Provider Mental Health and Telehealth Utilization During COVID-19: A Cross-sectional Survey of Providers at Clinics Treating Urban American Indian and Alaska Native Peoples

OBJECTIVE: The COVID-19 pandemic resulted in substantial changes to clinical work, particularly the rise of telehealth, with indeterminate benefits and challenges for healthcare providers (HCPs). HCPs serving American Indian and Alaska Native (AI/AN) patients may face additional challenges working in the unique healthcare systems designed for these populations. METHODS: Seventy-seven providers working at five healthcare organizations that serve urban AI/AN peoples completed questionnaires between January and May 2021. The questionnaire examined mental health symptoms using the Kessler Psychological Distress Scale 6 (K-6) and assessed self-reported emotional health compared to pre-pandemic levels, and inquired about potential risks of distress including demographics, telehealth use, work hours, and COVID-19 related stressors. We assessed the associations between risk factors and K-6 scores using a series of univariate Ordinary Least Squares regressions. RESULTS: Multiple factors were significantly associated with higher distress, including female sex, level of concern about self and colleagues contracting COVID-19, and number of hours worked per week. AI/AN identity was a protective factor for distress. Telehealth use increased from 37% pre-pandemic to 84% during the pandemic, but providing telehealth was not associated with distress. CONCLUSIONS: Psychological distress among HCPs who work in clinics which primarily treat AI/AN patients from January to May 2021 was linked to heightened occupational demands, collective wellbeing, and demographic factors. Support strategies in AI/AN-serving healthcare institutions should leverage the protective assets of cultural identity and collective resilience.