In the aftermath of the COVID-19 pandemic, telepsychiatry has emerged as a critical avenue for providing psychiatric care. However, the distribution of telepsychiatry services across different racial and sociodemographic groups remains under-researched, raising concerns about the perpetuation of a structural racial divide in telehealth. This article synthesizes findings from a comprehensive literature review on telepsychiatry, published on November 2, 2023, by Tashalee R. Brown and colleagues in Psychiatrist.com. This study focused on the racial and sociodemographic characteristics of individuals receiving audio-only versus audiovisual services post-pandemic.
The review analyzed peer-reviewed articles from PubMed, spanning March 1, 2020, to November 23, 2022, corresponding to the period before the US federal government announced the cessation of the COVID-19 public health emergency. From an initial pool of 553 articles, only four studies met the inclusion criteria by providing the necessary racial and sociodemographic data of the recipients of telepsychiatry services. These studies were predominantly observational and reliant on self-reported data or physician case logs, lacking in national representation or administrative claim data, and limited to the pandemic’s early phase.
Structural Inequities in Telepsychiatry
The historical context of racial inequalities in the United States provides a pertinent backdrop to understanding current disparities in telepsychiatry. These inequalities have been exacerbated during public health emergencies, with past incidents such as Hurricane Katrina highlighting the neglect of marginalized communities. The rollout of telepsychiatry, potentially bridging healthcare access gaps, may inadvertently replicate these inequities. Notably, substantial literature has failed to distinguish between the modalities of telepsychiatry, rendering the true scope of inequities opaque.
Evidence suggests that socioeconomic and racial disparities significantly affect access to telepsychiatry. For instance, a considerable segment of adult Medicare beneficiaries lack the technology for video consultations. Moreover, studies have indicated that a high proportion of telepsychiatry appointments for patients from historically marginalized groups were audio-only. This trend was particularly pronounced in California’s federally qualified health centers, where audio-only visits comprised over 90% of telemedicine encounters.
Implicit Bias and Patient Preference
Implicit bias remains a concern even in audio-only telepsychiatry, where linguistic profiling can lead to discrimination against non-native speakers or those with accents. Patients from minority backgrounds may prefer audio-only sessions due to privacy concerns or a lack of trust in the system, which merits further investigation into the underlying reasons for their preferences.
Implications for Quality of Care
Audio-only telepsychiatry, while eliminating visual cues, may contribute to diagnostic bias and exacerbate stigma. Research suggests that video or in-person visits result in more accurate diagnoses and greater patient satisfaction. However, the preference for audio-only sessions in specific patient demographics necessitates a nuanced understanding of the patient’s perspective, including considerations such as trauma history and the need for privacy.
The Need for Empirical Data
There is an urgent need for empirical data delineating the racial and sociodemographic distribution of audiovisual versus audio-only telepsychiatry services. Most mental health care is provided in primary care settings, where the evaluation of telemental health services across different populations is also essential. Although there has been an increase in literature on health equity, the absence of empirical research explicitly addressing the intersection of race, socioeconomic status, and telepsychiatry modalities since the pandemic remains a significant gap.
In conclusion, the current literature on telepsychiatry, while expansive, critically lacks empirical data on the racial and sociodemographic characteristics of service recipients, particularly in differentiating between audio-only and audiovisual services. This absence hampers the ability to develop targeted, antiracist interventions that could address the existing disparities in mental health care. As we navigate the post-pandemic landscape, this analysis of a telepsychiatry racial divide highlights the necessity for concerted research efforts to capture and manage the nuanced dynamics of racism within telepsychiatry to ensure equitable access and quality of care for all.
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