Health Services/Policy
Telehealth, assets, and completion of mental health services after suicidal behavior: an analysis using electronic health records Catherine K. Ettman* Catherine Ettman Catherine K. Ettman Grace V. Ringlein Kyungeun Jeon Priya Dohlman Jason Straub Sazal Sthapit Peter P. Zandi Elizabeth A. Stuart
It is unknown how telehealth contributes to mental health services use following suicidal behavior and whether utilization differs across socioeconomic status. Using electronic health records from a cohort of patients with depression in a large urban health system, we assessed patterns in mental health services use after hospital-documented suicidal behavior defined by ICD-10 code for suicidal attempt, self-harm, or ideation (N=687 patients with 7,710 individual telehealth-eligible outpatient psychiatry appointments) from January 1, 2021 – June 30, 2024. First, we estimated whether telehealth was associated with appointment completion (versus no-show or same-day cancellation) in the 6 months following suicidal behavior using generalized estimating equation logistic regression, accounting for multiple appointments per patient, and adjusting for demographic characteristics and comorbidities. Then, we tested for heterogeneity by area financial assets (area deprivation) and social assets (marital status and employment) by adding interactions with telehealth to the models. We found that telehealth appointments had higher odds of completion than in-person appointments (aOR=1.52, 95%CI=1.28-1.80). While we found higher odds of completion of appointments of patients from low deprivation areas (high socioeconomic status) relative to high deprivation areas (aOR=1.62, 1.18-2.26) and married relative to unmarried patients (aOR=1.38, 1.03-1.86), with no significant differences by employment status, we did not find evidence of heterogeneity of the association between telehealth and appointment completion by area deprivation, employment status, or marital status. Telehealth appointments had higher completion than in-person appointments in the 6 months after suicidal behavior. The appointments of patients living in lower deprivation areas and who were married were also more likely to be completed.