{"id":"https://openalex.org/W7213543370","doi":"https://doi.org/10.1177/20552076261490853","title":"Trajectories of suicide risk in virtual therapy for college students: A retrospective study","display_name":"Trajectories of suicide risk in virtual therapy for college students: A retrospective study","publication_year":2026,"publication_date":"2026-02-01","ids":{"openalex":"https://openalex.org/W7213543370","doi":"https://doi.org/10.1177/20552076261490853","pmid":"https://pubmed.ncbi.nlm.nih.gov/42973716","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13724956"},"language":"en","primary_location":{"id":"doi:10.1177/20552076261490853","doi":"https://doi.org/10.1177/20552076261490853","is_oa":true,"landing_page_url":"https://doi.org/10.1177/20552076261490853","pdf_url":null,"source":{"id":"https://openalex.org/S4210188408","display_name":"Digital Health","issn_l":"2055-2076","issn":["2055-2076"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"DIGITAL HEALTH","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1177/20552076261490853","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5119926740","display_name":"Kelly V. Klein","orcid":"https://orcid.org/0000-0001-5733-7307","observed_orcids":["https://orcid.org/0000-0001-5733-7307"]},"institutions":[{"id":"https://openalex.org/I181401687","display_name":"American University","ror":"https://ror.org/052w4zt36","country_code":"US","type":"education","lineage":["https://openalex.org/I181401687"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Kelly V. Klein","raw_affiliation_strings":["American University","Department of Care Transformation, TimelyCare"],"raw_orcid":"https://orcid.org/0000-0001-5733-7307","affiliations":[{"raw_affiliation_string":"American University","institution_ids":["https://openalex.org/I181401687"]},{"raw_affiliation_string":"Department of Care Transformation, TimelyCare","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5119926739","display_name":"Alyssa Palko","orcid":"https://orcid.org/0009-0003-9331-4446","observed_orcids":["https://orcid.org/0009-0003-9331-4446"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Alyssa Palko","raw_affiliation_strings":["Department of Care Transformation, TimelyCare"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Care Transformation, TimelyCare","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5056966152","display_name":"Dorothy McLeod Loren","orcid":"https://orcid.org/0000-0002-1068-9337","observed_orcids":["https://orcid.org/0000-0002-1068-9337"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Dorothy M. Loren","raw_affiliation_strings":["Department of Care Transformation, TimelyCare"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Care Transformation, TimelyCare","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5094160943","display_name":"Nassim Bickham","orcid":"https://orcid.org/0009-0007-0393-1643","observed_orcids":["https://orcid.org/0009-0007-0393-1643"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Nassim Bickham","raw_affiliation_strings":["Department of Care Transformation, TimelyCare"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Care Transformation, TimelyCare","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5114007136","display_name":"Robert T. Booth","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Robert T. Booth","raw_affiliation_strings":["Department of Care Transformation, TimelyCare"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Care Transformation, TimelyCare","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5066012005","display_name":"Nathaniel R. Herr","orcid":"https://orcid.org/0000-0002-4449-057X","observed_orcids":["https://orcid.org/0000-0002-4449-057X"]},"institutions":[{"id":"https://openalex.org/I181401687","display_name":"American University","ror":"https://ror.org/052w4zt36","country_code":"US","type":"education","lineage":["https://openalex.org/I181401687"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Nathaniel R. Herr","raw_affiliation_strings":["American University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"American University","institution_ids":["https://openalex.org/I181401687"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":2000,"currency":"USD","value_usd":2000},"apc_paid":{"value":2000,"currency":"USD","value_usd":2000},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.66746401,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"12","issue":null,"first_page":"20552076261490853","last_page":"20552076261490853"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10376","display_name":"Suicide and Self-Harm Studies","score":0.9872999787330627,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10376","display_name":"Suicide and Self-Harm Studies","score":0.9872999787330627,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11519","display_name":"Digital Mental Health Interventions","score":0.008100000210106373,"subfield":{"id":"https://openalex.org/subfields/3202","display_name":"Applied Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10214","display_name":"Psychotherapy Techniques and Applications","score":0.0005000000237487257,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/suicide-risk","display_name":"suicide risk","score":0.9660000205039978},{"id":"https://openalex.org/keywords/internet-based-therapy","display_name":"online therapy","score":0.777999997138977},{"id":"https://openalex.org/keywords/college-students","display_name":"university students","score":0.9789999723434448},{"id":"https://openalex.org/keywords/time-to-remission","display_name":"time to remission","score":0.777999997138977},{"id":"https://openalex.org/keywords/suicidal-ideation","display_name":"suicidal ideation","score":0.8889999985694885},{"id":"https://openalex.org/keywords/self-harm","display_name":"self-harm","score":0.9980000257492065},{"id":"https://openalex.org/keywords/digital-mental-health-platforms","display_name":"digital mental health platforms","score":0.8180000185966492},{"id":"https://openalex.org/keywords/non-binary-students","display_name":"non-binary students","score":0.7160000205039978},{"id":"https://openalex.org/keywords/gender-differences","display_name":"gender differences","score":0.9010000228881836},{"id":"https://openalex.org/keywords/racial-and-ethnic-differences","display_name":"racial and ethnic differences","score":0.8140000104904175}],"concepts":[{"id":"https://openalex.org/C2776641880","wikidata":"https://www.wikidata.org/wiki/Q944142","display_name":"Suicidal ideation","level":4,"score":0.6703000068664551},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.6365000009536743},{"id":"https://openalex.org/C2780842732","wikidata":"https://www.wikidata.org/wiki/Q3518184","display_name":"Suicide attempt","level":4,"score":0.4927999973297119},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4916999936103821},{"id":"https://openalex.org/C526869908","wikidata":"https://www.wikidata.org/wiki/Q3298118","display_name":"Suicide prevention","level":3,"score":0.49050000309944153},{"id":"https://openalex.org/C134362201","wikidata":"https://www.wikidata.org/wiki/Q317309","display_name":"Mental health","level":2,"score":0.4562999904155731},{"id":"https://openalex.org/C3017944768","wikidata":"https://www.wikidata.org/wiki/Q1450463","display_name":"Poison control","level":2,"score":0.45179998874664307},{"id":"https://openalex.org/C83849319","wikidata":"https://www.wikidata.org/wiki/Q7295720","display_name":"Rating scale","level":2,"score":0.4472000002861023},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.445499986410141},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.4397999942302704},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.43650001287460327},{"id":"https://openalex.org/C187155963","wikidata":"https://www.wikidata.org/wiki/Q629029","display_name":"Occupational safety and health","level":2,"score":0.392300009727478},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.3873000144958496},{"id":"https://openalex.org/C190385971","wikidata":"https://www.wikidata.org/wiki/Q373494","display_name":"Injury prevention","level":3,"score":0.38530001044273376},{"id":"https://openalex.org/C70410870","wikidata":"https://www.wikidata.org/wiki/Q199906","display_name":"Clinical psychology","level":1,"score":0.38089999556541443},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.3682999908924103},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.367000013589859},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.3492000102996826},{"id":"https://openalex.org/C166735990","wikidata":"https://www.wikidata.org/wiki/Q1750812","display_name":"Human factors and ergonomics","level":3,"score":0.3393999934196472},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.305400013923645},{"id":"https://openalex.org/C2779508988","wikidata":"https://www.wikidata.org/wiki/Q24037396","display_name":"Suicide Risk","level":4,"score":0.2989000082015991},{"id":"https://openalex.org/C10515644","wikidata":"https://www.wikidata.org/wiki/Q543310","display_name":"Survival analysis","level":2,"score":0.2890999913215637},{"id":"https://openalex.org/C82789193","wikidata":"https://www.wikidata.org/wiki/Q2142611","display_name":"Relative risk","level":3,"score":0.28870001435279846},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.251800000667572}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1177/20552076261490853","doi":"https://doi.org/10.1177/20552076261490853","is_oa":true,"landing_page_url":"https://doi.org/10.1177/20552076261490853","pdf_url":null,"source":{"id":"https://openalex.org/S4210188408","display_name":"Digital Health","issn_l":"2055-2076","issn":["2055-2076"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"DIGITAL HEALTH","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13724956","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13724956/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13724956/pdf/10.1177_20552076261490853.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Digit Health","raw_type":"Text"},{"id":"pmid:42973716","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42973716","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Digital health","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:a569eab0c2764ad69aae026854ceff41","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/a569eab0c2764ad69aae026854ceff41","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Digital Health, Vol 12 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1177/20552076261490853","doi":"https://doi.org/10.1177/20552076261490853","is_oa":true,"landing_page_url":"https://doi.org/10.1177/20552076261490853","pdf_url":null,"source":{"id":"https://openalex.org/S4210188408","display_name":"Digital Health","issn_l":"2055-2076","issn":["2055-2076"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1","poland-20","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320017","host_organization_name":"SAGE Publishing","host_organization_lineage":["https://openalex.org/P4310320017"],"host_organization_lineage_names":["SAGE Publishing"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"DIGITAL HEALTH","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7213543370.pdf","grobid_xml":"https://content.openalex.org/works/W7213543370.grobid-xml"},"referenced_works_count":34,"referenced_works":["https://openalex.org/W1587682423","https://openalex.org/W1893670457","https://openalex.org/W1982698797","https://openalex.org/W1996007928","https://openalex.org/W2008423289","https://openalex.org/W2024498794","https://openalex.org/W2029273432","https://openalex.org/W2045745149","https://openalex.org/W2074615854","https://openalex.org/W2118343190","https://openalex.org/W2132322340","https://openalex.org/W2148083007","https://openalex.org/W2161785057","https://openalex.org/W2162943997","https://openalex.org/W2239385095","https://openalex.org/W2503814187","https://openalex.org/W2508555717","https://openalex.org/W2790134514","https://openalex.org/W2891801059","https://openalex.org/W2899520395","https://openalex.org/W2904026243","https://openalex.org/W2950229699","https://openalex.org/W2965749712","https://openalex.org/W3001183894","https://openalex.org/W3013038708","https://openalex.org/W3041047318","https://openalex.org/W3092451239","https://openalex.org/W3094769430","https://openalex.org/W3134375062","https://openalex.org/W3147894994","https://openalex.org/W4220856280","https://openalex.org/W4311673264","https://openalex.org/W4413050326","https://openalex.org/W4415009084"],"related_works":["https://openalex.org/W2579908244","https://openalex.org/W4366140319","https://openalex.org/W7125781615","https://openalex.org/W6901781023","https://openalex.org/W4386911050","https://openalex.org/W1072135128","https://openalex.org/W4405610399","https://openalex.org/W4387439131","https://openalex.org/W3153563209","https://openalex.org/W4415009084"],"abstract_inverted_index":{"Objective:":[0],"This":[1],"study":[2],"examined":[3,131],"time-to-initial-remission":[4,122],"of":[5,46,68,80,137,164,191,219,227,243,255],"suicide":[6,89,149,192,228,244],"risk":[7,90,150,193,245],"among":[8],"college":[9,48],"students":[10,49,138,165,187,216],"engaging":[11],"in":[12,142,160],"virtual":[13],"psychotherapy.":[14],"Using":[15],"routine":[16],"measurement-based":[17],"care":[18],"data,":[19],"survival":[20,119],"analytic":[21],"methods":[22],"characterized":[23],"remission":[24,31,93,105,141,155,206,226,233],"across":[25,208],"therapy":[26],"visits":[27],"and":[28,57,101,126,144,148,210,251,264],"explored":[29],"whether":[30],"timing":[32],"differed":[33],"by":[34,78,123,181],"gender":[35,209],"or":[36],"race/ethnicity.":[37],"Methods:":[38],"Data":[39],"were":[40,60,76],"drawn":[41],"from":[42,111],"a":[43,51,176,182,195,235,239],"retrospective":[44],"cohort":[45],"U.S.":[47],"using":[50,65],"digital":[52],"mental":[53],"health":[54],"platform.":[55],"Self-harm":[56],"suicidal":[58,145],"ideation":[59,146],"screened":[61],"at":[62],"each":[63,116],"visit":[64,124],"item":[66],"9":[67,100],"the":[69,81,102,108,170,253],"Patient":[70],"Health":[71],"Questionnaire-9":[72],"(PHQ-9).":[73],"Positive":[74],"screens":[75],"followed":[77,180],"administration":[79],"Columbia-Suicide":[82],"Severity":[83],"Rating":[84],"Scale":[85],"(C-SSRS)":[86],"to":[87,113,167,198,223],"assess":[88],"comprehensively.":[91],"Time-to-initial":[92],"was":[94],"modeled":[95],"separately":[96],"for":[97,115,260],"PHQ-9":[98],"Item":[99],"C-SSRS,":[103],"with":[104,162],"defined":[106],"as":[107,234],"first":[109,171],"transition":[110],"endorsement":[112],"non-endorsement":[114,168],"measure.":[117],"Kaplan-Meier":[118],"curves":[120,174],"estimated":[121],"number,":[125],"Cox":[127],"proportional":[128],"hazards":[129],"models":[130],"demographic":[132,202],"differences.":[133],"Results:":[134],"A":[135],"majority":[136],"achieved":[139],"initial":[140,178,225,232],"self-harm":[143],"(77.2%)":[147],"(83.9%).":[151],"Across":[152],"both":[153],"measures,":[154],"most":[156],"frequently":[157],"occurred":[158],"early":[159],"care,":[161],"50%":[163],"transitioning":[166],"after":[169],"visit.":[172],"Survival":[173],"showed":[175],"steep":[177],"decline":[179],"gradual":[183],"tail,":[184],"indicating":[185],"many":[186],"experienced":[188],"rapid":[189],"resolution":[190,246],"while":[194],"subset":[196],"continued":[197],"endorse":[199],"ideation.":[200],"Exploratory":[201],"analyses":[203],"revealed":[204],"similar":[205],"trajectories":[207],"race/ethnicity,":[211],"although":[212],"it":[213],"took":[214],"non-binary":[215],"an":[217],"average":[218],"0.79":[220],"more":[221,240],"sessions":[222],"reach":[224],"risk.":[229],"Conclusions:":[230],"Modeling":[231],"time-to-event":[236],"outcome":[237],"provides":[238],"granular":[241],"characterization":[242],"than":[247],"traditional":[248],"pre-post":[249],"approaches":[250],"supports":[252],"value":[254],"routinely":[256],"collected":[257],"longitudinal":[258],"data":[259],"informing":[261],"monitoring":[262],"expectations":[263],"clinical":[265],"decision-making.":[266]},"counts_by_year":[],"updated_date":"2026-11-06T12:05:46.655746","created_date":"2026-09-18T00:00:00"}