Disparities Persist Among Minority Children Despite Telemental Health Surge During Pandemic

In part 1 of this interview, Xin Hu, PhD, MSPH, assistant professor at Emory University School of Medicine, discusses the background, objectives, and findings of her study, "Racial and Ethnic Disparities in Telemental Health Use Among Publicly Insured Children," published in the March 2025 issue of The American Journal of Managed Care^®.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How has the prevalence of mental health disorders among children changed in recent years? What impact did the COVID-19 pandemic have on telemental health use among this population?

The prevalence of mental health disorders among children has grown pretty substantially in recent years. For example, estimates from the National Survey of Drug Use and Health indicate that one of the more common mental health conditions, major depressive disorder, among adolescents aged 12 to 17 has increased from 8% in 2009 to 20% in 2021.

For other mental health conditions, the prevalence has also become more common among children. The COVID-19 pandemic definitely has accelerated the use of telehealth as a lot of the in-person visits were put on pause. That includes mental health services, and studies have shown that among Medicaid-enrolled children, telemental health visits have increased more than 8-fold.

What was the objective of your study? Why did you decide to investigate this?

Our study aimed to evaluate racial and ethnic disparities in telemental health use among Medicaid-enrolled children from 2016 to 2020. We focused on Medicaid-insured children because Medicaid is the largest payer for children, particularly for racial and ethnic minority groups and people from socioeconomically disadvantaged backgrounds.

We used 100% nationwide Medicaid data to examine racial disparities in telemental health use. Because of the large scale of this data, we were able to look at more granular racial and ethnic subgroups, including non-Hispanic Asian and non-Hispanic Pacific Islanders. This is something that prior studies may have lacked the sample size or the statistical power to do.

Can you discuss the main findings? Did any surprise you?

We found that telemental health use among children increased dramatically from less than 3% before COVID-19 to 36% in 2020. Although the utilization rose across all racial and ethnic groups, minority children, particularly Hispanic and non-Hispanic Black children, had lower rates of use and smaller increases in the first year of the COVID-19 pandemic compared with White children.

Most strikingly, the lowest utilization was observed among non-Hispanic Asian and non-Hispanic Pacific Islander children. The increase among these 2 children subgroups in telemental health was 21 and 25 percentage points compared with 36 percentage points among non-Hispanic White children.

We also found differences in telemental health use based on the racial and ethnic minority composition of the county where the child lived. Children living in the highest quartile of counties based on the proportion of non-Hispanic Black residents, they had lower prepandemic telemental health use. They also experienced a 5–percentage point smaller increase in telemental health use in 2020. Similar patterns were found when we stratified by quartiles of county level for the Hispanic population.

Lastly, we also found that children residing in rural areas and areas with mental health provider shortages were more likely to use telemental health and experience larger increases in telemental health use in 2020.