FORT WORTH, Texas — New peer-reviewed research from TimelyCare offers a rare look at how suicide risk changes from one therapy visit to the next among college students receiving virtual mental health care.

Published in DIGITAL HEALTH, the study, “Trajectories of suicide risk in virtual therapy for college students: A retrospective study,” analyzed 5,289 college students who entered virtual therapy reporting self-harm or suicidal ideation.

Researchers found that 77.2% of students achieved initial remission of self-harm and suicidal ideation during the observed course of care. Among students whose more comprehensive assessment indicated suicide risk, 83.9% achieved initial remission of that risk.

Improvement often appeared early. Across both measures, half of students who reached initial remission transitioned from endorsement to non-endorsement between their first and second visits. At the same time, a smaller group continued to experience suicidal ideation or suicide risk across multiple visits, highlighting the importance of continued monitoring.

“Getting a student connected to care is critically important, but access is only the beginning,” said Nassim Bickham, study co-author and VP of Care Transformation at TimelyCare. “We also need to know whether students are improving and recognize when they may need additional support. This research gives us a much clearer picture of how suicide risk changes during care.”

Unlike studies that compare symptoms only before and after treatment, researchers examined repeated clinical assessments to understand when initial improvement occurred. The approach reflects TimelyCare’s use of measurement-based care, in which standardized assessments help clinicians monitor changes and inform clinical decisions throughout treatment.

The findings also reinforce an important distinction: early improvement does not mean suicide risk has permanently resolved. Suicidal thoughts and behaviors can fluctuate or recur, and the researchers emphasize the importance of continued reassessment even after a student initially improves.

“There is no single path for a student experiencing suicide risk,” said Bob Booth, MD, study co-author and Chief Care Officer at TimelyCare. “Many students showed improvement early, while others needed more time. Clinically accountable care means being able to see those differences, guiding students to the right path and responding to what each student needs.”

Researchers found largely similar remission patterns across racial and ethnic groups and most gender groups. Non-binary students took slightly longer on average to reach initial remission of suicide risk, a finding the authors say warrants additional research.

The retrospective study used deidentified electronic health record data collected from June 2023 through September 2025 from students attending a broad range of U.S. colleges and universities. Because the study was observational, the researchers caution that it describes how suicide risk changed during virtual therapy but does not establish that therapy alone caused the improvement.

The research was conducted by Kelly V. Klein of American University and TimelyCare, Alyssa Palko, Dorothy M. Loren, Nassim Bickham and Robert T. Booth of TimelyCare, along with Nathaniel R. Herr of American University.

Read the study in DIGITAL HEALTH.