Background The US has a severe shortage of psychiatry workforce. In 2021, one in three Americans lived in Mental Health Professional Shortage Area (MHPSAs). Telehealth has long been advocated as a promising delivery model to mitigate the psychiatry workforce shortage but is limited by broadband access. This study identified counties without either psychiatrists or broadband coverage, described their characteristics, and examined their mental health outcomes.


Methods This cross-sectional analysis of all US counties employed public data in 2020. We used psychiatrist data from the Health Resources and Services Administration’s Area Health Resources Files, county socio-demographic characteristics from the American Community Survey, county-level measurements of broadband coverage from the Department of Commerce, and mental health outcomes from the County Health Rankings. We first identified counties without psychiatrists or broadband coverage in 2020 before performing a multivariate logistic regression to assess characteristics of those counties. The regression included state fixed effects, controlling for county level covariates: health insurance, unemployment, educational attainment, racial/ethnicity composition, household income, rurality (defined as the 2013 USDA rural-urban continuum codes of 8 or 9), and MHPSA designation. We used chi-squared tests to compare percent of adults with a history of depression, frequent mental distress, and drug overdose deaths and completed suicides per 100,000 population between counties without psychiatrists or broadband and other counties.


Results
We found that 596 (19%) counties were without psychiatrists or broadband, representing 10.5 million residents. Our regression results indicated that these counties were more likely to be rural (adjusted odds ratio [AOR]=3.048, p<0.01), have higher unemployment rates (AOR=1.122, p<0.01) and uninsurance rates (AOR=1.031, p<0.01), and lower proportion of population with bachelor’s degrees (AOR=0.919, p<0.01), but were not associated with MHPSA designation. 

Counties without psychiatrists or broadband had higher percentages of adults with a history of depression (22.4% vs 18.9%, p<0.01), frequent mental distress (16.5% vs 13.8%, p<0.01), drug overdose mortality (40.9 vs 11.1 per 100,000, p<0.01), and completed suicides (88.1 vs 11.3 per 100,000, p<0.01) compared to other counties. 


Conclusion: Despite the recent expansion of telehealth services, continued gaps in both broadband coverage and the psychiatrist workforce exist and are associated worse mental health outcomes, highlighting the need for further policy interventions to improve digital equity and access to psychiatric care, especially by targeting predominately rural counties and counties with lower socio-economic status.

Lacking Both Psychiatry Workforce and Broadband Coverage and Association with Mental Health Outcomes

 Psychiatry

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