Introduction
Early COVID-19 pandemic-era studies documented rapid adoption of telemental health, but current utilization patterns and disparities, particularly among children and young adults, remain poorly characterized since the COVID-19 Public Health Emergency ended in May 2023. The objective of this work was to characterize current utilization of virtual versus in-person outpatient mental health care in a large national cohort of commercially insured children and adults and to assess variation by patient, provider, clinical, and geographic characteristics.
Methods
In this retrospective cohort study, we analyzed 28,844,298 outpatient mental health visits delivered to 1,843,439 commercially insured patients aged 6–64 years between January 2023 and December 2025. The primary outcome was the percentage of visits delivered virtually, compared across age, gender, provider type, diagnosis, state, urbanicity, and social vulnerability index.
Results
Overall, 77.6% of visits were delivered virtually, declining from 79.7% (2023) to 76.2% (2025). Children aged 6–12 years had substantially lower telehealth utilization than young adults aged 18–24 years (37.1% vs. 77.0%, p < 0.001), a disparity more pronounced for psychotherapy than psychiatry. Virtual care was highest for attention-deficit/hyperactivity disorder, anxiety, and depressive disorders, and higher among prescribers than psychotherapists (90.4% vs. 75.7%). Rural patients used virtual care less than urban patients (70.3% vs. 77.5%), whereas utilization was higher among patients in areas of greater social vulnerability.
Conclusions
In this large national cohort, virtual mental health care remained widely used but unevenly distributed. Persistent disparities by age, geography, clinical need, and social vulnerability highlight the need for hybrid care models and policies addressing digital access barriers.
