Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts.
JAMA Netw Open. 2024 Nov 4;7(11):e2443054. doi: 10.1001/jamanetworkopen.2024.43054.
The rising suicide rates in the US emphasize the need for effective prevention. While telehealth has transformed access to mental health care, the impact of telehealth on suicide outcomes is unknown.
To evaluate the association of virtual mental health services with individual-level suicide-related events (SREs).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study using broadband access as an instrumental variable assessed a national sample of Veterans Health Administration patients who received mental health care between March 1, 2020, and December 31, 2021. Participants were recently separated (ie, discharged or released from active duty) veterans who completed their active duty service between March 1, 2019, and December 31, 2020, and who received at least 2 outpatient or inpatient diagnoses related to major depressive disorder, substance use disorder, or posttraumatic stress disorder within the year before their most recent separation date. Data were analyzed May 1 to October 31, 2023.
Percentage of a patient's total mental health visits that were conducted virtually by psychiatrists, psychologists, or social workers within a calendar month.
Binary measure indicating whether the patient had experienced an SRE (defined as a nonfatal suicide attempt, intentional self-harm, or suicide death) in a specific month and year as evaluated an instrumental variable probit model.
The sample included 66 387 data points from 16 236 unique recently separated veterans. Among these entries, 44 766 were for male veterans (67.4%), the mean (SD) age across the sample was 32.9 (8.9) years, and the sample was representative of the US veteran population. There were 929 SREs (1.4%). Virtual mental health visits comprised a mean (SD) of 44.6% (46.1%) of all mental health visits. In instrumental variable probit analyses accounting for factors simultaneously associated with use of virtual mental health care and SRE risk, a 1% increase in the probability of virtual mental health visits was associated with a 2.5% decrease in SREs.
Findings from this cohort study using a retrospective quasi-experimental design found that an increase in virtual mental health visits relative to total visits was associated with a statistically significant decrease in SREs, suggesting that providing virtual mental health services may reduce suicide-related outcomes.
美国自杀率的上升强调了有效预防的必要性。虽然远程医疗已经改变了获得心理健康护理的途径，但远程医疗对自杀结果的影响尚不清楚。
评估虚拟心理健康服务与个体层面自杀相关事件（SREs）之间的关联。
设计、设置和参与者：本回顾性队列研究使用宽带接入作为工具变量，评估了 2020 年 3 月 1 日至 2021 年 12 月 31 日期间接受美国退伍军人事务部心理健康护理的全国性退伍军人样本。参与者为最近退伍（即出院或退役）的退伍军人，他们在 2019 年 3 月 1 日至 2020 年 12 月 31 日期间完成现役，并且在最近退伍日期前的一年内至少接受过 2 次与重度抑郁症、物质使用障碍或创伤后应激障碍相关的门诊或住院诊断。数据于 2023 年 5 月 1 日至 10 月 31 日进行分析。
在一个日历月内，患者接受精神科医生、心理学家或社会工作者虚拟心理治疗的总就诊次数的百分比。
二元指标，表示在特定月份和年份内患者是否经历过 SRE（定义为非致命性自杀企图、故意自残或自杀死亡），评估使用工具变量概率模型。
该样本包括 16236 名最近退伍的退伍军人中的 66387 个数据点。在这些记录中，44766 人是男性退伍军人（67.4%），样本中平均（标准差）年龄为 32.9（8.9）岁，且样本具有代表性退伍军人人口。有 929 例 SRE（1.4%）。虚拟心理健康访问占所有心理健康访问的平均（SD）比例为 44.6%（46.1%）。在同时考虑虚拟心理健康护理使用和 SRE 风险相关因素的工具变量概率分析中，虚拟心理健康护理就诊概率增加 1%与 SRE 减少 2.5%相关。
本使用回顾性准实验设计的队列研究结果表明，相对于总就诊次数，虚拟心理健康就诊次数的增加与 SRE 显著减少相关，这表明提供虚拟心理健康服务可能会降低与自杀相关的结果。
