Knipe Duleeka, de Ossorno Garcia Santiago, Salhi Louisa, Afzal Nimrah, Sammut Samaryah, Mainstone-Cotton Lily, Sefi Aaron, Marchant Amanda, John Ann
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Kooth Plc.
PLoS One. 2025 Feb 13;20(2):e0316468. doi: 10.1371/journal.pone.0316468. eCollection 2025.
The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. The aim of this study was to assess whether service access and presenting concerns differed before and during the pandemic. Sociodemographic characteristics (gender, ethnicity, and deprivation level) were examined to identify disparities in service use. To do this we utilised routinely collected service data from a text-based online mental health service for children and young people. A total of 61221 service users consented to sharing their data which represented half of the service population. We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020) and whether this varied by sociodemographic characteristics. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black/African/Caribbean/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%), sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources changed at the start. Findings on access and service activity align with other studies observing reduced service utilization. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.
在新冠疫情期间，数字健康技术的采用加速，但由于数字排斥问题，人们对服务获取的公平性表示担忧。本研究的目的是评估疫情之前和期间服务获取情况以及所呈现的担忧是否存在差异。研究考察了社会人口学特征（性别、种族和贫困水平），以确定服务使用方面的差异。为此，我们利用了从一个针对儿童和青少年的基于文本的在线心理健康服务中定期收集的服务数据。共有61221名服务用户同意分享他们的数据，这占服务人群的一半。我们使用中断时间序列模型来评估与疫情前趋势（2019年6月至2020年3月）相比，在新冠疫情期间（2020年4月至2021年4月）服务使用的水平和速率是否发生了变化，以及这是否因社会人口学特征而异。大多数用户为女性（74%）和白人（80%），年龄在13至20岁之间。有证据表明，疫情开始时服务获取量突然增加（13%）（相对风险1.13，95%置信区间1.02，1.25），随后与疫情前趋势相比，疫情期间的参与率有所下降（从25%降至21%）（相对风险0.97，95%置信区间0.95，0.98）。除身体不适外，几乎所有呈现的问题都突然增加。有证据表明，黑人/非裔/加勒比裔/英国黑人（增加38%；95%置信区间：1%-90%）和白人种族群体（增加14%；95%置信区间：2%-27%）的联系人数有逐步增加，在疫情开始时，最贫困地区（增加58%；95%置信区间：1%-247%）和最不贫困地区（增加47%；95%置信区间：6%-204%）的服务使用量突然增加。在疫情期间，联系率下降，且一开始转诊来源发生了变化。关于服务获取和服务活动的研究结果与其他观察到服务利用率下降的研究一致。封锁期间贫困水平和种族方面缺乏差异，这表明需要探索获取匿名服务的公平性。该研究为英国新冠疫情期间数字心理健康使用的变化提供了独特见解。
