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Receipt of Video Tablets among Rural Veterans Was Associated with Increased Use of Mental Health Care and Less Suicidal Behavior

In 2016, VA’s Office of Rural Health and Office of Connected Care began distributing video-enabled tablets to Veterans with access barriers to facilitate their participation in home-based telehealth. As of September 1, 2021, there were 106,451 tablets in circulation, with nearly one-third issued to rural Veterans. This retrospective cohort study sought to evaluate the association between the escalated distribution of VA’s video-enabled tablets during the COVID-19 pandemic and rural Veterans’ mental health service use and suicide-related outcomes. Using VA data, investigators identified more than 13,000 Veterans who received tablets between March 16, 2020 and April 30, 2021, and who had >1 VA mental healthcare visit during 2019. Veterans were followed through June 30, 2021 and compared with similar Veterans who never received a tablet. Outcomes included psychotherapy visits, medication management visits, and comprehensive suicide risk evaluations via video, in addition to total visits (phone, video, and in-person). Other outcomes examined included the likelihood of an emergency department (ED) visit, likelihood of a suicide-related ED visit, and the number of suicide behavior and overdose reports (SBORs); covariates included patient demographics and comorbidities.


  • Receipt of a video tablet was associated with the increased use of mental healthcare via video and increased psychotherapy visits across all modalities. Tablets also were associated with an overall 20% reduction in the likelihood of an ED visit, a 36% reduction in the likelihood of a suicide-related ED visit, and a 22% reduction in the likelihood of suicide behavior as indicated by SBORs.


  • VA and other health systems should consider leveraging video-enabled tablets for improving access to mental healthcare via telehealth and for preventing suicides among rural residents.


  • Tablet assignments were non-random, and investigators needed to disentangle COVID-19 pandemic-related associations from tablet-related associations.

This study was partly funded by VA HSR&D’s Quality Enhancement Research Initiative (QUERI). Drs. Gujral and Jacobs are part of VA’s Health Economics Resource Center (HERC); Dr. Gujral also is part of HSR&D’s Center for Innovation to Implementation (Ci2i), along with all of the other authors.

Gujral K, Van Campen J, Jacobs J, Kimerling R, Blonigen D, and Zulman D. Mental Health Service Use, Suicide Behavior, and Emergency Department Visits among Rural US Veterans who Received Video-Enabled Tablets During the COVID-19 Pandemic. JAMA Network Open. April 6, 2022; 5(4):e226250.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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