Determinants of Patient Use of Telemental Health Services: Representative Cross-Sectional Survey From Germany.

Background: Telemental health services effectively address major challenges in mental health care delivery. To maximize the potential of the services, it is essential to facilitate patient use and reduce use disparities. Nevertheless, determinants of patient use of telemental health services have been scarcely investigated thus far.

Objective: We aimed to identify determinants of patient use of telemental health services since the onset of the COVID-19 pandemic and in the last 4 weeks.

Methods: In December 2023, we conducted a cross-sectional, quota-based (gender and age group) online survey. The sample comprised individuals aged 18 to 74 years, who had been using mental health services since March 2020 (n=2082). Telemental health service use was assessed using items that inquired whether individuals had used the services since March 2020 or currently (in the last 4 weeks). Logistic regressions were computed to test the associations of socioeconomic, access, health, COVID-19-related, psychosocial, and service factors, as well as personality and provider characteristics with patient use.

Results: Younger age, a more positive patient attitude toward telemental health services, a more positive provider attitude toward using the services, and higher provider skills for using the services were positively associated with patient use of telemental health services since the onset of the COVID-19 pandemic. When exclusively looking at current use, positive associations with full-time employment, lower neuroticism, a more positive provider attitude toward the services, and use of the services to avoid stigmatization, long waiting times, or inconvenient scheduling were observed. Access, health, and COVID-19-related factors were not associated with patient use (since the onset of the COVID-19 pandemic and currently).

Conclusions: Beyond socioeconomic factors, personality, and a positive patient attitude toward the services, patient use of telemental health services was associated with a positive provider attitude toward using the services and higher provider skills for using the services, which underscores the need for provider support and training in telemental health care. Furthermore, avoiding stigmatization and higher convenience of the services were associated with patient use, which highlights the substantial potential of the services to address current mental health care challenges.