Date of Submission

2025

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

Department Chair

Stephanie Felgoise, PhD, ABPP

First Advisor

Elizabeth Gosch, PhD, ABPP

Second Advisor

Stephanie Felgoise, PhD, ABPP

Third Advisor

Courtney Wolk, PhD

Abstract

The purpose of this study was to identify the predisposing, need, and enabling factors that predict mental health services use before and during COVID-19 in an integrated primary care network in the Philadelphia metropolitan area. This retrospective observational study examined a sample of primary care patients from January 2018 to February 2020 (i.e., pre-COVID-19) and March 2020 to December 2022 (i.e., peri- COVID-19) using electronic health record data. Mental health services use was defined as the number of appointments attended by patients. A hierarchical regression was conducted to identify predictors of mental health services use by sequentially adding sociodemographic predisposing factors, clinical need factors, and service-level enabling factors. In the pre-COVID-19 sample (N = 1070), only Asian race and non-Hispanic White race were significant predictors but only explained 6% of the variance in mental health services use, F(9, 1060) = 7.27, p < .001, R2 = .06). In the peri-Covid-19 sample (N = 2723), the final model incorporating enabling factors while controlling for predisposing and need factors accounted for an additional 1% in the variance of mental health services use, F(3, 2706) = 4.32, p = .005, R2 = .06. Findings suggest that financial status, age, Asian race, non-Hispanic White race, other race excluding non-Hispanic Black race, and depression symptoms were significantly associated with increased mental health services use during COVID-19. Thus, disparities based on race and financial status may have increased during COVID-19.

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