Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression

BackgroundTelemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes.MethodsData utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks.ResultsBoth lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints.ConclusionLower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities

Satisfaction With Psychology Training In the Veterans Healthcare Administration

Given that VA is the largest trainer of psychologists in the United States, this study sought to understand satisfaction with VA psychology training and which elements of training best predict trainees\u27 positive perceptions of training (e.g., willingness to choose training experience again, stated intentions to work in VA). Psychology trainees completed the Learners\u27 Perceptions Survey (LPS) from 2005 to 2017 (N = 5,342). Satisfaction was uniformly high. Trainee satisfaction was significantly associated with level of training, facility complexity, and some patient-mix factors. Learning environment (autonomy, time with patients, etc.), clinical faculty/preceptors (teaching ability, accessibility, etc.), and personal experiences (work/life balance, personal responsibility for patient care, etc.) were the biggest drivers of stated willingness to repeat training experiences in VA and seek employment there. Results have implications for psychologists involved in the provision of a training experience valued by trainees