MENTAL HEALTH DISPARITIES IN U.S. MILITARY ADOLESCENTS AND TELEHEALTH DISPARITIES IN MEDICAID: A MULTI-METHOD STUDY USING QUALITATIVE AND QUANTITATIVE RESEARCH METHODS

This manuscript style dissertation presents three studies highlighting significant challenges in mental health treatment and differences within, and between, civilian and military households. The included studies focus on mental health (MH) factors and the role disparities play in both civilian and military settings. Starting within Medicaid where one would traditionally expect to see health disparities, the first study examines MH and substance use as two areas of substantial inequity and the impact of recent telehealth expansion as a result of the COVID19 pandemic on a civilian focused population. Continuing into a cross examination of differences between military and civilian adolescents, study two looks at select MH conditions utilizing a national survey. The third study expands on the second, examining the role of stigma and the military environment on several MH conditions in a military-only population. The first and third study also examine modalities and access to care, while the second examines differences in receipt of care.The purpose of the first study was to understand how expanded access to telehealth has affected equitable care and uncover policy gaps. Semi-structured interviews were conducted to explore variations in telehealth access and implementation through three levels of care: patients, providers, and insurers. When asked about advantages,100% of participants expressed positives towards telehealth implementation, with 67% of patients expressing a preference for telehealth versus in-person care. Equity of accessibility, adaptability, and increased service availability to patients emerged as a key theme. The second study examined the prevalence and factors associated with suicidal behavior in adolescents in both military and civilian populations. This study utilized a robust analysis of differences between these two populations using a nationally representative sample which is the first of its kind. Compared to civilian adolescents, having a military parent was associated with 22% higher odds of being treated for active suicidal ideation (SI), suicidal planning (SP), or suicidal attempts (SA), 20% higher odds of self-reported active SI/SP/SA (not tied to help seeking), and 13% higher odds of self-reported passive suicidal thoughts. Military affiliated adolescents (MAAs) had significantly higher prevalences of most MH variables, with almost twice as many MAAs requiring inpatient services for emotional problems, higher overall MH service utilization, and higher levels of major depressive episodes than civilians. Finally, the third study examined the factors uniquely impacting mental health in MAAs, how military cultural norms may impact MH help seeking behaviors, and explored barriers and facilitators to care. Semi-structured interviews were conducted from both adolescents and their parents, combined with a pre-interview survey to thoroughly examine the MH burden in MAAs. History of MH included anxiety and fear (100%), depression (100%), self-harm and/or suicidal behaviors (73%), and aggression (67%), with participants attributing the majority of these issues to the military environment. The majority of participants reported stronger MH stigma in the military environment, with fear that MH care would impact the active-duty member's career, fervent minimization of MH concerns, and added gender role pressures reported. Our findings suggest that a more focused approach towards addressing MH concerns in both civilian and military families is warranted, and we suggest several implications for policy makers to address the critical unmet MH needs of these minority populations.

Author

• Edmonson, Kezia

• health disparities
• medicaid
• mental health
• military affiliated adolescents
• qualitative
• suicidal behaviors

Identifier

hdl:1920/14499

OAI identifier oai:identifier

oai:MARS:1920/14499