Telebehavioral health care utilization among U.S. military personnel before and during the COVID-19 pandemic

Abstract: INTRODUCTION: Behavioral health conditions, such as posttraumatic stress disorder (PTSD), major depressive disorder, and suicidality, affect 18% of service members each year and impact well-being and military readiness if left untreated. Telebehavioral health (TBH) is a crucial tool for expanding access to care by offering flexibility and privacy while reducing stigma. This study analyzes TBH utilization trends among active duty service members from 2015 to 2021 across various behavioral health diagnoses, examining shifts related to the COVID-19 pandemic and providing insights to enhance health care delivery within the Military Health System (MHS). MATERIALS AND METHODS: Medical and personnel records were obtained from the MHS Data Repository and the Career History Archival Medical and Personnel System. Service members with at least 1 behavioral health condition of interest (e.g., PTSD, suicidal behavior) and at least 1 outpatient behavioral health evaluation or treatment session between October 2015 and September 2021 were included. Study analyses were run using eligible visits; there were 8255906 eligible behavioral health visits included in analyses completed by 602834 unique service members. RESULTS: Telebehavioral health utilization rose sharply for all diagnostic categories early in the pandemic. Before the pandemic, the percentage of visits completed virtually ranged from 0% to 14.8%; rose to between 12.9% and 58.5% immediately after the emergency declaration in March 2020, then declined to between 8.7% and 42.5% by September 2021. Using an interrupted time series design, we analyzed the ratio of TBH to in-person visits across 11 diagnostic categories before and after March 17, 2020. Between October 2015 and March 2020, the rate of change in weekly ratios of TBH visits to in-person visits was stable. After the start of the pandemic, the weekly ratio significantly increased for all conditions (all P<.001) except suicidal behavior, which did not significantly change (P>.05). Following the pandemic, the ratio for all conditions except suicidal behavior trended downwards; however, t-tests comparing the ratio of visits at the end of 2021 to the pre-pandemic period revealed TBH utilization remained statistically significantly elevated for all conditions (all P <.05). CONCLUSION: Telebehavioral health utilization increased rapidly, but briefly, in March 2020, and then quickly declined across all diagnostic categories, with service members with conditions like ADHD and suicide ideation returning more quickly to in-person care compared to those with PTSD or adjustment disorder. Findings highlight the need to optimize resource allocation and provide targeted training for effective remote care delivery. Future research should extend findings to determine how utilization has changed into the current time.