Changing rural-urban and racial patterns in VA tele-mental health use among women Veterans, 2019-2022

To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings.

This retrospective cohort study used VA administrative data to examine temporal trends in outpatient VA mental health use from January 1, 2019, through December 31, 2022-a period spanning the pre- and post-COVID-19 pandemic. The cohort included VA-enrolled women veterans ages 18-60 years with at least one outpatient mental health visit delivered by a VA provider in-person (VA-MH) or via SVT-MH. Outcomes included (1) any SVT-MH use and (2) annual SVT-MH visit counts. Models adjusted for demographics and used Bayesian logistic and Poisson regression to estimate effects and interactions over time.

SVT-MH use increased from 7% in 2019 to 32% in 2022. Rural women Veterans initially had higher SVT-MH use, but by 2022, urban women had higher use and visit counts. Black and Hispanic women Veterans showed the largest increases, especially in urban areas. American Indian and Alaska Native (AIAN) women Veterans were the only group without significant rural-urban differences in 2022, though they had lower overall visit counts.

SVT-MH use among women veterans increased substantially during the study period, with rural-urban gaps narrowing over time. These findings suggest SVT-MH differences may shift rapidly based on infrastructure, outreach, and policy implementation. Ongoing monitoring and tailored strategies are needed to ensure fair access to SVT-MH for all veterans, especially for AIAN and rural women veterans.