Study Finds Telehealth Use in Depression Skews Towards Higher-Wealth Patients

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that patients with depression from high-wealth neighborhoods in Maryland were significantly more likely to use telehealth for mental health care compared to those from low-wealth neighborhoods between mid-2021 and mid-2024.1

Telehealth became widely used during the COVID-19 pandemic as in-person healthcare options were limited, prompting researchers to investigate changes in mental health care visits over time. The study analyzed deidentified electronic health records from the Johns Hopkins Health System spanning mid-2016 to mid-2024. Patients were categorized by neighborhood wealth using the Area Deprivation Index, a measure that incorporates income, education, employment, and housing quality.1

Before the pandemic, few patients in the study cohort utilized telehealth for mental health care. Telehealth visits peaked in mid-2020 and remained a substantial component of care through mid-2024, with 65% of psychiatric visits and 24% of primary care mental health visits conducted remotely from mid-2021 to mid-2024.1

Study lead author Catherine Ettman, PhD, an assistant professor in the Department of Health Policy and Management at the Bloomberg School, noted that while telehealth can reduce barriers to mental health care, disparities in access remain. “Our findings suggest that telehealth may not be improving access to care for all patients, especially those living in low-wealth/high-deprivation areas,” Ettman said.2

The study examined data from 132,275 mental health visits by 29,608 patients receiving primary care treatment for depression and 172,080 visits by 7,577 patients treated in psychiatry from July 2020 to June 2024. Approximately two-thirds of the study participants were women.1

Results showed that from mid-2021, after Maryland lifted COVID-19 emergency restrictions, through mid-2024, patients from high-wealth neighborhoods were significantly more likely to use telehealth compared to those from low-wealth neighborhoods. The odds of telehealth use were 1.62 times higher for primary care mental health visits and 1.67 times higher for psychiatry visits among high-wealth patients.1

Further analysis of both in-person and telehealth visits from mid-2016 to mid-2024 showed that before the pandemic, psychiatric visit rates increased for both wealth groups but grew more rapidly among high-wealth patients. After Maryland lifted restrictions in July 2021, telehealth visits declined in both groups, though patients from high-wealth neighborhoods continued to use telehealth at levels above pre-pandemic rates, while usage among low-wealth patients returned to pre-pandemic levels.1

The authors caution that these findings may not be generalizable to all health systems or geographic locations. Ettman emphasized the need to consider how telehealth can improve access to mental health care more equitably. “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,” she said.2

References:

1. Ettman CK, Ringlein GV, Dohlman P. Trends in mental health care and telehealth use across area deprivation: An analysis of electronic health records from 2016 to 2024. PNAS Nexus. 2025 Feb 7;4(2):pgaf016. doi: 10.1093/pnasnexus/pgaf016

2. Patients With Depression From Wealthier Areas More Likely to Use Telehealth for Mental Health Care. News release. Johns Hopkins Bloomberg School of Health. February 27, 2025. Accessed February 27, 2025. https://publichealth.jhu.edu/2025/patients-with-depression-from-wealthier-areas-more-likely-to-use-telehealth-for-mental-health-care