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The Association Between COVID-fear with Psychological Distress and Substance Use: the Moderating Effect of Treatment Engagement

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Abstract

The purpose of this brief report was to examine the association between COVID-fear with psychiatric symptoms severity and substance use risk in an outpatient population with co-occurring substance use and mental health disorders and whether these associations were moderated by treatment engagement, especially after providers had shifted from an in-person care model to a telehealth format. A total of 136 patients receiving outpatient treatment for comorbid substance use and mental health disorders completed self-report questionnaires on their psychiatric symptoms, substance use, and treatment engagement (i.e., frequency, length, and helpfulness of phone and video sessions with a mental health counselor, psychiatrist, or primary care provider) in the past month between November 2020 and March 2021. Results showed that COVID-fear was significantly associated with psychiatric symptom severity, but not substance use risk. Additionally, perceived helpfulness of phone counseling sessions moderated the associations between COVID-fear and global psychiatric symptom severity, such that COVID-fear and global psychiatric symptom severity were positively associated when perceived helpfulness was low, and not associated if perceived helpfulness was high. The present results highlight the importance of directly addressing fears specific to a national emergency, as well as for providers to build strong rapport with their clients.

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Authors and Affiliations

  1. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Isabella J. Kneeland BA

  2. Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, 33604, USA

    Judith N. Biesen PhD

  3. Department of Psychiatry and Behavioral Science, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Brandi C. Fink PhD

  4. Private Practice, Albuquerque, NM, USA

    Lori A. Keeling PhD

  5. Addictions and Substance Abuse Program, University of New Mexico Hospitals, Albuquerque, NM, USA

    Larissa Lindsey PhD

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The authors have no conflicts or competing interests to declare. This research was supported in part by a grant from the University of New Mexico Substance Use Disorders Grand Challenge and the National Center for Advancing Translational Sciences, National Institutes of Health under grant number ULITR001449.

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Kneeland, I.J., Biesen, J.N., Fink, B.C. et al. The Association Between COVID-fear with Psychological Distress and Substance Use: the Moderating Effect of Treatment Engagement. J Behav Health Serv Res 52, 231–248 (2025). https://doi.org/10.1007/s11414-024-09905-3

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