Virtual Mental Health Visits Linked to Lower Suicide-Related Events

Greater use of virtual mental health care services was linked to a lower risk of suicide-related events, according to a retrospective cohort study.

The study of more than 16,000 veterans with prior mental health diagnoses showed that a 1% increase in the proportion of mental health care received through telehealth services was associated with a 2.5% decrease in suicide-related events, Kertu Tenso, PhD, of Boston University School of Public Health, and co-authors reported in JAMA Network Open.

“An increase in virtual mental health visits relative to total visits was associated with a decrease in suicide-related events among recently separated Veterans,” Tenso told MedPage Today in an email.

“Virtual mental health services may be protective in terms of suicide-related outcomes,” she added. “However, this may not be the case for all patients, as some may still prefer traditional in-person mental health care, and thus it is important to keep offering both care options.”

Tenso said the mechanisms behind the reduction “could be related to the increased access through reduced travel time and costs. Another explanation could be linked to alleviating the discomfort and stigma that is sometimes associated with in-person care.”

In an invited commentary, Jean Yoon, PhD, MHS, of the VA Palo Alto Health Care, wrote that virtual care offers greater access to mental health services for veterans transitioning into civilian life, as their leading cause of death is suicide.

“These findings highlight the potential for telehealth to improve access to mental health care and health outcomes among veterans at risk of suicide or other adverse outcomes,” Yoon wrote.

He noted, however, that the study’s focus on the quantity of care provided through telehealth service does leave questions about its overall benefits and risks.

For their study, the authors identified a nationally representative sample of Veterans Health Administration patients who received mental health care between March 1, 2020, and December 31, 2021. All participants were recently separated veterans who completed active duty between March 1, 2019, and December 31, 2020, and who received at least 2 diagnoses related to major depressive disorder, substance use disorder, or posttraumatic stress disorder in the year before their separation date.

The researchers used a quasi-experimental instrumental variable probit model to conduct the study. The variable they chose was the percentage of the population in a county with broadband access, which they defined as access to 3 or more internet providers offering speeds of 100 megabits per second or higher.

In total, they analyzed 66,387 data points from 16,236 veterans, who had a mean age of 32.9 years. Just more than half of participants were white (50.5%), 26% were Black, and 16.4% had an unknown ethnicity. Among the observations, 67.4% were male veterans, and there were 929 suicide-related events.

The authors also noted that virtual visits represented a mean of 44.6% of all mental health visits in the data sample, and there was a mean of 2.2 visits per month, which included virtual, phone, and in-person visits.

The study had several limitations. First, about 7% of the data sample for veterans relied on zip code data for locations, which may not be precise or may represent addresses where the veterans no longer live, such as their parents’ homes. The authors also noted that the findings may not be generalizable to non-veteran populations, and there is still the possibility that unmeasured confounders could have influenced broadband access or outcome of suicide-related events.