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The digital divide in access to broadband internet and mental healthcare

Nature Mental Health volume 2, pages 88–95 (2024)Cite this article

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Abstract

Telemedicine has greatly improved mental healthcare access worldwide, particularly following the COVID-19 pandemic. However, the growing reliance on broadband internet-based mental healthcare raises concerns surrounding telemedicine’s accessibility in communities already facing barriers in seeking mental health information and care. This study aims to (1) correspond access to broadband internet with access to several mental health resources and (2) quantify the association between social determinants of health and broadband access in the United States. For each of 3,138 US counties, we collected data for the percentage of households without broadband access, the density of various mental healthcare services, urbanization level, and percentage of households with an income below the poverty line. Two-sample t tests and two-proportion z tests were used to substantiate the association between broadband access and mental health resource availability, while multivariate linear regressions were performed to quantify the association between broadband internet access and mental health resource availability, while controlling for urbanicity level and poverty rate. Finally, geographical trends in broadband access and mental health services were visualized in QGIS. US counties with reduced broadband access have lower average densities of mental healthcare physicians, non-physician mental health practitioners, inpatient psychiatric and substance abuse treatment facilities, and outpatient facilities (P < 0.001). Moreover, counties with reduced broadband access are nearly three times as likely to have no mental health physicians and no outpatient facilities, over twice as likely to have no non-physician mental health practitioners, and nearly twice as likely to have no psychiatric/substance abuse hospitals (P < 0.001). These results suggest that expanding access to mental health resources in rural, low-income, and medically under-resourced communities is necessary in light of their reduced access to both broadband internet and mental healthcare services.

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Fig. 1: Geographical distributions of rural areas, broadband, and poverty.
Fig. 2: Geographical distributions of mental health and substance abuse clinicians and facilities.

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Data availability

All data used in this study are publicly available, as described in Methods.

Code availability

All code used to conduct statistical analyses of the data is available upon request.

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Acknowledgments

E.C.D. is funded in part through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748). E.C.D. has received funding through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748).

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Authors and Affiliations

  1. Harvard University, Cambridge, MA, USA

    Khushi Kohli

  2. Stanford University School of Medicine, Stanford, CA, USA

    Bhav Jain

  3. University of Pennsylvania, Philadelphia, PA, USA

    Tej A. Patel

  4. Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Hatice Nur Eken

  5. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Edward Christopher Dee

  6. Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    John Torous

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  1. Khushi Kohli
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  2. Bhav Jain
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Conception and design: All authors. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.

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Correspondence to John Torous.

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Kohli, K., Jain, B., Patel, T.A. et al. The digital divide in access to broadband internet and mental healthcare. Nat. Mental Health 2, 88–95 (2024). https://doi.org/10.1038/s44220-023-00176-z

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