The Digital Divide: Counties Lacking Access to Broadband Internet Have Reduced Access to Mental Healthcare Resources

Abstract

Background 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 i) correspond access to broadband internet with access to several mental health resources and ii) quantify the association between social determinants of health and broadband access in the US. Methods For each of 3138 US counties, we collected data for the percentage of households without broadband access (2020 Federal Communications Commission Mapping Broadband Health in America), the density of various mental healthcare services (2017 National Neighborhood Data Archive), urbanization level (2013 Urban-Rural Classification Scheme for Counties), and percentage of households with an income below the poverty line (2019 American Community Survey). 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. Results 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). Finally, multivariate linear regressions demonstrated that a 1% increase the proportion of a county’s population lacking broadband access is associated with a decrease of 0.0452 nonphysician mental health practitioners (P < 0.001), 0.00578 psychiatric/substance abuse hospitals (P < 0.001), 0.00835 inpatient psychiatric and substance abuse treatment facilities (P < 0.001), 0.0272 mental healthcare physicians (P < 0.001), 0.0779 pharmacies and drugstores (P < 0.001), and 0.0488 outpatient facilities (P < 0.001) per 100,000 people. Conclusion 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.