Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Abstract

Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n = 94) had low health-related quality of life (HRQOL), often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n = 40) was associated with an improvement in mental health-related quality of life (d = 0.70, P < .001). These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

Rural mental health service utilization in a Texas telepsychology clinic

“…In total, data from 290 clients were analyzed in this study. This client population has been described elsewhere (Ponciano, Philip, Tarlow, & McCord, ; Sanchez Gonzalez et al, ; Tarlow, Johnson, & McCord, ; Tarlow et al, ), though relevant characteristics are summarized here.…”

“…The physical and mental health problems reported by clients served at the telepsychology clinic were typical of low‐income individuals living in a rural HPSA. The average client served by the clinic had poor physical health, with physical health‐related quality of life equivalent to the 25th percentile of a national sample (Tarlow et al, ). Clients often presented with chronic, comorbid, untreated medical diagnoses, including diabetes, heart failure, chronic pain, limited mobility, and chronic obstructive pulmonary disease.…”

“…Clients presented to services for a range of mental health concerns, though by far the most frequent problem reported at intake was depression, followed by stress, sleep problems, and loneliness (Ponciano et al, ). Over 80% of clients screened positive for major depressive disorder at intake, and 40% of clients reported suicide ideation in the 2 weeks before their first session (Tarlow et al, ; Tarlow, Johnson, & McCord, 2019). In addition to depression and suicidality, clients frequently disclosed histories of trauma and adverse childhood experiences.…”

“…Most concerning is the persistent widening of the digital divide (Hindman, ; Whitacre et al, ) despite substantial public investment in rural telecommunications infrastructure for healthcare (e.g., Federal Communications Commission, ). One strategy recommended for improving access to telepsychology services in rural areas with poor connectivity is a “hub and spoke” model in which clients travel to nearby access points (such as community centers with reliable network connectivity) to receive services from centrally located service providers (Gonzalez & Brossart, ; McCord et al, ; Tarlow, McCord, Elliott, & Brossart, ). However, other obstacles to telepsychology service utilization remain even when the digital divide between rural and metropolitan regions is addressed with hub and spoke or other models.…”

Telepsychology: Training perspectives

“…Trainees also produced empirically‐supported telehealth policies to inform local stakeholders who participate in service delivery (Chang, Frazier, & Elliott, ; McCord et al, ; Wendel, Brossart, Elliott, McCord, & Diaz, ). A third area of research is the study of clinical outcomes of telehealth clients (McCord et al, ; Tarlow, McCord, Elliott, & Brossart, ). This robust research program provided trainees with opportunities to contribute scholarship via conferences and peer‐reviewed publications, and it also created remarkable synergy between trainees’ roles of scientist and clinician.…”