Multilevel Growth Curve Models Research Articles

Burnt out and still single: Susceptibility to dating app burnout over time

Despite the ubiquity of dating apps, there is little longitudinal research examining the mental health and well-being of dating app users. To fill this void, this study takes a social compensation approach to exploring dating app users’ burnout experiences (i.e., emotional exhaustion, inefficacy, and depersonalization) over time. Four hundred ninety-three active single dating app users were surveyed over four waves across 12 weeks, with a final sample of 190. Multilevel growth curve models showed that dating app users experienced increased emotional exhaustion and inefficacy over time. Furthermore, depression, anxiety, and loneliness predicted more emotional exhaustion and inefficacy, while problematic dating app use predicted more emotional exhaustion and less inefficacy. The results suggest that dating apps may exacerbate existing difficulties with relationship initiation among vulnerable users by increasing their risk of burnout. Dating app burnout is a potential intervention target to improve users’ dating success.

Study protocol for a pragmatic randomised multiple baseline trial evaluating Knowledge Insight Tools (KIT), a cognitive behavioural therapy-informed school-based counselling intervention for children and young people in UK secondary schools with low mood and anxiety.

There is a pressing need to offer more accessible, evidence-based psychological interventions to secondary school students who are increasingly reporting difficulties with anxiety and low mood. The aim of this pragmatic randomised multiple baseline trial is to evaluate the efficacy of a school-based counselling intervention called Knowledge Insight Tools (KIT) for reducing anxiety and low mood in UK secondary school students. KIT is a flexible intervention delivered individually and informed by cognitive behavioural therapy (CBT). We will use a randomised multiple baseline design whereby young people will be randomly allocated to a baseline wait period of 3, 4, 5, 6, 7, or 8 weekly measurements, followed by receiving up to 10 weekly sessions of KIT delivered by trained, school-based practitioners. We aim to recruit 60 young people aged 11-18 who are primarily experiencing problems with low mood and/or anxiety from secondary schools across England and Scotland. We will assess child-reported anxiety, mood, and general psychological distress/coping with the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE), recorded at each session during the baseline and intervention phases. We will also assess child-reported anxiety and low mood with the Revised Children's Anxiety and Depression Scale (RCADS) at the beginning and end of treatment; practitioner-reported treatment fidelity with the KIT Fidelity Checklist; and practitioner-reported feasibility with an end-of-treatment Implementation Survey. We will analyse within-person and between-person change in YP-CORE scores across the baseline and intervention phases using visual analysis and piecewise multilevel growth curve models. We will also analyse pre-post changes in YP-CORE scores using randomisation tests, and reliable and clinically significant change using the RCADS scores. The KIT trial is a pragmatic, randomised multiple baseline trial aimed at evaluating a school-based, individual CBTcounselling intervention for reducing anxiety and low mood in UK secondary school students. Results will directly inform the provision of KIT in school-based counselling services, as well as the growing evidence-base for school-based CBT interventions. ClinicalTrials.gov NCT06188962. Retrospectively registered on 02/01/24.

Association between frailty and subsequent disability trajectories among older adults: a growth curve longitudinal analysis from the Survey of Health, Ageing and Retirement in Europe (2004-19).

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

The Pace of Change in Videoconferencing and Face-to-Face Adult Psychotherapy: A Longitudinal Study.

The current study explores the pace of psychological change in face-to-face (F2F) and videoconferencing psychotherapy (VCP). It also aims to offer a methodological tool for studying it and to suggest some hypotheses that could explain the pace of change in F2F and VCP. Change in therapy was predicted to be non-linear and faster in F2F than in VCP. Session-by-session records of two measures of change (as assessed by therapists and clients, respectively) were collected from 113 participants from F2F ( = 57) and VCP ( = 56), resulting in 2552 therapy sessions. A non-manipulative longitudinal design was proposed in which multilevel growth curve models were performed. Different models were specified to account for the trajectories followed on average by all cases as closely as possible. The chosen models for therapists' ( χ = 4.42, < .05, β = .54) and clients' ( χ = 6.31, < .05, β = .53)data, showed large effect sizes. The results were significant and showed that change was not linear and was faster in F2F, as we had predicted. Our results contribute to knowledge about psychological therapy provided through the internet. Several hypotheses are suggested to explain which processes may underlie those results.

Depressive symptoms across the retirement transition in men and women: associations with emotion regulation, adjustment difficulties and work centrality

BackgroundRetirement is a major life event and factors driving depression in the retirement transition might differ in men and women. The aim was to prospectively study depressive symptoms across the retirement transition in men and women and to test associations with emotion regulation strategies (suppression and reappraisal), adjustment difficulties, and work centrality.MethodsThe sample included 527 individuals from the population-based Health, Aging and Retirement Transitions in Sweden (HEARTS) study who were working at baseline and retired during one of the following four annual measurement waves. Participants contributed with a total of 2635 observations across five measurement waves. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D); total score was modelled as a function of time to and from retirement. Changes over the retirement transition were analyzed with multilevel growth curve models. Gender differences in associations with emotion regulation, adjustment difficulties and work centrality were examined by including interaction effects with sex.ResultsWe observed a general reduction of depressive symptoms in the early years of retirement in both men and women. Higher suppression was related to higher depression scores while higher cognitive reappraisal was related to lower levels of depressive symptoms. Women more often used cognitive reappraisal, and men more often suppression, but no significant gender interaction in associations with depressive symptoms could be shown. Retirement adjustment difficulties and greater importance of work for self-esteem were related to higher depression scores. Greater meaning of work, on the other hand, was related to lower levels of depressive symptoms, and this association was stronger in men.ConclusionsThere was a general reduction of depression scores in the early years of retirement in both women and men. Findings suggest that basing one’s self-esteem on workplace performance was related to higher levels of depressive symptoms after retirement, while perceiving one’s job as important and meaningful may facilitate better adjustment in terms of lower depression symptom levels, especially in men.

Habitual Caffeine Use Is Associated With Heightened Cortisol Reactivity to Lab-Based Stress in Two Samples.

Habitual caffeine consumption protects against depression but through unclear mechanisms. Although habitual caffeine use predicts cortisol release in response to other acute stressors (e.g., exercise), this is less examined with lab-based psychosocial stress in healthy adults. Furthermore, caffeine-induced cortisol increases may mask theory-predicted cortisol blunting to robust stress in people with elevated depression risk. In two samples, we tested whether acute (same-day) and habitual caffeine use would predict greater cortisol reactivity to lab-based stress, and whether caffeine would "mask" the effect of a depression risk factor, trait rumination, on blunted cortisol reactivity. In sample 1, N = 128 emerging adults completed one of three Trier Social Stress Test conditions: nonevaluative control, ambiguously evaluative intermediate, or explicit negative evaluative. In sample 2, N = 148 emerging adults completed either a control or negative evaluative condition. In both samples, multilevel growth curve modeling indicated that habitual caffeine use ( t = -1.99, p = .048; t = -2.73, p = .007, samples 1 and 2, respectively) but not acute caffeine use predicted heightened cortisol reactivity as a function of condition. In sample 1, the relationship between condition, rumination, and blunted cortisol was evident only in caffeine nonusers, which differed from users ( t = 2.82, p = .005), but in sample 2, the predicted blunting pattern was evident regardless of caffeine use. The results provide evidence that habitual caffeine use is associated with greater cortisol release under psychosocial lab-based stress and may mask the influence of psychosocial variables; future research should examine whether habitual caffeine-induced cortisol release has behaviorally activating effects that protect against depression.

Household Environments and Cognitive Decline Among Middle-Aged and Older Adults in China: Exploring Gender, Age, and Residential Variations

This study examined the relationship between household environments and trajectories of cognitive function among middle-aged and older adults in China and its urban/rural, gender, and age variations. We estimated multi-level linear growth curve models using a representative sample of 16,111 respondents aged 45 years and over from the China Health and Retirement Longitudinal Study (2011–2018). Older people who lived with a spouse, but not with children, and those with higher living expenditures, better housing quality, and indoor clean fuels for cooking had a slower cognitive decline. Living arrangement more strongly predicted men's cognitive decline, while living expenditure, solid fuel use, and housing quality significantly predicted only women's cognitive decline. Only for older adults and rural residents, those living alone had significantly faster cognitive decline than those living with a spouse only. These findings underscore the importance of improving the living conditions of older adults to help alleviate their cognitive decline.

Today’s Adolescents Are More Satisfied With Being Single: Findings From a German Cohort-Sequential Study Among 14- to 40-Year-Olds

In Western societies, singlehood has become increasingly normative over historical time. But whether singles are more satisfied nowadays remains unclear. In this preregistered cohort-sequential study, we analyzed data from 2,936 German participants ( M = 21.01 years, SD = 7.60 years) from different birth cohorts. Singlehood satisfaction and life satisfaction were reported annually at two different time periods (2008-2011 and 2018-2021). This design allowed us to compare earlier-born and later-born singles during adolescence (14-20 years), emerging adulthood (24-30 years), and established adulthood (34-40 years). Results from multilevel growth-curve models indicated that adolescent singles born in 2001 to 2003 (vs. 1991-1993) were more often single and more satisfied with singlehood. No cohort-related differences emerged among emerging and established adults. Younger age and lower neuroticism predicted higher satisfaction, regardless of birth cohort. The results highlight the importance of considering both societal and individual factors to understand singles’ satisfaction.

Is 70 the new 60? A longitudinal analysis of cohort trends inintrinsic capacity in England and China.

To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). We applied multilevel growth curve models to examine change over time and cohort trends. We found that more recent cohorts entered older ages with higher levels of capacity, and their subsequent age-related declines were somewhat compressed compared to earlier cohorts. These improvements in capacity were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old ELSA participant born in 1950 had higher capacity than a 62-year-old born just 10 years earlier. Trends were similar for men and women, and findings were generally consistent across English and Chinese cohorts.

Assessing the E-bike trends and impact on sustainable mobility: A national-level study in the Netherlands

Over the past decade, e-bikes have become increasingly popular, sparking interest in their potential replacement for car use and benefit for the environment. However, many studies on e-bike development and their substitution effects exhibit limitations. These include a lack of modeling on e-bike trend development, inadequate assessments of their impact on national-level mobility, a predominant focus on commuting, and a lack of foresight into future e-bike substitution effects. Our research introduces an innovative approach to model e-bike development, employing a multilevel Richards growth curve model fitted within a hierarchical Bayesian framework using the Hamiltonian Monte Carlo (HMC) method. Further, we incorporate an intention-based method to delve into the potential of e-bikes in stimulating sustainable mobility in the Netherlands. Our findings highlight an ongoing increase in e-bike distance share, with marked gender and generational differences in growth patterns. Notably, women have higher e-bike usage than men, and this gap is narrowing for older age groups while widening among younger demographics, suggesting that younger people may adopt e-bike usage differently than older generation. E-bike ownership strongly reduces the conventional bicycle use and, to a lesser extent, car and public transport use, especially for commuting. This study provides insight into whether and to what extent e-bikes substitute for car use and other modes of transportation, and how the expected growth in e-bike use in coming years may impact national mobility in the Netherlands.

Behavioral and neural responses to social rejection: Individual differences in developmental trajectories across childhood and adolescence

Dealing with social rejection is challenging, especially during childhood when behavioral and neural responses to social rejection are still developing. In the current longitudinal study, we used a Bayesian multilevel growth curve model to describe individual differences in the development of behavioral and neural responses to social rejection in a large sample (n > 500). We found a peak in aggression following negative feedback (compared to neutral feedback) during late childhood, as well as individual differences during this developmental phase, possibly suggesting a sensitive window for dealing with social rejection across late childhood. Moreover, we found evidence for individual differences in the linear development of neural responses to social rejection in our three brain regions of interest: The anterior insula, the medial prefrontal cortex, and the dorsolateral prefrontal cortex. In addition to providing insights in the individual trajectories of dealing with social rejection during childhood, this study also makes a meaningful methodological contribution: Our statistical analysis strategy (and can be found in this study’s online supplementary materials at https://jeroendmulder.github.io/social-emotion-regulation/) can be used as an example on how to take into account the many complexities of developmental neuroimaging datasets, while still enabling researchers to answer interesting questions about individual-level relationships.

Contextualizing Lives and Historical Time: Examining Changes in the Transition to Adulthood and Age-Arrest Trajectories from the 1960s to 2018

Objectives: The changing nature and timing of adult role acquisition during the transition to adulthood over the past several decades may hold implications for criminal offending as adult roles are fundamental to theories of desistance. This research explores whether changes in adult role attainment during young adulthood are associated with the changes in the level and slope of the age-arrest trajectory over the past half-century. Methods: Combining US Census and Uniform Crime Report data, we map the average rate of adult role attainment (e.g., marriage, parenthood, labor force, independent living) and aggregate age-arrest trajectories among young adults (ages 18-24) biennially from 1960 to 2018. We fit a multilevel growth curve model where ages are nested within years to examine whether variation in the aggregate age-arrest trajectory is associated with variation in the attainment of adulthood. Results: At the macro level, periods with higher levels of adult role attainment are associated with a swifter decline in the young adult arrest rate but not the level. Conclusions: This research positions sociohistorical context at the center of life course criminological inquiry and highlights how historical shifts in the attainment and timing of adult social roles can alter behavioral patterns during the transition to adulthood.

Changes in mindfulness facets across yoga, CBT and stress education in individuals with generalized anxiety disorder

Improving mindfulness is an important treatment target for generalized anxiety disorder (GAD). However, less is known about how different treatments impact specific aspects of mindfulness. In a clinical trial (Simon et al., 2021), 226 individuals with GAD were randomized to 12 weeks of Kundalini Yoga (KY), cognitive behavioral therapy (CBT) or stress education (SE). To examine whether specific facets of mindfulness, as measured by the Five Facet Mindfulness Questionnaire (FFMQ) change more than others across treatment and between treatments, we ran a multi-variate multilevel growth curve model (MMLM). Results indicated that while the Non-judge, Act with Awareness, and Non-react facets increased significantly during treatment, the Observe and Describe facets did not. Improvement in the Acting with Awareness facet during treatment was significantly greater for KY than CBT. These findings reveal the need to better understand how behavioral treatments can influence specific components of mindfulness for those with anxiety.

Enhancing mental wellbeing by changing mindsets? Results from two randomized controlled trials

Improving mental wellbeing is often targeted with behavioral interventions, while mindset interventions might be more appealing as they require less time and effort. In addition to recent experimental studies demonstrating that attributional beliefs can be changed to improve emotional wellbeing and performance, the current study examines whether a positive change in people’s beliefs about stress and life philosophy enhances emotional, social and psychological wellbeing using brief educational interventions. Two parallel double-blind randomized controlled trials were conducted. Study 1 (N = 106; 62.3% female, mean age 36.0) compared an educational video about the benefits of a stress-is-enhancing mindset versus an active control video. In Study 2 (N = 136; 57.4% female, mean age 35.7), educational texts about the benefits of a stress-is-enhancing mindset and holding a life-is-long-and-easy mindset were compared to an active control text. Results of multilevel growth curve modeling showed that a stress mindset could be significantly changed using an educational video or text, while the change in the philosophies of life mindset did not significantly differ between conditions. Furthermore, none of the manipulations were able to sustain the positive change in mindset which might explain why there was no significant increase in mental wellbeing compared to control. To have a lasting effect on people’s mental wellbeing, a change in mindset might need to be embodied in everyday life. Future research should investigate simple versus intensive interventions with longer follow-up time to examine whether and how a mindset can be sustainably changed to promote flourishing mental health in the general population.

Measurement reactivity in ambulatory assessment: Increase in emotional clarity over time independent of sampling frequency

Ambulatory assessment (AA) studies are frequently used to study emotions, cognitions, and behavior in daily life. But does the measurement itself produce reactivity, that is, are the constructs that are measured influenced by participation? We investigated individual differences in intraindividual change in momentary emotional clarity and momentary pleasant-unpleasant mood over the course of an AA study. Specifically, we experimentally manipulated sampling frequency and hypothesized that the intraindividual change over time would be stronger when sampling frequency was high (vs. low). Moreover, we assumed that individual differences in dispositional mood regulation would moderate the direction of intraindividual change in momentary pleasant-unpleasant mood over time. Students (n = 313) were prompted either three or nine times a day for 1 week (data collection took place in 2019 and 2020). Multilevel growth curve models showed that momentary emotional clarity increased within participants over the course of the AA phase, but this increase did not differ between the two sampling frequency groups. Pleasant-unpleasant mood did not show a systematic trend over the course of the study, and mood regulation did not predict individual differences in mood change over time. Again, results were not moderated by the sampling frequency group. We discuss limitations of our study (e.g., WEIRD sample) and potential practical implications regarding sampling frequency in AA studies. Future studies should further systematically investigate the circumstances under which measurement reactivity is more likely to occur.

Vegetarianism and mental health: Evidence from the 1970 British Cohort Study

BackgroundReducing animal product consumption has benefits for population health and the environment. The relationship between vegetarianism and mental health, however, remains poorly understood. This study explores this relationship in a nationally representative cohort in Great Britain. MethodsWe use data from the 1970 British Cohort Study, which collected information on vegetarianism at age 30 in 2000 (n = 11,204) and psychological distress (PD) at ages 26, 30, 34, 42, and 46–48 in 2016/18. We first developed a statistical adjustment strategy by regressing PD at age 30 on vegetarianism and 14 confounders measured at ages 10 and 26. We then ran multilevel growth curve models, testing whether within-person changes in PD between ages 30 and 46–48 differed by vegetarianism, before and after statistical adjustment. ResultsAt age 30, 4.5 % of participants reported being vegetarian. In the cross-sectional models at age 30, vegetarians reported more distress compared with non-vegetarians in bivariate analysis (b = 0.30, 95%CI 0.09, 0.52), but this difference disappeared in the fully-adjusted model (b = 0.02, 95%CI −0.17, 0.21). In the longitudinal models between ages 30 and 46/48, there were no differences in within-person changes in psychological distress between vegetarians and non-vegetarians (p = .723). Sensitivity analyses using red meat consumption yielded similar findings. ConclusionIn this British cohort, vegetarianism at age 30 was not associated with changes in psychological distress during mid-adulthood. Since psychological distress in early adulthood predicted vegetarianism at age 30, more studies are needed to disentangle the progression of this relationship over the life-course.

The shape of the change: Cumulative and incremental changes in daily mood during mobile-app-supported mindfulness training.

Understanding of the exact trajectories of mood improvements during mindfulness practice helps to optimize mindfulness-based interventions. The Mindfulness-to-Meaning model expects mood improvements to be linear, incremental, and cumulative. Our findings align with this expectation. We used multilevel growth curve models to analyze daily changes in positive mood reported by 190 Polish participants during 42 days of a mobile-app-supported, mindfulness-based intervention. The daily positive mood increased among 83.68% of participants. Participants who started the training reported worse mood improved more and faster than participants with better mood at the baseline. Dispositional mindfulness and narcissism - individual difference variables associated with high vs. low emotion regulation ability, respectively - were not associated with mood improvement trajectories. A small group of participants (16.32%) showed a steady decline in positive mood during the intervention. The results underscore the importance of a more comprehensive understanding of individual variability in benefiting from mindfulness-based interventions.

HOUSEHOLD ENVIRONMENTS AND COGNITIVE DECLINE AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA

Abstract Household conditions play a crucial role in the well-being of older adults, who usually spend much longer time in their homes than younger adults. Few studies have examined the compound effects of multiple household conditions on trajectory of cognition function among older adults. This study examines the relationship between household environments and trajectories of cognitive function among middle-aged and older adults in China. It also examines urban/rural, gender, and age variations in this relationship. Using a representative sample of 16,111 respondents aged 45 years and over from four waves of the China Health and Retirement Longitudinal Study (2011-2018), we estimated multi-level linear growth curve models of household social, economic, and physical conditions on cognitive decline over seven years. The results show that older people who lived with spouse but not with children and those with higher living expenditures, better housing quality, and indoor clean fuels for cooking had slower cognitive decline. Living arrangement more strongly predicted men’s cognitive decline while living expenditure, solid fuel use and housing quality significantly predicted only women’s cognitive decline. Only for adults aged 60 year and over, living alone or living with spouse and adult children significantly predicted a faster cognitive decline. Only for rural residents, living alone or living with young children and no adult children significantly predicted a faster cognitive decline. These findings underscore the importance of social policies and programs targeting at improving the living conditions of older adults to help mitigate their cognitive decline.

OLDER ADULTS’ SAVORING ABILITY IS ASSOCIATED WITH LONGITUDINAL CHANGE IN WELL-BEING

Abstract Well-being in older adults is an important concern as the aging population grows, as is identifying modifiable factors that contribute to well-being over time. The ability to savor the moment (i.e., to notice and enhance one’s emotional response to positive events) has been shown to be associated with greater well-being, though few studies have examined these relationships longitudinally or in older adults. The current study examined whether savoring ability moderated the trajectory of older adults’ life satisfaction and depressive symptoms over time. A sample of 5777 older adults (Mage = 83.83, SD = 6.61; 66.6% female), recruited from Life Plan Communities, completed four consecutive annual surveys. Multilevel growth curve models revealed main effects of small but significant declines in well-being over time (life satisfaction: B = -.09, SE = .01, p &amp;lt; .001; depressive symptoms: B = .13, SE = .01, p &amp;lt; .001), after accounting for age, gender, education, life stress, and health. Interactions between time and savoring ability indicated that participants with greater savoring ability were better able to maintain their levels of well-being (i.e., smaller decline in life satisfaction [B = .05, SE = .01, p &amp;lt; .01] and smaller increase in depressive symptoms [B = -.10, SE = .01, p &amp;lt; .01]). In contrast, individuals lower in savoring ability experienced less favorable well-being trajectories. Savoring is a malleable emotion regulation ability that is associated with attenuated declines in well-being over time. Implications for savoring interventions in older adults will be discussed.

Black veteran use of video telehealth for mental health care.

Black veterans experience disparities in mental health (MH) care access and are disproportionately affected by COVID-19. Video telehealth to home (VTH) may reduce disparities by addressing barriers, particularly with pandemic-related shifts to remotely delivered care. Considering potential needs for tailored implementation across racial/ethnic groups, we examined differences in VTH use by non-Hispanic Black veterans versus all other races/ethnicities and among Black (Hispanic and non-Hispanic) veterans by age, rurality, and gender during the pandemic. We extracted a cohort of Veterans Health Administration-enrolled veterans receiving at least one MH encounter between October 2019 and September 2020 (n = 1,627,791) from electronic health records. Multilevel linear growth curve models examined the percentage of VTH use for non-Hispanic Black versus other races/ethnicities before and after pandemic onset. Black veteran-only subgroup analyses examined differences by ethnicity in percentage of VTH MH encounters since pandemic onset by age, rurality, and gender, using regression and analysis of covariance models. Despite significant increases in VTH during the pandemic, on average, VTH use was consistently lower for non-Hispanic Black veterans across both periods. During the pandemic, differences in VTH use between non-Hispanic Black and non-Black veterans accelerated over time. VTH use was greater during the pandemic for Black veterans who were Hispanic, younger, urban, and female. Adoption of VTH for MH was low for non-Hispanic Black veterans before COVID-19 and during COVID-19 compared to non-Black groups. Future VTH research and implementation efforts should question why adoption remains low, work to meet cultural needs, and promote equitable adoption for Black veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).