JMIR Publications

ABSTRACT

Background:

Access to mental health services continues to be a systemic problem in the United States and around the world due to a variety of barriers including limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple options available to address their presenting problem (e.g., telehealth, group therapy, one-to-one therapy). In fact, the dominant model of care - one-to-one, in-person treatment with a masters or doctoral level trained mental health provider, may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care. These platforms have the potential to optimize mental health care delivery by assessing presenting problems, clinical severity, and therapy modality preferences and recommending the appropriate level of care. In order to facilitate patient-centered stepped care, more research is needed to understand patient preferences for mental healthcare as additional modalities become increasingly validated as effective treatment options.

Objective:

The purpose of this study was to examine rates and predictors of psychological treatment modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform.

Methods:

This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology enabled platform to optimize mental health care delivery. Chi-square and one-way ANOVA were used to evaluate associations among categorical and continuous factors of interest and preferred care modality. Univariate multinomial logistic regression models were constructed to estimate odds ratios (ORs) of preferring one-on-one care versus self-guided, group, or no preference.

Results:

Data were analyzed for (n = 3,661) employees. The most common treatment modality preference one-on-one care (44.06%, n = 1,613). One quarter of respondents (24.06%, n = 881) expressed a preference for pursuing self-guided care, and 8.03% expressed a preference for group care (n = 294). Odds ratios indicated that individuals aged 45 and older were significantly more likely to express a preference for self-guided care compared to individuals between 18 and 24 (OR = 2.47, 95% CI = 1.70-3.59, p < .001). Individuals screening positive for anxiety (OR = 0.73, 95% CI 0.62-0.86, p < .001) or depression (OR = 0.79, 95% CI = 0.66-0.95, p = .019) were more likely to prefer one-on-one care.

Conclusions:

Our findings elucidated patient preferences for care modality are related to both clinical severity factors as well as demographic variables.