Trajectories of suicide risk in virtual therapy for college students: A retrospective study
- 1Department of Care Transformation, TimelyCare, Fort Worth, TX, USA
- 2Department of Psychology, American University, Washington, DC, USA
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.
Methods: 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.
Results: 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.
Conclusions: 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.
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BibTeX
@article{klein2026trajectories,
title = {{Trajectories of suicide risk in virtual therapy for college students: A retrospective study}},
author = {Kelly V. Klein and Alyssa Palko and Dorothy M. Loren and Nassim Bickham and Robert T. Booth and Nathaniel R. Herr},
journal = {Digital Health},
year = {2026},
month = sep,
doi = {10.1177/20552076261490853},
url = {https://doi.org/10.1177/20552076261490853},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Trajectories of suicide risk in virtual therapy for college students: A retrospective study
AU - Kelly V. Klein
AU - Alyssa Palko
AU - Dorothy M. Loren
AU - Nassim Bickham
AU - Robert T. Booth
AU - Nathaniel R. Herr
PY - 2026
DA - 2026/09/18
JO - Digital Health
DO - 10.1177/20552076261490853
UR - https://doi.org/10.1177/20552076261490853
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2055-2076
ER -