logistical challenges, such as repurposing office spaces to accommodate therapy rooms. Additionally, outreach and marketing strategies were refined to enhance client enrollment.

Recommendations: Trust is a vital ingredient in the successful implementation of EBPs within CMHAs. To advance implementation science, future efforts should leverage insights from Metz’s Practice Guide, emphasizing the integration of evidence-based strategies with relationship-building initiatives. Leading with empathy and curiosity, implementation practitioners should acknowledge and address the unique challenges faced by each agency, fostering a culture of collaboration and peer support. Proactively evaluating provider fit and logistical constraints demonstrates thoughtful consideration and fosters early trust. By combining relational strategies with technical approaches, implementation support practitioners can navigate complexities, foster collaboration, and ultimately, enhance mental health outcomes for diverse communities.