{
  "abstract": "Objective: This study examined time-to-initial-remission of suicide risk among college students engaging in virtual psychotherapy. Using routine measurement-based care data, survival analytic methods characterized remission across therapy visits and explored whether remission timing differed by gender or race/ethnicity.\n\nMethods: Data were drawn from a retrospective cohort of U.S. college students using a digital mental health platform. Self-harm and suicidal ideation were screened at each visit using item 9 of the Patient Health Questionnaire-9 (PHQ-9). Positive screens were followed by administration of the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess suicide risk comprehensively. Time-to-initial remission was modeled separately for PHQ-9 Item 9 and the C-SSRS, with remission defined as the first transition from endorsement to non-endorsement for each measure. Kaplan-Meier survival curves estimated time-to-initial-remission by visit number, and Cox proportional hazards models examined demographic differences.\n\nResults: A majority of students achieved initial remission in self-harm and suicidal ideation (77.2%) and suicide risk (83.9%). Across both measures, remission most frequently occurred early in care, with 50% of students transitioning to non-endorsement after the first visit. Survival curves showed a steep initial decline followed by a gradual tail, indicating many students experienced rapid resolution of suicide risk while a subset continued to endorse ideation. Exploratory demographic analyses revealed similar remission trajectories across gender and race/ethnicity, although it took non-binary students an average of 0.79 more sessions to reach initial remission of suicide risk.\n\nConclusions: Modeling initial remission as a time-to-event outcome provides a more granular characterization of suicide risk resolution than traditional pre-post approaches and supports the value of routinely collected longitudinal data for informing monitoring expectations and clinical decision-making.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Care Transformation, TimelyCare, Fort Worth, TX, USA",
    "Department of Psychology, American University, Washington, DC, USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Kelly V. Klein",
      "orcid": "0000-0001-5733-7307"
    },
    {
      "affs": [
        0
      ],
      "name": "Alyssa Palko"
    },
    {
      "affs": [
        0
      ],
      "name": "Dorothy M. Loren"
    },
    {
      "affs": [
        0
      ],
      "name": "Nassim Bickham"
    },
    {
      "affs": [
        0
      ],
      "name": "Robert T. Booth"
    },
    {
      "affs": [
        1
      ],
      "name": "Nathaniel R. Herr"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dqfn170dg78yw.bib",
  "cited_by": 0,
  "doi": "10.1177/20552076261490853",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13724956/",
  "id": "dqfn170dg78yw",
  "issns": [
    "2055-2076"
  ],
  "landing_url": "https://doi.org/10.1177/20552076261490853",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research Article"
    ],
    [
      "heading",
      "Patient-Reported Outcome Measures in Mobile Health"
    ],
    [
      "openalex",
      "3203|Suicide and Self-Harm Studies"
    ]
  ],
  "openalex": "W7213543370",
  "pdf_url": null,
  "pmcid": "PMC13724956",
  "pmid": "42973716",
  "published": "2026-09-18",
  "publisher": "SAGE Publications",
  "ris": "https://research.draconitic.com/paper/dqfn170dg78yw.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:23:26Z",
      "native_id": "PMC13724956",
      "source": "pmc",
      "url": "https://doi.org/10.1177/20552076261490853"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:3203|Suicide and Self-Harm Studies",
      "subfield": "psychiatry"
    }
  ],
  "title": "Trajectories of suicide risk in virtual therapy for college students: A retrospective study",
  "title_text": "Trajectories of suicide risk in virtual therapy for college students: A retrospective study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:21:19Z",
  "url": "https://research.draconitic.com/paper/dqfn170dg78yw",
  "venue": "Digital Health",
  "versions": []
}