<section id="sec1" style="margin: 0px 0px 8px; padding: 0px;"><p id="p0025" style="color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">There has been rapid growth and diffusion of patient portal access in the United States (U.S.) over the last decade. </span><span style="font-family: Helvetica; font-size: 14px;">. Approximately thirty-two percent (32%) of patients had access to their medical records through online portals in 2018, up from 25.6% in 2014 and 30.5% in 2017</span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">. Patient portals, a type of&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/electronic-patient-record" title="Learn more about personal health record from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">personal health record</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;that is connected to an&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/electronic-health-record" title="Learn more about electronic health record from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">electronic health record</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;system, provide patients with secure access to their clinical data while also facilitating patient-centered care and equitable, effective, and quality&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/delivery-of-health-care" title="Learn more about health care delivery from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">health care delivery</span></a></span></span><span style="font-family: Helvetica; font-size: 14px;">. Features of patient portals include secure messaging, after-visit summaries, medication charts, allergy lists, laboratory results, and appointment scheduling</span><span style="font-family: Helvetica; font-size: 14px;">. Evidence from observational studies and systematic reviews indicate that when used effectively, access to patient portals can be beneficial for improved disease management and outcomes among diverse patient populations</span><span style="font-family: Helvetica; font-size: 14px;">. Despite the identified benefits of online patient portals, access and use of these portals are variable. Although other studies have investigated factors that may explain this variability</span><span style="font-family: Helvetica; font-size: 14px;">, there is a gap in the literature about the trends and distinct patterns of patient portal access and usage in mental health contexts in the U.S.</span></p><p id="p0030" style="color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Mental disorders are one of the highest contributors to the&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/global-disease-burden" title="Learn more about global disease burden from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">global disease burden</span></a><span style="font-family: Helvetica; font-size: 14px;">, accounting for the greatest proportion of years lived with disability</span></span><span style="font-family: Helvetica; font-size: 14px;">. Empirical evidence from prior research on patient portal technology among mental health patients seems promising and suggests a potential for online portals to improve mental healthcare</span><span style="font-family: Helvetica; font-size: 14px;">. For example, in their report, Khan and colleagues observed that sharing clinical notes with mental health patient could be a therapeutic intervention for managing these patients, which in turn demonstrates respect and reduces stigma, empower patients by dismantling power imbalances between the provider and patients, and encourages open and transparent care that helps patients better manage and track their progress</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;Similarly, other researchers have found that access to online medical records for mental health patients aids medication adherence, improves knowledge of why their medication was prescribed, understanding of the importance of their medicine, facilitates remembrance of their care plan, increases awareness of their condition, while also enabling patients to be active participants in their care</span><span style="font-family: Helvetica; font-size: 14px;">. Insights from these studies indicate the potential utility of patient portal access in managing, monitoring, and treating mental health illnesses. Moreover, the utility of patients' access to their online medical records can be attributed to the rapid adoption of technological platforms by health systems, which has become a mainstay in the enhancement of clinical care and workflow</span><span style="font-family: Helvetica; font-size: 14px;">.</span></p><p id="p0035" style="margin-bottom: 16px; padding: 0px;"><span style="color: rgb(46, 46, 46); font-family: Helvetica; font-size: 14px;">Yet, among people living with mental disorders, peculiar barriers limit their ability to access their online medical records. So far, available literature on online portal adoption among mental health populations is currently limited to small sample sizes</span><span style="color: rgb(46, 46, 46); font-family: Helvetica; font-size: 14px;">, and veteran populations</span><span style="color: rgb(46, 46, 46); font-family: Helvetica; font-size: 14px;">, and has not been nationally representative</span><span style="margin: 0px; padding: 0px;"><span style="color: rgb(46, 46, 46); font-family: Helvetica; font-size: 14px;">. Further, although there is evidence suggesting that significant&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/disparity" title="Learn more about disparities from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">disparities</span></a><font color="#2e2e2e" face="Helvetica">, as well as barriers to online portal usage,&nbsp;exist in other patient populations</font></span><span style="color: rgb(46, 46, 46); font-family: Helvetica; font-size: 14px;">, less is known about which subgroups of individuals with mental disorders are more likely to use online portals in accessing their medical data. In some cases, providers may also be reluctant to allow patients with mental health disorders to see aspects of their electronic medical records.</span><span style="color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;Some patients may also lack internet access or the digital literacy to adopt patient portals. This combination of barriers and limited diffusion of patient portal technology may exacerbate treatment barriers. In the face of the rapid transition to online and telehealth-based models of delivery care due to the Covid-19&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/pandemic" title="Learn more about pandemic from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">pandemic</span></a><span style="font-family: Helvetica; font-size: 14px;">, it is important to understand how individuals with common mental disorders are interfacing with their online portals.</span></span></p><p id="p0040" style="color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Therefore, this study aims to add to the extant literature by evaluating the usage patterns, barriers, and factors associated with online portal use among people with depression and anxiety, drawing from a large, nationally representative sample of US adults.</span></p></section><section id="sec2" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><h2 id="sectitle0025" class="u-h3 u-margin-l-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 32px !important; margin-bottom: 8px !important; font-size: 1.2rem !important; line-height: 1.333 !important;"><span style="font-family: Helvetica; font-size: 14px;"><b>Materials and methods</b></span></h2><section id="sec2.1" style="margin: 0px 0px 8px; padding: 0px;"><h3 id="sectitle0030" class="u-h4 u-margin-m-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 24px !important; margin-bottom: 8px !important; font-size: 1rem !important; line-height: 1.4 !important;"><span style="font-family: Helvetica; font-size: 14px;"><b>&nbsp;Data sample</b></span></h3><p id="p0045" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">We analyzed data from the fifth iteration of the National Cancer Institute's Health Information National Trends Survey (HINTS 5). HINTS is a nationally representative survey of the US adult population conducted every 1–3 years since 2003 to collect data related to health information, health behaviors,&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/cancer-risk-factor" title="Learn more about cancer risk factors from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">cancer risk factors</span></a><span style="font-family: Helvetica; font-size: 14px;">, and communication technology</span></span><span style="font-family: Helvetica; font-size: 14px;">. The target sample for the HINTS was non-institutionalized, civilian adults (aged ≥18 years) living in the U.S.</span></p><p id="p0050" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Data used in this study comprised respondents of HINTS 5, Cycle 1 (2017), HINTS 5, Cycle 2 (2018); HINTS 5, Cycle 3 (2019); and HINTS 5, Cycle 4 (2020). Data collection periods data were from January 2017 through May 2017 (HINTS 5, cycle 1), January through May 2018 (HINTS 5, cycle 2), January through April 2019 (HINTS 5, cycle 3), and February through June 2020 (HINTS 5, cycle 4). HINTS 5 cycles 1, 2, and 4 were administered as a single-mode mailed survey. However, HINTS 5 cycle 3 differed from the other iterations by using a mixed-mode—both self-administered mail and web survey to collect participant responses. A total of 13,360, 14,586, 23,430, and 15,347 households received the questionnaires in cycles 1, 2, 3, and 4 respectively, and the response rates were 32.4% for cycle 1, 32.9% for cycle 2, 30.3% for cycle 3, and 36.7% for cycle 4.</span></p><p id="p0055" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">HINTS 5, Cycle 1 comprised of 3285 respondents; HINTS 5, cycle 2, had a total of 3504 respondents; HINTS 5, cycle 3, had a total of 5438 respondents; and HINTS 5, cycle 4, had a total of 3865 respondents. All iterations of the HINTS 5 employed a two-stage, stratified random sampling technique. The&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/stage-1" title="Learn more about first stage from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">first stage</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;involves the selection of non-vacant residential addresses obtained from the Marketing Systems Group (MSG). In the&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/stage-2" title="Learn more about second stage from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">second stage</span></a><span style="font-family: Helvetica; font-size: 14px;">, an adult from each household was selected for participation in the survey using the ‘Next Birthday’ method. For HINTS 5, cycle 1, the database of residential addresses was grouped into three strata including addresses in areas with high concentrations of people from racial or ethnic minority groups; addresses in areas with low concentrations of people from racial or ethnic minority groups; and addresses located in counties comprising Central Appalachia, regardless of racial or ethnic minority status. In HINTS 5, cycles 2, 3, and 4 two strata were used and included (1) addresses in areas with a high concentration of people from racial or ethnic minority groups, and (2) addresses in areas with a low concentration of people from racial or ethnic minority groups.</span></p><p id="p0060" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">For this study, depression and/or anxiety status was determined from responses to the survey item on depression/anxiety diagnosis, which was worded as: “</span><em style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Has a doctor or other health professional ever told you that you had depression or anxiety disorder (yes/no)?”</span></em><span style="font-family: Helvetica; font-size: 14px;">&nbsp;Participants who responded “Yes” were classified as having depression and anxiety.&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">After combining all four HINTS iterations, a total of 3585 participants self-reported a history of depression and/or anxiety disorder. Of these, 391 participants with missing data for portal usage were excluded. Thus, the final eligible sample consisted of 3194 respondents.</span></p></section></section><section id="sec3" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><h2 id="sectitle0035" class="u-h3 u-margin-l-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 32px !important; margin-bottom: 8px !important; font-size: 1.2rem !important; line-height: 1.333 !important;"><span style="font-family: Helvetica; font-size: 14px;"><b>&nbsp;Measures</b></span></h2><section id="sec3.1" style="margin: 0px 0px 8px; padding: 0px;"><h3 id="sectitle0040" class="u-h4 u-margin-m-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 24px !important; margin-bottom: 8px !important; font-size: 1rem !important; line-height: 1.4 !important;"><span style="font-family: Helvetica; font-size: 14px;"><b>&nbsp;Exposure variable</b></span></h3><p id="p0065" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">The main variable of interest was portal use within the past 12 months preceding the survey. This was determined by asking whether participants have accessed patient portals of&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/electronic-health-record" title="Learn more about EHR from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">EHR</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;in the past 12 months. Participants who responded using patient portals one or more times were categorized as portal users and those reporting no use of the portal in the preceding 12 months were characterized as non-users of patient portals.</span></span></p></section><section id="sec3.2" style="margin: 0px 0px 8px; padding: 0px;"><h3 id="sectitle0045" class="u-h4 u-margin-m-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 24px !important; margin-bottom: 8px !important; font-size: 1rem !important; line-height: 1.4 !important;"><span style="font-family: Helvetica; font-size: 14px;"><b>Use of patient portals</b></span></h3><p id="p0070" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">To better understand the patterns and variations in how people with depression and/or anxiety use their medical records (patient portals), which may give us insight into familiarity with different uses of the portal, we evaluated participants' reported uses of their patient portals. Measures indicating reasons for using the patient portals included viewing test results, medication refills, securely messaging health care providers or staff, adding health information such as side effects to share with a provider, downloading health information to a personal device such as a phone, and using the information to decide on treatment. Additionally, participants perceived usefulness of patient portals was ascertained from one survey item asking if they found patient portals useful. Responses to all these questions were (yes vs no), and they were dichotomized.</span></p></section><section id="sec3.3" style="margin: 0px 0px 8px; padding: 0px;"><h3 id="sectitle0050" class="u-h4 u-margin-m-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 24px !important; margin-bottom: 8px !important; font-size: 1rem !important; line-height: 1.4 !important;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;<b>Barriers to portal use</b></span></h3><p id="p0075" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">We also sought to assess the reasons for the non-use of patient portals among individuals with depression and or anxiety who reported not using patient portals in the preceding 12 months. HINTS 5 asked nonusers whether any of seven reasons why they had not accessed an online medical record in the past twelve months: no way to access the website (that is, no internet), not having such a record, preferring to speaking directly to a provider, having concerns about the privacy or security of the website, having difficulty logging into their portals, having limited experience with computers, and having no need to access the record. Participants were allowed to select more than one reason. Each of these reasons was categorized as a binary variable (Yes vs No)</span></p></section><section id="sec3.4" style="margin: 0px 0px 8px; padding: 0px;"><h3 id="sectitle0055" class="u-h4 u-margin-m-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 24px !important; margin-bottom: 8px !important; font-size: 1rem !important; line-height: 1.4 !important;"><span style="font-family: Helvetica; font-size: 14px;"><b>Participant characteristics</b></span></h3><p id="p0080" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Informed by previous studies</span><span style="font-family: Helvetica; font-size: 14px;">, as well as the Andersen Model of health services utilization,</span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;the specific sociodemographic variables and health-related variables included in the present study were age, gender, race, educational level, household income, insurance status, comorbidities, and rural-urban residence. Gender was categorized as male or female. Age was categorized as 18–34&nbsp;​y, 35 to 49&nbsp;​y, 50 to 64&nbsp;​y, and 65&nbsp;​y or older. The race was categorized as white, Black or African American, Hispanic and others. Level of education was categorized as a high school graduate or less, some college, and college graduate or postgraduate. Rural or urban residence was defined using the US Department of Agriculture's (USDA) 2003 Rural-Urban Continuum Codes. Codes 1 to 3 were classified as urban, while codes 4 to 9 were classified as rural. Household annual income was categorized as lowest to low income (less than USD 20,000 to 34,999 USD) and middle to high income (USD 35, 000 to USD 75,000 or more). Respondents were classified as having a comorbidity if they had one or more of the following conditions: diabetes mellitus, hypertension, heart disease, or&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/silo-fillers-disease" title="Learn more about lung disease from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">lung disease</span></a><span style="font-family: Helvetica; font-size: 14px;">.</span></span></p></section></section><section id="sec4" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><h2 id="sectitle0060" class="u-h3 u-margin-l-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 32px !important; margin-bottom: 8px !important; font-size: 1.2rem !important; line-height: 1.333 !important;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;<b>Statistical analysis</b></span></h2><p id="p0085" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Analyses were conducted using the “svy” command in Stata 17.0 statistical software (StataCorp LP, College Station, Texas, USA). Final person weights and jack-knife replicate weights provided within the HINTS 5 dataset were used to provide national estimates representative of the USA population. We first conducted basic descriptive statistics for the entire study sample (those with depression and anxiety) and stratified by portal use. Both unweighted frequencies and weighted percentages were presented. Chi-squared tests were used to estimate the prevalence of portal use after stratifying the study population by key sociodemographic factors and by study year. We used multivariable&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/logistic-regression-analysis" title="Learn more about logistic regression from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">logistic regression</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;adjusting for age, gender, race, educational level, household income, insurance status, comorbidities, rural-urban residence, and study year to examine the factors associated with portal utilization. All tests were two-sided and p values&nbsp;​&lt;&nbsp;​0.05 were considered statistically significant.</span></p><p id="p0085" style="margin-bottom: 16px; padding: 0px;"><img src="/media/django-summernote/2022-11-16/9940671f-61fe-4d16-8cb8-db7b79d9ca2b.png" style="width: 100%;"><span style="font-family: Helvetica; font-size: 14px;"><br></span></p></section>