Abstract
Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders. Compounding risk for poor outcomes related to these disorders, individuals living in rural areas face barriers receiving evidence-based mental health treatment. Video to home telehealth (VTH) has been implemented broadly within the Veterans Health Administration to improve access to care for rural veterans. However, VTH may not be utilized equally across disorders and comorbidities, including co-occurring anxiety and alcohol use disorders, potentially contributing to gaps in care that are not available in person. A cohort of veterans who received at least one VTH mental health visit between fiscal years 2016–2019 was compiled from VA administrative data. Multilevel linear growth curve models were used to examine growth in VTH use over time among veterans with anxiety only, alcohol use disorder only, and co-occurring disorders. Fixed effects were significant for both time and diagnosis group and a significant interaction between time and group. For each subsequent fiscal year, the percentage of total MH visits that were VTH increased for all groups but less so for those with co-occurring anxiety and alcohol use diagnoses. Despite VTH being an important tool to reach underserved rural veterans, rural veterans with AUD and co-occurring anxiety and AUD are at risk for not receiving care using this modality. Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services.
Highlights
Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders
Unadjusted analyses revealed that the total percentage of mental health visits that was Video to home telehealth (VTH) across the 4-year period significantly differed between rural veterans with anxiety disorders only, alcohol use disorder (AUD) only, and comorbid anxiety/AUD, F (2, 10,248) = 137.36, p < .001, η2 =
Analyses that controlled for the number of fiscal years with any mental health visits revealed a significant difference in the percentage of visits that was VTH between rural veterans with anxiety disorders only, AUD only, and comorbid anxiety/AUD, F (3, 10,247) = 130.56, p < 0.0001
Summary
Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders. Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services. Center (a virtual center), Houston, TX, USA given year, one in four adults is at risk of meeting criteria for anxiety disorders (Beesdo et al 2010). These conditions are characterized by intense fear and avoidance of a range of stimuli (e.g., social situations, worry, bodily sensations), resulting in high levels of social, occupational, relational, and physical distress and impairment (American Psychiatric Association 2013; Norton and Barrera 2012; Stein et al 2005). Understanding how to best serve individuals with co-occurring anxiety and AUD is an important research and clinical goal
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