Mental Health Virtual Care Associated with Lower Risk for Suicide-Related Events

Increased use of virtual mental health services is associated with a significant reduction in suicide-related events (SREs) among veterans, according to study results published in JAMA Network Open.

Researchers conducted a cohort study that utilized observational data from the Veterans Health Administration (VHA) and employed a quasi-experimental instrumental variable (IV) probit model to analyze the relationship between virtual mental health care utilization and SREs. They aimed to determine whether the transition from face-to-face to virtual mental health service delivery is linked to the risk of individual-level SREs among veterans, particularly in the context of increased telehealth utilization during the COVID-19 pandemic.

The study focused on recently discharged or released from active duty with behavioral health diagnoses, examining their mental health visits from March 1, 2020, for up to 13 months post-separation.

Among 6,387 observations representing 16,236 unique veterans (mean [SD] age 32.9 (8.9); 32.6% women, 67.4% men), 1.4% of individual-month observations included an SRE. Of these veterans, 26.0% were Black, 50.5% White, 3.4% Asian, and 14.5% Hispanic. Rural veterans comprised 19.0% of observations, and 66.4% of enrollees had comprehensive health insurance. The researchers noted a mean (SD) of 2.2 (2.8) health visits per month, with 44.6% (46.1%) conducted virtually. The mean (SD) driving distance to the nearest VHA primary care facility was 12.7 (10.8) miles.

The researchers found that an increase in virtual mental health visits was significantly associated with a reduction in SREs (coefficient −0.0032, SE 0.0003; P<.001), with a 1% increase in virtual visits linked to a 0.4% decrease in SREs. The IV probit analysis confirmed this result, showing a stronger effect (coefficient −0.0161, SE 0.0049; P=.001), indicating a 1% increase in virtual visits led to a 2.5% decrease in SREs.

Sensitivity analyses reinforced these findings, demonstrating consistent results even after adjusting for a 1-month lead time for SRE outcomes (coefficient −0.0179, SE 0.0044; P<.001) and excluding early pandemic data (coefficient −0.0178, SE 0.0054; P=.001), yielding elasticities of −3.2 and −3.4, respectively. These results suggest that increased use of virtual mental health care correlates with reduced SREs in the veteran population.

Study limitations include that the zip codes sourced from the data may not be precise or may represent addresses where the veterans no longer live, the findings may not be generalizable, and unmeasured confounders may influence broadband access and the outcome of SREs.

Study authors concluded, “This national cohort study using a retrospective quasi-experimental design found that increased use of virtual mental health services at the VHA was associated with a significant reduction in SREs among veterans.”

This article originally appeared on Psychiatry Advisor