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Telebehavioral health is almost as effective as in-person care when it comes to reducing depression and anxiety among rural populations, recently study found.

The study, published in BMC Psychiatry, analyzed 1,514 patients using the Patient Health Questionnaire-9 (PHQ-9) to measure depression and the Generalized Anxiety Disorder-7 (GAD-7) to measure anxiety. The PHQ-9 score was 27 points and the GAD-7 score was 21. The researchers compared patients’ baseline scores with a one-month follow-up. They found that reductions in PHQ-9 scores averaged 2.8 points for the telehealth group and 2.9 points for the in-person group. The reduction in GAD-7 score averaged two points for the telehealth group and 2.4 points for the in-person group.

“This study suggests that telebehavioral health care delivered in rural settings is as effective as in-person care for symptoms of anxiety and depression, an important reassurance as telehealth continues to expand beyond the pandemic surge in telehealth adoption,” the researchers said.

To conduct the study, the researchers looked at the results of two federal grant programs. One was the Evidence-Based Telehealth Network Program, which was funded from September 2018 to August 2021. The second was the Substance Abuse Treatment Telehealth Network Grant Program, which was funded from September 2017 to August 2020. She looked at patients from the programs’ 17 grantees and 95 associated citations. Each grantee had data from both telehealth and in-person patients.

Rural populations have a particularly difficult time accessing behavioral health care, and the Covid-19 pandemic has only exacerbated the problem, according to the report. Stigma is often a barrier, and rural residents typically have to travel long distances to receive care, have lower rates of insured patients, higher rates of poverty, and lower levels of education and health literacy. Women and minority groups also have additional challenges due to childcare and discrimination.

“Although the pandemic has exacerbated underlying mental health problems for many Americans, barriers to receiving mental health care have existed for years,” the researchers said.

Telehealth is often cited as a solution for reaching rural residents, especially for behavioral health, because of its privacy and convenience. However, the researchers say there is not much research comparing telebehavioral health with in-person care in rural areas.

“Randomized control trials and follow-up reviews have demonstrated the efficacy of telebehavioral health and failed to find significant differences between in-person and telehealth interventions,” the study states. “However, many previous studies have limited generalizability and often lack diversity in patient populations, with rural and minority patients often underrepresented.” More pragmatic research is needed to understand the effectiveness in real-world settings and particularly among rural populations.

Photo: marekuliasz, Getty Images

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