In response to the COVID-19 public health crisis in 2020, PCORI launched an initiative to enhance existing research projects so that they could offer findings related to COVID-19. The initiative funded this study and others.
Youth with mental health conditions may have faced challenges during the COVID-19 pandemic, especially in obtaining mental health treatment. During the pandemic, health systems shifted from in-person visits to telehealth. Telehealth is a way to provide care to patients remotely using phone or video.
To explore the effect of using telehealth to treat youth with bipolar spectrum disorder (BSD) during the COVID-19 pandemic
|316 youth with BSD receiving care at hospitals in the Northeast, the Midwest, Texas, and California, 363 caregivers, and 57 clinicians; youth and caregivers were enrolled in an ongoing study for youth with BSD with obesity or overweight who were taking second-generation antipsychotics
Primary: overall functioning
Secondary: delivery and frequency of mental health care, BSD medication adherence, depression, anxiety, trauma, suicidal ideation, substance use, COVID-19 vaccine hesitancy, and barriers to receiving mental health services
|Data Collection Timeframe
|Youth and caregiver surveys and interviews: December 2020–October 2021
Clinician surveys: January 2021–May 2021
This study explored how the use of telehealth during the pandemic affected functioning, BSD medication adherence, symptom severity, COVID-19 vaccine hesitancy, and barriers to receiving mental health care among youth with BSD. Researchers compared youth using telehealth therapy via telephone or video, youth using in-person therapy, and youth who were not using therapy. Researchers did not randomly assign youth to the type of therapy.
Youth and caregivers completed surveys and interviews at baseline and six months later. Surveys asked about mental health care, functioning, and impairment. Researchers also interviewed clinicians about changes in their perceptions of telehealth since March 2020.
The study included 316 youth with BSD, 363 caregivers, and 57 clinicians. Of youth, 68% were White, 18% were Black, and 14% were another race; 14% were Hispanic. The average age of youth was 16, and 54% were male.
Youth with BSD, caregivers, and clinicians gave input throughout the study.
Compared with youth who did not use any therapy, youth who used either telehealth or in-person therapy reported worse depression and higher rates of substance use and psychiatric emergency room visits (all p≤0.05). The two treatment groups did not differ significantly in other outcomes.
Youth who used telehealth reported higher overall functioning and less mania and mood instability (all p≤0.01) than youth who only used in-person therapy. Telehealth and in-person therapy did not differ significantly in other outcomes.
Among youth using telehealth therapy:
- Higher frequency of telehealth visits was associated with greater suicidal ideation and more psychiatric emergency room visits (both p≤0.01).
- Youth who used video telehealth were less depressed and anxious than youth who used telephone telehealth (both p≤0.01).
- Youth who used video for medication management were less likely to report feelings of neglect than youth who used telephone telehealth (p=0.01).
Clinicians reported that their perceptions of telehealth improved since March 2020. They also reported feeling confident in using technology and that telehealth did not decrease productivity.
Researchers could not determine whether the outcomes among youth were the result of using therapy or if youth with more severe symptoms at baseline sought therapy or used it more often. The sample size was smaller than planned, which potentially limited the ability to detect differences between groups.
Conclusions and Relevance
In this study, youth with BSD who used in-person or telehealth therapy had unfavorable outcomes compared with youth who were not using therapy. However, among youth who used therapy, telehealth, especially video telehealth, had more favorable outcomes than in-person therapy.