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Trauma, Military Fitness, and Eating Disorders
Military culture may hold 2 salient risk factors for eating disorders: exposure to trauma and body condition standards. A recent study from the US Department of Veteran Affairs (VA) Salisbury Health Care System (VASHCS) found that veterans with posttraumatic stress disorder (PTSD) are more likely to report eating disturbances—particularly issues related to body dissatisfaction and dissatisfaction with eating habits. A 2019 study found that one-third of veterans who were overweight or obese screened positive for engaging in “making weight” behaviors during military service, or unhealthy weight control strategies. Frequently reported weight management behavior was excessive exercise, fasting/skipping meals, sitting in a sauna/wearing a latex suit, laxatives, diuretics, and vomiting.
Service members who are “normal” weight by civilian standards may be labeled “overweight” by the military. In a March 12 memo, Secretary of Defense Pete Hegseth ordered a US Department of Defense review of existing standards for physical fitness, body composition, and grooming. “Our troops will be fit — not fat. Our troops will look sharp — not sloppy. We seek only quality — not quotas. BOTTOM LINE: our @DeptofDefense will make standards HIGH & GREAT again — across the entire force,” he posted on X.
The desire to control weight to fit military standards, however, isn’t the only risk factor. Researchers at VASHCS surveyed 527 post-9/11 veterans (80.7% male) who typically deployed 1 or 2 times. All participants completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; the Neuro-Quality of Life in Neurological Disorders Positive Affect and Well-Being Scale (PAWB); and the Eating Disturbances Scale.
Nearly half (46%) of the sample met diagnostic criteria for a lifetime PTSD diagnosis. The study also reported significantly greater eating disturbances in veterans with a lifetime PTSD diagnosis than those without. Women reported significantly greater eating disturbances than men.
Most participants (80%) reported some level of dissatisfaction with their eating disturbances and 74% of participants reported feeling as if they were too fat.
Eating disturbances include refusing food, overexercising, overeating, and misusing laxatives or diuretic pills. Previous research that suggest that 10% to 15% of female veterans and 4% to 8% of male veterans report clinically significant disordered eating behaviors, especially binge eating. One study found that 78% of 45,477 overweight or obese veterans receiving care in VA facilities reported clinically significant binge eating. In a 2021 study, 254 veterans presenting for routine clinical care completed self‐report questionnaires assessing eating disorders, PTSD, depression, and shame, and 31% met probable criteria for bulimia nervosa, binge‐eating disorder, or purging disorder.
According to a 2023 study, eating disturbances that do not meet diagnostic criteria for a formal disorder can be problematic and may function as coping strategies for some facets of military life. The VASHCS researchers found that interventions focused on PAWB, such as acceptance and commitment therapy or compassion-focused therapy, may have potential as a protective factor. Including components that foster hope, optimism, and personal strength may positively mitigate the relationship between PTSD and eating disturbances. PAWB was significantly correlated with eating disturbances; individuals with a lifetime PTSD diagnosis reported significantly lower PAWB than those without.
Interventions grounded in positive psychology have shown promise. A group-based program found “noticeable” (although nonsignificant) improvements in optimistic thinking and treatment engagement. The study also cites that clinicians are beginning to incorporate positive psychology strategies (eg, gratitude journaling, goal setting, and “best possible self” visualization) as adjuncts to traditional treatments. Positive psychology, they write, holds “significant promise as a complementary approach to enhance recovery outcomes in both PTSD and eating disorders.”
Military culture may hold 2 salient risk factors for eating disorders: exposure to trauma and body condition standards. A recent study from the US Department of Veteran Affairs (VA) Salisbury Health Care System (VASHCS) found that veterans with posttraumatic stress disorder (PTSD) are more likely to report eating disturbances—particularly issues related to body dissatisfaction and dissatisfaction with eating habits. A 2019 study found that one-third of veterans who were overweight or obese screened positive for engaging in “making weight” behaviors during military service, or unhealthy weight control strategies. Frequently reported weight management behavior was excessive exercise, fasting/skipping meals, sitting in a sauna/wearing a latex suit, laxatives, diuretics, and vomiting.
Service members who are “normal” weight by civilian standards may be labeled “overweight” by the military. In a March 12 memo, Secretary of Defense Pete Hegseth ordered a US Department of Defense review of existing standards for physical fitness, body composition, and grooming. “Our troops will be fit — not fat. Our troops will look sharp — not sloppy. We seek only quality — not quotas. BOTTOM LINE: our @DeptofDefense will make standards HIGH & GREAT again — across the entire force,” he posted on X.
The desire to control weight to fit military standards, however, isn’t the only risk factor. Researchers at VASHCS surveyed 527 post-9/11 veterans (80.7% male) who typically deployed 1 or 2 times. All participants completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; the Neuro-Quality of Life in Neurological Disorders Positive Affect and Well-Being Scale (PAWB); and the Eating Disturbances Scale.
Nearly half (46%) of the sample met diagnostic criteria for a lifetime PTSD diagnosis. The study also reported significantly greater eating disturbances in veterans with a lifetime PTSD diagnosis than those without. Women reported significantly greater eating disturbances than men.
Most participants (80%) reported some level of dissatisfaction with their eating disturbances and 74% of participants reported feeling as if they were too fat.
Eating disturbances include refusing food, overexercising, overeating, and misusing laxatives or diuretic pills. Previous research that suggest that 10% to 15% of female veterans and 4% to 8% of male veterans report clinically significant disordered eating behaviors, especially binge eating. One study found that 78% of 45,477 overweight or obese veterans receiving care in VA facilities reported clinically significant binge eating. In a 2021 study, 254 veterans presenting for routine clinical care completed self‐report questionnaires assessing eating disorders, PTSD, depression, and shame, and 31% met probable criteria for bulimia nervosa, binge‐eating disorder, or purging disorder.
According to a 2023 study, eating disturbances that do not meet diagnostic criteria for a formal disorder can be problematic and may function as coping strategies for some facets of military life. The VASHCS researchers found that interventions focused on PAWB, such as acceptance and commitment therapy or compassion-focused therapy, may have potential as a protective factor. Including components that foster hope, optimism, and personal strength may positively mitigate the relationship between PTSD and eating disturbances. PAWB was significantly correlated with eating disturbances; individuals with a lifetime PTSD diagnosis reported significantly lower PAWB than those without.
Interventions grounded in positive psychology have shown promise. A group-based program found “noticeable” (although nonsignificant) improvements in optimistic thinking and treatment engagement. The study also cites that clinicians are beginning to incorporate positive psychology strategies (eg, gratitude journaling, goal setting, and “best possible self” visualization) as adjuncts to traditional treatments. Positive psychology, they write, holds “significant promise as a complementary approach to enhance recovery outcomes in both PTSD and eating disorders.”
Military culture may hold 2 salient risk factors for eating disorders: exposure to trauma and body condition standards. A recent study from the US Department of Veteran Affairs (VA) Salisbury Health Care System (VASHCS) found that veterans with posttraumatic stress disorder (PTSD) are more likely to report eating disturbances—particularly issues related to body dissatisfaction and dissatisfaction with eating habits. A 2019 study found that one-third of veterans who were overweight or obese screened positive for engaging in “making weight” behaviors during military service, or unhealthy weight control strategies. Frequently reported weight management behavior was excessive exercise, fasting/skipping meals, sitting in a sauna/wearing a latex suit, laxatives, diuretics, and vomiting.
Service members who are “normal” weight by civilian standards may be labeled “overweight” by the military. In a March 12 memo, Secretary of Defense Pete Hegseth ordered a US Department of Defense review of existing standards for physical fitness, body composition, and grooming. “Our troops will be fit — not fat. Our troops will look sharp — not sloppy. We seek only quality — not quotas. BOTTOM LINE: our @DeptofDefense will make standards HIGH & GREAT again — across the entire force,” he posted on X.
The desire to control weight to fit military standards, however, isn’t the only risk factor. Researchers at VASHCS surveyed 527 post-9/11 veterans (80.7% male) who typically deployed 1 or 2 times. All participants completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; the Neuro-Quality of Life in Neurological Disorders Positive Affect and Well-Being Scale (PAWB); and the Eating Disturbances Scale.
Nearly half (46%) of the sample met diagnostic criteria for a lifetime PTSD diagnosis. The study also reported significantly greater eating disturbances in veterans with a lifetime PTSD diagnosis than those without. Women reported significantly greater eating disturbances than men.
Most participants (80%) reported some level of dissatisfaction with their eating disturbances and 74% of participants reported feeling as if they were too fat.
Eating disturbances include refusing food, overexercising, overeating, and misusing laxatives or diuretic pills. Previous research that suggest that 10% to 15% of female veterans and 4% to 8% of male veterans report clinically significant disordered eating behaviors, especially binge eating. One study found that 78% of 45,477 overweight or obese veterans receiving care in VA facilities reported clinically significant binge eating. In a 2021 study, 254 veterans presenting for routine clinical care completed self‐report questionnaires assessing eating disorders, PTSD, depression, and shame, and 31% met probable criteria for bulimia nervosa, binge‐eating disorder, or purging disorder.
According to a 2023 study, eating disturbances that do not meet diagnostic criteria for a formal disorder can be problematic and may function as coping strategies for some facets of military life. The VASHCS researchers found that interventions focused on PAWB, such as acceptance and commitment therapy or compassion-focused therapy, may have potential as a protective factor. Including components that foster hope, optimism, and personal strength may positively mitigate the relationship between PTSD and eating disturbances. PAWB was significantly correlated with eating disturbances; individuals with a lifetime PTSD diagnosis reported significantly lower PAWB than those without.
Interventions grounded in positive psychology have shown promise. A group-based program found “noticeable” (although nonsignificant) improvements in optimistic thinking and treatment engagement. The study also cites that clinicians are beginning to incorporate positive psychology strategies (eg, gratitude journaling, goal setting, and “best possible self” visualization) as adjuncts to traditional treatments. Positive psychology, they write, holds “significant promise as a complementary approach to enhance recovery outcomes in both PTSD and eating disorders.”
'Distress is the Norm': How Oncologists Can Open the Door to Patient Mental Health
'Distress is the Norm': How Oncologists Can Open the Door to Patient Mental Health
For patients with cancer, the determining factor in whether they pursue mental health services is often whether their oncologist explicitly says it is a good idea, a psychologist said during the July Association of VA Hematology and Oncology (AVAHO) seminar in Long Beach, California, on treating veterans with renal cell carcinoma (RCC).
Kysa Christie, PhD, of the West Los Angeles Veterans Affairs Medical Center, presented findings from a 2018 study in which researchers asked Swiss patients with cancer whether their oncologist discussed their emotional health with them.
In terms of boosting intake, it did not matter if oncologists acknowledged distress or pointed out that psychosocial services existed. Instead, a direct recommendation made a difference, increasing the likelihood of using the services over a 4-month period after initial assessment (odds ratio, 6.27).
“What it took was, ‘I really recommend this. This is something that I would want you to try,’” Christie said.
Oncologists are crucial links between patients and mental health services, Christie said: “If people don’t ask about [distress], you’re not going to see it, but it’s there. Distress is the norm, right? It is not a weakness. It is something that we expect to see.”
Christie noted that an estimated 20% of cancer patients have major depressive disorder, and 35% to 40% have a diagnosable psychiatric condition. RCC shows disproportionately high rates of mental strain. According to Christie, research suggests that about three-fourths of the population report elevated levels of distress as evidenced by patients who scored ≥ 5 on the NCCN Distress Thermometer. Patients with cancer have an estimated 20% higher risk of suicide, especially during the first 12 months after diagnosis and at end of life, she added.
“Early during a diagnosis phase, where you’re having a lot of tests being done, you know something is happening. But you don’t know what,” Christie said. “It could be very serious. That’s just a lot of stress to hold and not know how to plan for.”
After diagnosis, routine could set in and lower distress, she said. Then terminal illness may spike it back up again. Does mental health treatment work in patients with cancer?
“There’s a really strong body of evidence-based treatments for depression, anxiety, adjustment disorders, and coping with different cancers,” Christie said. But it is a step too far to expect patients to ask for help while they are juggling appointments, tests, infusions, and more. “It’s a big ask, right? It’s setting people up for failure.”
To help, Christie said she is embedded with a medical oncology team and routinely talks with the staff about which patients may need help. “One thing I like to do is try to have brief visits with veterans and introduce myself when they come to clinic. I treat it like an opt-out rather than an opt-in program: I’ll just pop into the exam room. They don’t have to ask to see me.”
Christie focuses on open-ended questions and talks about resources ranging from support groups and brief appointments to extensive individual therapy.
Another approach is a strategy known as the “warm handoff,” when an oncologist directly introduces a patient to a mental health professional. “It’s a transfer of care in front of the veteran: It’s much more time-efficient than putting in a referral.”
Christie explained how this can work. A clinician will ask her to meet with a patient during an appointment, perhaps in a couple minutes.
“Then I pop into the room, and the oncologist says, ‘Thanks for joining us. This is Mr. Jones. He has been experiencing feelings of anxiety and sadness, and we’d appreciate your help in exploring some options that might help.’ I turn to the patient and ask, ‘What more would you add?’ Then I either take Mr. Jones back to my office or stay in clinic, and we’re off to the races.”
Christie reported no disclosures.
For patients with cancer, the determining factor in whether they pursue mental health services is often whether their oncologist explicitly says it is a good idea, a psychologist said during the July Association of VA Hematology and Oncology (AVAHO) seminar in Long Beach, California, on treating veterans with renal cell carcinoma (RCC).
Kysa Christie, PhD, of the West Los Angeles Veterans Affairs Medical Center, presented findings from a 2018 study in which researchers asked Swiss patients with cancer whether their oncologist discussed their emotional health with them.
In terms of boosting intake, it did not matter if oncologists acknowledged distress or pointed out that psychosocial services existed. Instead, a direct recommendation made a difference, increasing the likelihood of using the services over a 4-month period after initial assessment (odds ratio, 6.27).
“What it took was, ‘I really recommend this. This is something that I would want you to try,’” Christie said.
Oncologists are crucial links between patients and mental health services, Christie said: “If people don’t ask about [distress], you’re not going to see it, but it’s there. Distress is the norm, right? It is not a weakness. It is something that we expect to see.”
Christie noted that an estimated 20% of cancer patients have major depressive disorder, and 35% to 40% have a diagnosable psychiatric condition. RCC shows disproportionately high rates of mental strain. According to Christie, research suggests that about three-fourths of the population report elevated levels of distress as evidenced by patients who scored ≥ 5 on the NCCN Distress Thermometer. Patients with cancer have an estimated 20% higher risk of suicide, especially during the first 12 months after diagnosis and at end of life, she added.
“Early during a diagnosis phase, where you’re having a lot of tests being done, you know something is happening. But you don’t know what,” Christie said. “It could be very serious. That’s just a lot of stress to hold and not know how to plan for.”
After diagnosis, routine could set in and lower distress, she said. Then terminal illness may spike it back up again. Does mental health treatment work in patients with cancer?
“There’s a really strong body of evidence-based treatments for depression, anxiety, adjustment disorders, and coping with different cancers,” Christie said. But it is a step too far to expect patients to ask for help while they are juggling appointments, tests, infusions, and more. “It’s a big ask, right? It’s setting people up for failure.”
To help, Christie said she is embedded with a medical oncology team and routinely talks with the staff about which patients may need help. “One thing I like to do is try to have brief visits with veterans and introduce myself when they come to clinic. I treat it like an opt-out rather than an opt-in program: I’ll just pop into the exam room. They don’t have to ask to see me.”
Christie focuses on open-ended questions and talks about resources ranging from support groups and brief appointments to extensive individual therapy.
Another approach is a strategy known as the “warm handoff,” when an oncologist directly introduces a patient to a mental health professional. “It’s a transfer of care in front of the veteran: It’s much more time-efficient than putting in a referral.”
Christie explained how this can work. A clinician will ask her to meet with a patient during an appointment, perhaps in a couple minutes.
“Then I pop into the room, and the oncologist says, ‘Thanks for joining us. This is Mr. Jones. He has been experiencing feelings of anxiety and sadness, and we’d appreciate your help in exploring some options that might help.’ I turn to the patient and ask, ‘What more would you add?’ Then I either take Mr. Jones back to my office or stay in clinic, and we’re off to the races.”
Christie reported no disclosures.
For patients with cancer, the determining factor in whether they pursue mental health services is often whether their oncologist explicitly says it is a good idea, a psychologist said during the July Association of VA Hematology and Oncology (AVAHO) seminar in Long Beach, California, on treating veterans with renal cell carcinoma (RCC).
Kysa Christie, PhD, of the West Los Angeles Veterans Affairs Medical Center, presented findings from a 2018 study in which researchers asked Swiss patients with cancer whether their oncologist discussed their emotional health with them.
In terms of boosting intake, it did not matter if oncologists acknowledged distress or pointed out that psychosocial services existed. Instead, a direct recommendation made a difference, increasing the likelihood of using the services over a 4-month period after initial assessment (odds ratio, 6.27).
“What it took was, ‘I really recommend this. This is something that I would want you to try,’” Christie said.
Oncologists are crucial links between patients and mental health services, Christie said: “If people don’t ask about [distress], you’re not going to see it, but it’s there. Distress is the norm, right? It is not a weakness. It is something that we expect to see.”
Christie noted that an estimated 20% of cancer patients have major depressive disorder, and 35% to 40% have a diagnosable psychiatric condition. RCC shows disproportionately high rates of mental strain. According to Christie, research suggests that about three-fourths of the population report elevated levels of distress as evidenced by patients who scored ≥ 5 on the NCCN Distress Thermometer. Patients with cancer have an estimated 20% higher risk of suicide, especially during the first 12 months after diagnosis and at end of life, she added.
“Early during a diagnosis phase, where you’re having a lot of tests being done, you know something is happening. But you don’t know what,” Christie said. “It could be very serious. That’s just a lot of stress to hold and not know how to plan for.”
After diagnosis, routine could set in and lower distress, she said. Then terminal illness may spike it back up again. Does mental health treatment work in patients with cancer?
“There’s a really strong body of evidence-based treatments for depression, anxiety, adjustment disorders, and coping with different cancers,” Christie said. But it is a step too far to expect patients to ask for help while they are juggling appointments, tests, infusions, and more. “It’s a big ask, right? It’s setting people up for failure.”
To help, Christie said she is embedded with a medical oncology team and routinely talks with the staff about which patients may need help. “One thing I like to do is try to have brief visits with veterans and introduce myself when they come to clinic. I treat it like an opt-out rather than an opt-in program: I’ll just pop into the exam room. They don’t have to ask to see me.”
Christie focuses on open-ended questions and talks about resources ranging from support groups and brief appointments to extensive individual therapy.
Another approach is a strategy known as the “warm handoff,” when an oncologist directly introduces a patient to a mental health professional. “It’s a transfer of care in front of the veteran: It’s much more time-efficient than putting in a referral.”
Christie explained how this can work. A clinician will ask her to meet with a patient during an appointment, perhaps in a couple minutes.
“Then I pop into the room, and the oncologist says, ‘Thanks for joining us. This is Mr. Jones. He has been experiencing feelings of anxiety and sadness, and we’d appreciate your help in exploring some options that might help.’ I turn to the patient and ask, ‘What more would you add?’ Then I either take Mr. Jones back to my office or stay in clinic, and we’re off to the races.”
Christie reported no disclosures.
'Distress is the Norm': How Oncologists Can Open the Door to Patient Mental Health
'Distress is the Norm': How Oncologists Can Open the Door to Patient Mental Health
Is High Quality VA Psychiatric Care Keeping Readmissions Rates Low?
Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results
The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.
Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.
“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.
“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”
IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.
Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention.
Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.
“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.
“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”
Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results
The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.
Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.
“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.
“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”
IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.
Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention.
Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.
“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.
“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”
Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results
The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.
Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.
“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.
“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”
IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.
Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention.
Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.
“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.
“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”
As Federal Cuts Deepen Mental Health Crisis, Philanthropy Scrambles to Fill the Gap
As Federal Cuts Deepen Mental Health Crisis, Philanthropy Scrambles to Fill the Gap
It's hardly news that the United States is experiencing a mental health crisis -- the CDC says as much. But experts in the field say that the current administration has severely compounded the problem by eliminating agency funding and national programs, slashing research grants and data resources, and creating new barriers to behavioral health care.
Philanthropic foundations aim to do what they can to address the shortfall. The numbers, however, just don't add up.
"Some big foundations and philanthropies have said they're going to increase what they give out in the next 4 years, but they'll never be able to fill the gap," said Morgan F. McDonald, MD, national director of population health at the Milbank Memorial Fund in New York City, which works with states on health policy. "Even if every one of them were to spend down their endowments, they still couldn't."
Given the financial limitations, some foundations are taking a different tack. While looking for ways to join forces with fellow nonprofits, they are providing emergency grants to bridge funding in the short term to keep research from grinding to a halt.
Budget Cuts Reach Far and Wide
Mental health research certainly didn't escape the extensive grant cancellations at the National Institutes of Health and the National Science Foundation.
"It's already affecting our ability to stay on the cutting edge of research, best practices, and treatment approaches," said Zainab Okolo, EdD, senior vice president of policy, advocacy, and government relations at The Jed Foundation in New York City, which focuses on the emotional health of teens and young adults.
The upheaval is evident in an array of government agencies. The Health Resources and Services Administration, which last year awarded $12 billion in grants to community health centers and addiction treatment services, has seen > one-fourth of its staff eliminated. The Substance Abuse and Mental Health Services Administration has lost more than a third of its staff as federal cuts took a $1 billion bite out of its operating budget. The Education Department has halted $1 billion in grants used to hire mental health workers in school districts nationwide.
"We're very, very concerned about cuts to behavioral health systems," said Alonzo Plough, PhD, chief science officer at the Robert Wood Johnson Foundation in Princeton, New Jersey. "Doctors and nurses working in safety-net clinics are seeing tremendous reductions."
All in all, the new tax and spending law means $1 trillion in cuts to health care programs including Medicaid -- the nation's largest payer for mental health services -- Medicare, and Affordable Care Act insurance. An estimated 10 million Americans are expected to lose their health coverage as a result.
"When accessibility to care goes down, there's a chance that more people will die by suicide," said Jill Harkavy-Friedman, PhD, senior vice president of research at the American Foundation for Suicide Prevention. "But it also means people will come into care later in the course of their difficulties. Health professionals will be dealing with worse problems."
Foundations Take Emergency Measures
Even if private dollars can't replace what's been lost, philanthropic and medical foundations are stepping up.
We're seeing a lot of foundations and funders that are shifting their funding," said Alyson Niemann, CEO of Mindful Philanthropy, an organization that works with > 1000 private funders to marshal resources for mental health. This year, in response to federal cuts, "many increased funding to health and well-being, doubling or even tripling it," Niemann noted.
"They're making a great deal of effort to respond with emergency funds, really getting in the trenches and being good partners to their grantees," she said. "We've seen them asking deliberate questions, thinking about where their funding can have the most impact."
The American Psychological Foundation (APF), a longtime supporter of research and innovation, is addressing the current crisis with 2 initiatives, Michelle Quist Ryder, PhD, the organization's CEO, explained in an email. The first is APF Director Action, which funds innovative interventions at the community level. The second, Direct Action Crisis Funding Grants, will help continue research that is at risk of stalling because of budget cuts.
"Studies that are 'paused' or lose funding often cannot simply pick back up where they left off. Having to halt progress on a project can invalidate the work already completed," Ryder wrote. "These Direct Action Crisis Grants help bridge funding gaps and keep research viable."
At the same time, collaboration between foundations is becoming more widespread as they seek to maximize their impact. Philanthropic organizations are sharing ideas and best practices as well as pooling fundings.
"The goal of philanthropy is to help people," Harkavy-Friedman said. "There's strength in numbers and more dollars in numbers."
Some See Hope in Raised Voices
Despite the emergency scrambling, many of those in the trenches remain surprisingly optimistic. Some point out that the current turmoil has put a helpful spotlight on behavioral health care. Practitioners, meanwhile, have an essential role to play.
"There's a reason that things were the way they were: People advocated for many years to get where we've gotten," Harkavy-Friedman said, citing veterans' mental health care, the national violent death reporting system, and 988 as examples. "We have to raise our voices louder -- professionals in particular, because they know the impact a person in the general public many not fully grasp."
As a growing numbers of health professionals call attention to the damage wrought by deep cuts in the federal budget, foundation executives see an opportunity.
"In the mental health field, there's a deficit in the narrative, where there's a lot of focus on crisis. What we're hoping to do is shift the narrative toward 'How do we flourish together?'" Niemann said. "Sometimes deficits are where the most incredible innovations appear."
Debbie Koenig is a health writer whose work has been published by WebMD, The New York Times, and The Washington Post.
A version of this article first appeared on Medscape.com.
It's hardly news that the United States is experiencing a mental health crisis -- the CDC says as much. But experts in the field say that the current administration has severely compounded the problem by eliminating agency funding and national programs, slashing research grants and data resources, and creating new barriers to behavioral health care.
Philanthropic foundations aim to do what they can to address the shortfall. The numbers, however, just don't add up.
"Some big foundations and philanthropies have said they're going to increase what they give out in the next 4 years, but they'll never be able to fill the gap," said Morgan F. McDonald, MD, national director of population health at the Milbank Memorial Fund in New York City, which works with states on health policy. "Even if every one of them were to spend down their endowments, they still couldn't."
Given the financial limitations, some foundations are taking a different tack. While looking for ways to join forces with fellow nonprofits, they are providing emergency grants to bridge funding in the short term to keep research from grinding to a halt.
Budget Cuts Reach Far and Wide
Mental health research certainly didn't escape the extensive grant cancellations at the National Institutes of Health and the National Science Foundation.
"It's already affecting our ability to stay on the cutting edge of research, best practices, and treatment approaches," said Zainab Okolo, EdD, senior vice president of policy, advocacy, and government relations at The Jed Foundation in New York City, which focuses on the emotional health of teens and young adults.
The upheaval is evident in an array of government agencies. The Health Resources and Services Administration, which last year awarded $12 billion in grants to community health centers and addiction treatment services, has seen > one-fourth of its staff eliminated. The Substance Abuse and Mental Health Services Administration has lost more than a third of its staff as federal cuts took a $1 billion bite out of its operating budget. The Education Department has halted $1 billion in grants used to hire mental health workers in school districts nationwide.
"We're very, very concerned about cuts to behavioral health systems," said Alonzo Plough, PhD, chief science officer at the Robert Wood Johnson Foundation in Princeton, New Jersey. "Doctors and nurses working in safety-net clinics are seeing tremendous reductions."
All in all, the new tax and spending law means $1 trillion in cuts to health care programs including Medicaid -- the nation's largest payer for mental health services -- Medicare, and Affordable Care Act insurance. An estimated 10 million Americans are expected to lose their health coverage as a result.
"When accessibility to care goes down, there's a chance that more people will die by suicide," said Jill Harkavy-Friedman, PhD, senior vice president of research at the American Foundation for Suicide Prevention. "But it also means people will come into care later in the course of their difficulties. Health professionals will be dealing with worse problems."
Foundations Take Emergency Measures
Even if private dollars can't replace what's been lost, philanthropic and medical foundations are stepping up.
We're seeing a lot of foundations and funders that are shifting their funding," said Alyson Niemann, CEO of Mindful Philanthropy, an organization that works with > 1000 private funders to marshal resources for mental health. This year, in response to federal cuts, "many increased funding to health and well-being, doubling or even tripling it," Niemann noted.
"They're making a great deal of effort to respond with emergency funds, really getting in the trenches and being good partners to their grantees," she said. "We've seen them asking deliberate questions, thinking about where their funding can have the most impact."
The American Psychological Foundation (APF), a longtime supporter of research and innovation, is addressing the current crisis with 2 initiatives, Michelle Quist Ryder, PhD, the organization's CEO, explained in an email. The first is APF Director Action, which funds innovative interventions at the community level. The second, Direct Action Crisis Funding Grants, will help continue research that is at risk of stalling because of budget cuts.
"Studies that are 'paused' or lose funding often cannot simply pick back up where they left off. Having to halt progress on a project can invalidate the work already completed," Ryder wrote. "These Direct Action Crisis Grants help bridge funding gaps and keep research viable."
At the same time, collaboration between foundations is becoming more widespread as they seek to maximize their impact. Philanthropic organizations are sharing ideas and best practices as well as pooling fundings.
"The goal of philanthropy is to help people," Harkavy-Friedman said. "There's strength in numbers and more dollars in numbers."
Some See Hope in Raised Voices
Despite the emergency scrambling, many of those in the trenches remain surprisingly optimistic. Some point out that the current turmoil has put a helpful spotlight on behavioral health care. Practitioners, meanwhile, have an essential role to play.
"There's a reason that things were the way they were: People advocated for many years to get where we've gotten," Harkavy-Friedman said, citing veterans' mental health care, the national violent death reporting system, and 988 as examples. "We have to raise our voices louder -- professionals in particular, because they know the impact a person in the general public many not fully grasp."
As a growing numbers of health professionals call attention to the damage wrought by deep cuts in the federal budget, foundation executives see an opportunity.
"In the mental health field, there's a deficit in the narrative, where there's a lot of focus on crisis. What we're hoping to do is shift the narrative toward 'How do we flourish together?'" Niemann said. "Sometimes deficits are where the most incredible innovations appear."
Debbie Koenig is a health writer whose work has been published by WebMD, The New York Times, and The Washington Post.
A version of this article first appeared on Medscape.com.
It's hardly news that the United States is experiencing a mental health crisis -- the CDC says as much. But experts in the field say that the current administration has severely compounded the problem by eliminating agency funding and national programs, slashing research grants and data resources, and creating new barriers to behavioral health care.
Philanthropic foundations aim to do what they can to address the shortfall. The numbers, however, just don't add up.
"Some big foundations and philanthropies have said they're going to increase what they give out in the next 4 years, but they'll never be able to fill the gap," said Morgan F. McDonald, MD, national director of population health at the Milbank Memorial Fund in New York City, which works with states on health policy. "Even if every one of them were to spend down their endowments, they still couldn't."
Given the financial limitations, some foundations are taking a different tack. While looking for ways to join forces with fellow nonprofits, they are providing emergency grants to bridge funding in the short term to keep research from grinding to a halt.
Budget Cuts Reach Far and Wide
Mental health research certainly didn't escape the extensive grant cancellations at the National Institutes of Health and the National Science Foundation.
"It's already affecting our ability to stay on the cutting edge of research, best practices, and treatment approaches," said Zainab Okolo, EdD, senior vice president of policy, advocacy, and government relations at The Jed Foundation in New York City, which focuses on the emotional health of teens and young adults.
The upheaval is evident in an array of government agencies. The Health Resources and Services Administration, which last year awarded $12 billion in grants to community health centers and addiction treatment services, has seen > one-fourth of its staff eliminated. The Substance Abuse and Mental Health Services Administration has lost more than a third of its staff as federal cuts took a $1 billion bite out of its operating budget. The Education Department has halted $1 billion in grants used to hire mental health workers in school districts nationwide.
"We're very, very concerned about cuts to behavioral health systems," said Alonzo Plough, PhD, chief science officer at the Robert Wood Johnson Foundation in Princeton, New Jersey. "Doctors and nurses working in safety-net clinics are seeing tremendous reductions."
All in all, the new tax and spending law means $1 trillion in cuts to health care programs including Medicaid -- the nation's largest payer for mental health services -- Medicare, and Affordable Care Act insurance. An estimated 10 million Americans are expected to lose their health coverage as a result.
"When accessibility to care goes down, there's a chance that more people will die by suicide," said Jill Harkavy-Friedman, PhD, senior vice president of research at the American Foundation for Suicide Prevention. "But it also means people will come into care later in the course of their difficulties. Health professionals will be dealing with worse problems."
Foundations Take Emergency Measures
Even if private dollars can't replace what's been lost, philanthropic and medical foundations are stepping up.
We're seeing a lot of foundations and funders that are shifting their funding," said Alyson Niemann, CEO of Mindful Philanthropy, an organization that works with > 1000 private funders to marshal resources for mental health. This year, in response to federal cuts, "many increased funding to health and well-being, doubling or even tripling it," Niemann noted.
"They're making a great deal of effort to respond with emergency funds, really getting in the trenches and being good partners to their grantees," she said. "We've seen them asking deliberate questions, thinking about where their funding can have the most impact."
The American Psychological Foundation (APF), a longtime supporter of research and innovation, is addressing the current crisis with 2 initiatives, Michelle Quist Ryder, PhD, the organization's CEO, explained in an email. The first is APF Director Action, which funds innovative interventions at the community level. The second, Direct Action Crisis Funding Grants, will help continue research that is at risk of stalling because of budget cuts.
"Studies that are 'paused' or lose funding often cannot simply pick back up where they left off. Having to halt progress on a project can invalidate the work already completed," Ryder wrote. "These Direct Action Crisis Grants help bridge funding gaps and keep research viable."
At the same time, collaboration between foundations is becoming more widespread as they seek to maximize their impact. Philanthropic organizations are sharing ideas and best practices as well as pooling fundings.
"The goal of philanthropy is to help people," Harkavy-Friedman said. "There's strength in numbers and more dollars in numbers."
Some See Hope in Raised Voices
Despite the emergency scrambling, many of those in the trenches remain surprisingly optimistic. Some point out that the current turmoil has put a helpful spotlight on behavioral health care. Practitioners, meanwhile, have an essential role to play.
"There's a reason that things were the way they were: People advocated for many years to get where we've gotten," Harkavy-Friedman said, citing veterans' mental health care, the national violent death reporting system, and 988 as examples. "We have to raise our voices louder -- professionals in particular, because they know the impact a person in the general public many not fully grasp."
As a growing numbers of health professionals call attention to the damage wrought by deep cuts in the federal budget, foundation executives see an opportunity.
"In the mental health field, there's a deficit in the narrative, where there's a lot of focus on crisis. What we're hoping to do is shift the narrative toward 'How do we flourish together?'" Niemann said. "Sometimes deficits are where the most incredible innovations appear."
Debbie Koenig is a health writer whose work has been published by WebMD, The New York Times, and The Washington Post.
A version of this article first appeared on Medscape.com.
As Federal Cuts Deepen Mental Health Crisis, Philanthropy Scrambles to Fill the Gap
As Federal Cuts Deepen Mental Health Crisis, Philanthropy Scrambles to Fill the Gap
Taking Therapy Home With Mobile Mental Health Apps
For Kelly, a retired Navy operations specialist, coping with depression and anxiety hindered her ability to enjoy everyday life. Then she elected to enter therapy, a decision she calls “transformative.”
“When I started doing therapy, it was like releasing the toxins, releasing the buildup of the fear or the rage or the overwhelming feelings of shame,” she says. “We can’t just hold on to it. Just telling the truth, it helps me every single day. It is so worth it.”
Kurt, an Army veteran, tried to power through his anxiety, depression, and survivor guilt. He didn’t have much faith in mental health therapy, thinking no one could relate to him. He was surprised, though, once he started treatment, how much his life improved. He now encourages other veterans to face their own mental health challenges, be it through virtual/mental health apps or in-person care.
“From getting help, every day of my life is better,” he says, “and I couldn’t be more grateful for it.”
Stories from Kelly and Kurt are 2 of 7 the US Department of Veterans Affairs (VA) highlighted during National Recovery Month, outlining how their lives were forever changed with the support of mental health care.
But for every Kelly and Kurt, there are thousands of individuals reluctant to seek mental health care. A analysis of 2019-2020 data from the National Health and Resilience in Veterans Study found that 924 (26%) of 4069 veterans met criteria for ≥ 1 psychological disorders, but only 12% reported engagement in mental health care. The researchers considered the role of protective psychosocial characteristics, such as grit (ie, “trait perseverance that extends to one’s decision or commitment to address mental health needs on one’s own; dispositional optimism; and purpose in life”). Veterans who reported mental dysfunction but scored highly on grit were less likely to be engaged in treatment. This pattern suggests higher levels of grit may reduce the likelihood of seeking treatment, “even in the presence of clinically meaningful distress.”
A 2004 study found only 23% to 40% of service members who screened positive for a mental disorder sought care. They often believed they would be seen as weak, or their unit leadership might treat them differently, and unit members would have less confidence in them.
Given that military members and veterans are at increased risk of posttraumatic stress disorder (PTSD) in addition to mood, anxiety, and substance use disorders, any alternatives that increase their access to support and services are crucial. For those who aren’t disposed to office visits and group therapy, the answer may lie in mobile apps.
In a recent randomized controlled trial, 201 veterans who screened positive for PTSD and alcohol use disorder were divided into 2 groups: a mobile mindfulness-based intervention group enhanced with brief alcohol intervention content (Mind Guide), and an active stress management program group. Mind Guide engagement was excellent, according to the study, with averages of > 31 logins and 5 hours of app use. At 16 weeks, the Mind Guide group showed significant reductions in PTSD symptoms (no differences emerged for alcohol use frequency). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. The VA currently offers 16 apps, including MHA for Veterans, an app designed for patients to complete mental health assessments after their clinician assigned them. Other apps address a variety of issues, such as anger management, insomnia, chronic pain, and PTSD.
Two apps were created with an eye toward specific communities. One, Veterans Wellness Path, was designed for American Indians and Alaska Natives with input from those veterans, their family members, and health care practitioners. It supports the transition from military service to home and encourages balance and connection with self, family, community, and environment. Similarly, WellWithin Coach was designed by the VA National Center for PTSD with input from women veterans and subject matter experts in women’s mental health.
Whatever form it takes—in-person or virtual—finding support that works can make all the difference for veterans. Kelly founded and serves as the executive director of Acta Non Verba: Youth Urban Farm Project, an organization that brings together > 3000 low-income youth and families annually to learn about urban farming, aiming to fill a gap in an area known as a food desert: “We do have the power and the right to wake up the next day and try to do something different,” she said.
For Kelly, a retired Navy operations specialist, coping with depression and anxiety hindered her ability to enjoy everyday life. Then she elected to enter therapy, a decision she calls “transformative.”
“When I started doing therapy, it was like releasing the toxins, releasing the buildup of the fear or the rage or the overwhelming feelings of shame,” she says. “We can’t just hold on to it. Just telling the truth, it helps me every single day. It is so worth it.”
Kurt, an Army veteran, tried to power through his anxiety, depression, and survivor guilt. He didn’t have much faith in mental health therapy, thinking no one could relate to him. He was surprised, though, once he started treatment, how much his life improved. He now encourages other veterans to face their own mental health challenges, be it through virtual/mental health apps or in-person care.
“From getting help, every day of my life is better,” he says, “and I couldn’t be more grateful for it.”
Stories from Kelly and Kurt are 2 of 7 the US Department of Veterans Affairs (VA) highlighted during National Recovery Month, outlining how their lives were forever changed with the support of mental health care.
But for every Kelly and Kurt, there are thousands of individuals reluctant to seek mental health care. A analysis of 2019-2020 data from the National Health and Resilience in Veterans Study found that 924 (26%) of 4069 veterans met criteria for ≥ 1 psychological disorders, but only 12% reported engagement in mental health care. The researchers considered the role of protective psychosocial characteristics, such as grit (ie, “trait perseverance that extends to one’s decision or commitment to address mental health needs on one’s own; dispositional optimism; and purpose in life”). Veterans who reported mental dysfunction but scored highly on grit were less likely to be engaged in treatment. This pattern suggests higher levels of grit may reduce the likelihood of seeking treatment, “even in the presence of clinically meaningful distress.”
A 2004 study found only 23% to 40% of service members who screened positive for a mental disorder sought care. They often believed they would be seen as weak, or their unit leadership might treat them differently, and unit members would have less confidence in them.
Given that military members and veterans are at increased risk of posttraumatic stress disorder (PTSD) in addition to mood, anxiety, and substance use disorders, any alternatives that increase their access to support and services are crucial. For those who aren’t disposed to office visits and group therapy, the answer may lie in mobile apps.
In a recent randomized controlled trial, 201 veterans who screened positive for PTSD and alcohol use disorder were divided into 2 groups: a mobile mindfulness-based intervention group enhanced with brief alcohol intervention content (Mind Guide), and an active stress management program group. Mind Guide engagement was excellent, according to the study, with averages of > 31 logins and 5 hours of app use. At 16 weeks, the Mind Guide group showed significant reductions in PTSD symptoms (no differences emerged for alcohol use frequency). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. The VA currently offers 16 apps, including MHA for Veterans, an app designed for patients to complete mental health assessments after their clinician assigned them. Other apps address a variety of issues, such as anger management, insomnia, chronic pain, and PTSD.
Two apps were created with an eye toward specific communities. One, Veterans Wellness Path, was designed for American Indians and Alaska Natives with input from those veterans, their family members, and health care practitioners. It supports the transition from military service to home and encourages balance and connection with self, family, community, and environment. Similarly, WellWithin Coach was designed by the VA National Center for PTSD with input from women veterans and subject matter experts in women’s mental health.
Whatever form it takes—in-person or virtual—finding support that works can make all the difference for veterans. Kelly founded and serves as the executive director of Acta Non Verba: Youth Urban Farm Project, an organization that brings together > 3000 low-income youth and families annually to learn about urban farming, aiming to fill a gap in an area known as a food desert: “We do have the power and the right to wake up the next day and try to do something different,” she said.
For Kelly, a retired Navy operations specialist, coping with depression and anxiety hindered her ability to enjoy everyday life. Then she elected to enter therapy, a decision she calls “transformative.”
“When I started doing therapy, it was like releasing the toxins, releasing the buildup of the fear or the rage or the overwhelming feelings of shame,” she says. “We can’t just hold on to it. Just telling the truth, it helps me every single day. It is so worth it.”
Kurt, an Army veteran, tried to power through his anxiety, depression, and survivor guilt. He didn’t have much faith in mental health therapy, thinking no one could relate to him. He was surprised, though, once he started treatment, how much his life improved. He now encourages other veterans to face their own mental health challenges, be it through virtual/mental health apps or in-person care.
“From getting help, every day of my life is better,” he says, “and I couldn’t be more grateful for it.”
Stories from Kelly and Kurt are 2 of 7 the US Department of Veterans Affairs (VA) highlighted during National Recovery Month, outlining how their lives were forever changed with the support of mental health care.
But for every Kelly and Kurt, there are thousands of individuals reluctant to seek mental health care. A analysis of 2019-2020 data from the National Health and Resilience in Veterans Study found that 924 (26%) of 4069 veterans met criteria for ≥ 1 psychological disorders, but only 12% reported engagement in mental health care. The researchers considered the role of protective psychosocial characteristics, such as grit (ie, “trait perseverance that extends to one’s decision or commitment to address mental health needs on one’s own; dispositional optimism; and purpose in life”). Veterans who reported mental dysfunction but scored highly on grit were less likely to be engaged in treatment. This pattern suggests higher levels of grit may reduce the likelihood of seeking treatment, “even in the presence of clinically meaningful distress.”
A 2004 study found only 23% to 40% of service members who screened positive for a mental disorder sought care. They often believed they would be seen as weak, or their unit leadership might treat them differently, and unit members would have less confidence in them.
Given that military members and veterans are at increased risk of posttraumatic stress disorder (PTSD) in addition to mood, anxiety, and substance use disorders, any alternatives that increase their access to support and services are crucial. For those who aren’t disposed to office visits and group therapy, the answer may lie in mobile apps.
In a recent randomized controlled trial, 201 veterans who screened positive for PTSD and alcohol use disorder were divided into 2 groups: a mobile mindfulness-based intervention group enhanced with brief alcohol intervention content (Mind Guide), and an active stress management program group. Mind Guide engagement was excellent, according to the study, with averages of > 31 logins and 5 hours of app use. At 16 weeks, the Mind Guide group showed significant reductions in PTSD symptoms (no differences emerged for alcohol use frequency). Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. The VA currently offers 16 apps, including MHA for Veterans, an app designed for patients to complete mental health assessments after their clinician assigned them. Other apps address a variety of issues, such as anger management, insomnia, chronic pain, and PTSD.
Two apps were created with an eye toward specific communities. One, Veterans Wellness Path, was designed for American Indians and Alaska Natives with input from those veterans, their family members, and health care practitioners. It supports the transition from military service to home and encourages balance and connection with self, family, community, and environment. Similarly, WellWithin Coach was designed by the VA National Center for PTSD with input from women veterans and subject matter experts in women’s mental health.
Whatever form it takes—in-person or virtual—finding support that works can make all the difference for veterans. Kelly founded and serves as the executive director of Acta Non Verba: Youth Urban Farm Project, an organization that brings together > 3000 low-income youth and families annually to learn about urban farming, aiming to fill a gap in an area known as a food desert: “We do have the power and the right to wake up the next day and try to do something different,” she said.
Hospitalists Must Encourage Mental Stimulation for Patients
As a hospitalist, you are in a unique position to notice changes in your hospitalized patients. This frontline perspective can be used to improve inpatient attention and care, and differs from primary care, where a clinician might only see a patient once or twice a year, and subtle, gradual changes may be missed, said George Cao, MD, MBA, a hospitalist at the University of Vermont Medical Center in Burlington and assistant professor at UVM’s Larner College of Medicine.
But in the hospital, Cao said even small shifts — like becoming less active, eating less, or changes in personality — can become much more obvious.
“As hospitalists…we see patients throughout the day, in different situations, and often end up spending more time with them over the course of a week than their primary care provider might in a year,” Cao explained. “This gives us a real advantage in picking up on subtle changes in mental awareness.”
These assessments can also be evaluated with the benefit of daily labs, frequent bedside interactions, and 24–hour observations.
With older adults, Cao said it’s important to go beyond just what’s in the chart.
“I always start by reviewing notes from the primary care provider and previous admissions, but some of the most valuable insights come from talking with family and close friends to get a true sense of the patient’s baseline — how they usually think, move, and interact,” he said.
Why to Watch for Declining Mental Awareness
Declining mental awareness in the inpatient setting is often a sign of an underlying problem — whether that’s a reversible medical condition, unrecognized dementia, or the development of delirium, Cao said.
“On the inpatient side, I pay close attention to more than just memory loss,” he said.
Changes in how patients function day–to–day, shifts in their behavior, or even something as simple as not wanting to get out of bed can be early signs of an aging mind or untreated psychiatric issues, he noted.
“Of course, we always rule out infections and medication side effects, but I also look for other reversible causes like thyroid problems, electrolyte imbalances, low oxygen, pain, urinary retention, constipation, and nutritional deficiencies,” Cao said.
Of note, delirium is the most common cause of sudden mental status changes in the hospital, and “it’s easy to miss if you’re not looking for it.”
He summarized that classic signs are an acute and fluctuating course with changes in alertness, but added there are other red flags too: disorientation, hallucinations, changes in sleep patterns, sporadic unsafe behaviors, mood swings, and changes in activity level, whether that’s agitation or just being unusually quiet.
By combining what he notices bedside and what is learned from the medical record (and from the people who know the patient best), Cao said he’s able to catch these changes early, identify the underlying cause, and work toward the best possible outcome.
“One of the main interventions is providing mental stimulation,” he said.
Why Mental Stimulation Is So Vital
Mental stimulation of the patient is critical to recovery and may prevent prolonged illness, said Meghana R. Medavaram, MD, associate director of consultation liaison and emergency psychiatry at Montefiore Medical Center’s Weiler Hospital in New York City. “Keeping a patient active both physically and mentally can help prevent deconditioning and risks of prolonged immobility,” she said.
It’s important to note that when patients are out of their familiar routines, away from their usual environment and people, and their sleep is fragmented, this can make them even more vulnerable. Keeping patients mentally stimulated during their hospital stay can help maintain their attention, orientation, and a healthy sleep-wake cycle — all things that are easily thrown off in the hospital, Cao said.
“These disruptions hit the pathways that control attention, wakefulness, and the sleep–wake cycle. That’s when you see attention drifting, orientation fading, and circadian rhythms unraveling, especially at night, which is why “sundowning” is so common, Cao said, referring to the syndrome where older adults or people with dementia experience behavioral changes in late afternoon or evening. “Mental stimulation is critical in the hospital because when the brain isn’t active and gets disoriented, it becomes an easy target for delirium.”
He said delirium often develops in older adults when acute stressors like inflammation, low oxygen, metabolic imbalances, or sedating medications disrupt the brain’s arousal systems and networks, especially in older adults.
Therefore, Cao said, encourage your patients to be more engaged during the day through conversation, activities, or regular reorientation. “This supports the brain networks that help prevent inattention and confusion, which are the hallmarks of delirium. Daytime stimulation also helps build up the natural drive for nighttime sleep, so patients are less likely to nap during the day and be awake and disoriented at night.”
To support this, it’s helpful to schedule medications during waking hours instead of around–the–clock dosing that interrupts sleep, and to cluster nighttime care activities to minimize disturbances, Cao explained. Ensuring patients have their glasses, hearing aids, and familiar routines, along with encouraging mobility and hydration, further protects against delirium and supports patients’ cognitive health during hospitalization. “These same principles are just as important in outpatient subacute rehab settings and at home, so it’s essential to take home these strategies after discharge,” he said.
A Family Member or Friend May Help
Hospitalists can suggest straightforward ways to encourage families and friends to keep patients engaged during a hospital stay. Visits and chats can go a long way as conversations are incredibly grounding, Cao said. Other methods could be bringing in favorite foods or snacks, a phone chat or video call, or even showing prerecorded video messages. “These can be effective. Patients respond well to seeing and hearing familiar faces and voices, even if it’s just on a screen,” Cao said.
Beyond that, he said, activities such as watching and discussing the news, reading aloud, using tablets for games, watching movies, doing crossword puzzles, knitting, reminiscing, and playing word games can also be mentally stimulating for patients.
In addition, safe exercises/activities that patients can do in bed — with advice from physical therapy and occupational therapy — are beneficial, Medavaram said. “These often include gentle range–of-motion activities,” she said.
Share Importance of Mental Stimulation With Patients and Caregivers
If a hospitalist wants to motivate patients to keep their minds active, the framing should be simple, positive, and tied directly to their goals of getting better and getting home, said Medavaram. She provided this script suggestion:
“One of the best ways to help your recovery isn’t just taking your medicine, it’s keeping your mind active. When you’re in the hospital, it’s easy to spend the day lying in bed and staring at the TV in your room, but that can make your brain slow down and even cause confusion. Simple things — like reading, talking with visitors, doing puzzles, listening to music you enjoy, or telling a nurse about your favorite memories — can keep your brain sharp. Staying mentally active helps your thinking stay clear and can even help you get home sooner. Think of it like physical therapy for your brain.”
A version of this article first appeared on Medscape.com.
As a hospitalist, you are in a unique position to notice changes in your hospitalized patients. This frontline perspective can be used to improve inpatient attention and care, and differs from primary care, where a clinician might only see a patient once or twice a year, and subtle, gradual changes may be missed, said George Cao, MD, MBA, a hospitalist at the University of Vermont Medical Center in Burlington and assistant professor at UVM’s Larner College of Medicine.
But in the hospital, Cao said even small shifts — like becoming less active, eating less, or changes in personality — can become much more obvious.
“As hospitalists…we see patients throughout the day, in different situations, and often end up spending more time with them over the course of a week than their primary care provider might in a year,” Cao explained. “This gives us a real advantage in picking up on subtle changes in mental awareness.”
These assessments can also be evaluated with the benefit of daily labs, frequent bedside interactions, and 24–hour observations.
With older adults, Cao said it’s important to go beyond just what’s in the chart.
“I always start by reviewing notes from the primary care provider and previous admissions, but some of the most valuable insights come from talking with family and close friends to get a true sense of the patient’s baseline — how they usually think, move, and interact,” he said.
Why to Watch for Declining Mental Awareness
Declining mental awareness in the inpatient setting is often a sign of an underlying problem — whether that’s a reversible medical condition, unrecognized dementia, or the development of delirium, Cao said.
“On the inpatient side, I pay close attention to more than just memory loss,” he said.
Changes in how patients function day–to–day, shifts in their behavior, or even something as simple as not wanting to get out of bed can be early signs of an aging mind or untreated psychiatric issues, he noted.
“Of course, we always rule out infections and medication side effects, but I also look for other reversible causes like thyroid problems, electrolyte imbalances, low oxygen, pain, urinary retention, constipation, and nutritional deficiencies,” Cao said.
Of note, delirium is the most common cause of sudden mental status changes in the hospital, and “it’s easy to miss if you’re not looking for it.”
He summarized that classic signs are an acute and fluctuating course with changes in alertness, but added there are other red flags too: disorientation, hallucinations, changes in sleep patterns, sporadic unsafe behaviors, mood swings, and changes in activity level, whether that’s agitation or just being unusually quiet.
By combining what he notices bedside and what is learned from the medical record (and from the people who know the patient best), Cao said he’s able to catch these changes early, identify the underlying cause, and work toward the best possible outcome.
“One of the main interventions is providing mental stimulation,” he said.
Why Mental Stimulation Is So Vital
Mental stimulation of the patient is critical to recovery and may prevent prolonged illness, said Meghana R. Medavaram, MD, associate director of consultation liaison and emergency psychiatry at Montefiore Medical Center’s Weiler Hospital in New York City. “Keeping a patient active both physically and mentally can help prevent deconditioning and risks of prolonged immobility,” she said.
It’s important to note that when patients are out of their familiar routines, away from their usual environment and people, and their sleep is fragmented, this can make them even more vulnerable. Keeping patients mentally stimulated during their hospital stay can help maintain their attention, orientation, and a healthy sleep-wake cycle — all things that are easily thrown off in the hospital, Cao said.
“These disruptions hit the pathways that control attention, wakefulness, and the sleep–wake cycle. That’s when you see attention drifting, orientation fading, and circadian rhythms unraveling, especially at night, which is why “sundowning” is so common, Cao said, referring to the syndrome where older adults or people with dementia experience behavioral changes in late afternoon or evening. “Mental stimulation is critical in the hospital because when the brain isn’t active and gets disoriented, it becomes an easy target for delirium.”
He said delirium often develops in older adults when acute stressors like inflammation, low oxygen, metabolic imbalances, or sedating medications disrupt the brain’s arousal systems and networks, especially in older adults.
Therefore, Cao said, encourage your patients to be more engaged during the day through conversation, activities, or regular reorientation. “This supports the brain networks that help prevent inattention and confusion, which are the hallmarks of delirium. Daytime stimulation also helps build up the natural drive for nighttime sleep, so patients are less likely to nap during the day and be awake and disoriented at night.”
To support this, it’s helpful to schedule medications during waking hours instead of around–the–clock dosing that interrupts sleep, and to cluster nighttime care activities to minimize disturbances, Cao explained. Ensuring patients have their glasses, hearing aids, and familiar routines, along with encouraging mobility and hydration, further protects against delirium and supports patients’ cognitive health during hospitalization. “These same principles are just as important in outpatient subacute rehab settings and at home, so it’s essential to take home these strategies after discharge,” he said.
A Family Member or Friend May Help
Hospitalists can suggest straightforward ways to encourage families and friends to keep patients engaged during a hospital stay. Visits and chats can go a long way as conversations are incredibly grounding, Cao said. Other methods could be bringing in favorite foods or snacks, a phone chat or video call, or even showing prerecorded video messages. “These can be effective. Patients respond well to seeing and hearing familiar faces and voices, even if it’s just on a screen,” Cao said.
Beyond that, he said, activities such as watching and discussing the news, reading aloud, using tablets for games, watching movies, doing crossword puzzles, knitting, reminiscing, and playing word games can also be mentally stimulating for patients.
In addition, safe exercises/activities that patients can do in bed — with advice from physical therapy and occupational therapy — are beneficial, Medavaram said. “These often include gentle range–of-motion activities,” she said.
Share Importance of Mental Stimulation With Patients and Caregivers
If a hospitalist wants to motivate patients to keep their minds active, the framing should be simple, positive, and tied directly to their goals of getting better and getting home, said Medavaram. She provided this script suggestion:
“One of the best ways to help your recovery isn’t just taking your medicine, it’s keeping your mind active. When you’re in the hospital, it’s easy to spend the day lying in bed and staring at the TV in your room, but that can make your brain slow down and even cause confusion. Simple things — like reading, talking with visitors, doing puzzles, listening to music you enjoy, or telling a nurse about your favorite memories — can keep your brain sharp. Staying mentally active helps your thinking stay clear and can even help you get home sooner. Think of it like physical therapy for your brain.”
A version of this article first appeared on Medscape.com.
As a hospitalist, you are in a unique position to notice changes in your hospitalized patients. This frontline perspective can be used to improve inpatient attention and care, and differs from primary care, where a clinician might only see a patient once or twice a year, and subtle, gradual changes may be missed, said George Cao, MD, MBA, a hospitalist at the University of Vermont Medical Center in Burlington and assistant professor at UVM’s Larner College of Medicine.
But in the hospital, Cao said even small shifts — like becoming less active, eating less, or changes in personality — can become much more obvious.
“As hospitalists…we see patients throughout the day, in different situations, and often end up spending more time with them over the course of a week than their primary care provider might in a year,” Cao explained. “This gives us a real advantage in picking up on subtle changes in mental awareness.”
These assessments can also be evaluated with the benefit of daily labs, frequent bedside interactions, and 24–hour observations.
With older adults, Cao said it’s important to go beyond just what’s in the chart.
“I always start by reviewing notes from the primary care provider and previous admissions, but some of the most valuable insights come from talking with family and close friends to get a true sense of the patient’s baseline — how they usually think, move, and interact,” he said.
Why to Watch for Declining Mental Awareness
Declining mental awareness in the inpatient setting is often a sign of an underlying problem — whether that’s a reversible medical condition, unrecognized dementia, or the development of delirium, Cao said.
“On the inpatient side, I pay close attention to more than just memory loss,” he said.
Changes in how patients function day–to–day, shifts in their behavior, or even something as simple as not wanting to get out of bed can be early signs of an aging mind or untreated psychiatric issues, he noted.
“Of course, we always rule out infections and medication side effects, but I also look for other reversible causes like thyroid problems, electrolyte imbalances, low oxygen, pain, urinary retention, constipation, and nutritional deficiencies,” Cao said.
Of note, delirium is the most common cause of sudden mental status changes in the hospital, and “it’s easy to miss if you’re not looking for it.”
He summarized that classic signs are an acute and fluctuating course with changes in alertness, but added there are other red flags too: disorientation, hallucinations, changes in sleep patterns, sporadic unsafe behaviors, mood swings, and changes in activity level, whether that’s agitation or just being unusually quiet.
By combining what he notices bedside and what is learned from the medical record (and from the people who know the patient best), Cao said he’s able to catch these changes early, identify the underlying cause, and work toward the best possible outcome.
“One of the main interventions is providing mental stimulation,” he said.
Why Mental Stimulation Is So Vital
Mental stimulation of the patient is critical to recovery and may prevent prolonged illness, said Meghana R. Medavaram, MD, associate director of consultation liaison and emergency psychiatry at Montefiore Medical Center’s Weiler Hospital in New York City. “Keeping a patient active both physically and mentally can help prevent deconditioning and risks of prolonged immobility,” she said.
It’s important to note that when patients are out of their familiar routines, away from their usual environment and people, and their sleep is fragmented, this can make them even more vulnerable. Keeping patients mentally stimulated during their hospital stay can help maintain their attention, orientation, and a healthy sleep-wake cycle — all things that are easily thrown off in the hospital, Cao said.
“These disruptions hit the pathways that control attention, wakefulness, and the sleep–wake cycle. That’s when you see attention drifting, orientation fading, and circadian rhythms unraveling, especially at night, which is why “sundowning” is so common, Cao said, referring to the syndrome where older adults or people with dementia experience behavioral changes in late afternoon or evening. “Mental stimulation is critical in the hospital because when the brain isn’t active and gets disoriented, it becomes an easy target for delirium.”
He said delirium often develops in older adults when acute stressors like inflammation, low oxygen, metabolic imbalances, or sedating medications disrupt the brain’s arousal systems and networks, especially in older adults.
Therefore, Cao said, encourage your patients to be more engaged during the day through conversation, activities, or regular reorientation. “This supports the brain networks that help prevent inattention and confusion, which are the hallmarks of delirium. Daytime stimulation also helps build up the natural drive for nighttime sleep, so patients are less likely to nap during the day and be awake and disoriented at night.”
To support this, it’s helpful to schedule medications during waking hours instead of around–the–clock dosing that interrupts sleep, and to cluster nighttime care activities to minimize disturbances, Cao explained. Ensuring patients have their glasses, hearing aids, and familiar routines, along with encouraging mobility and hydration, further protects against delirium and supports patients’ cognitive health during hospitalization. “These same principles are just as important in outpatient subacute rehab settings and at home, so it’s essential to take home these strategies after discharge,” he said.
A Family Member or Friend May Help
Hospitalists can suggest straightforward ways to encourage families and friends to keep patients engaged during a hospital stay. Visits and chats can go a long way as conversations are incredibly grounding, Cao said. Other methods could be bringing in favorite foods or snacks, a phone chat or video call, or even showing prerecorded video messages. “These can be effective. Patients respond well to seeing and hearing familiar faces and voices, even if it’s just on a screen,” Cao said.
Beyond that, he said, activities such as watching and discussing the news, reading aloud, using tablets for games, watching movies, doing crossword puzzles, knitting, reminiscing, and playing word games can also be mentally stimulating for patients.
In addition, safe exercises/activities that patients can do in bed — with advice from physical therapy and occupational therapy — are beneficial, Medavaram said. “These often include gentle range–of-motion activities,” she said.
Share Importance of Mental Stimulation With Patients and Caregivers
If a hospitalist wants to motivate patients to keep their minds active, the framing should be simple, positive, and tied directly to their goals of getting better and getting home, said Medavaram. She provided this script suggestion:
“One of the best ways to help your recovery isn’t just taking your medicine, it’s keeping your mind active. When you’re in the hospital, it’s easy to spend the day lying in bed and staring at the TV in your room, but that can make your brain slow down and even cause confusion. Simple things — like reading, talking with visitors, doing puzzles, listening to music you enjoy, or telling a nurse about your favorite memories — can keep your brain sharp. Staying mentally active helps your thinking stay clear and can even help you get home sooner. Think of it like physical therapy for your brain.”
A version of this article first appeared on Medscape.com.
Signs Your Hospital Patient May Have Lost Some Mental Acuity
Signs Your Hospital Patient May Have Lost Some Mental Acuity
The role of the hospitalist is multidisciplinary and one of the primary responsibilities in your role is to notice and act on the changes you notice regarding your patients, including mental awareness and acuity.
"Evaluation of orientation and level of awareness is a core component of any hospitalist's daily evaluation," said Tara Scribner, MD, an internal medicine hospitalist, The University of Vermont Medical Center; associate program director for POCUS and Procedure Curriculum, UVMMC Internal Medicine Residency Program; and an assistant professor, Robert Larner, M.D. College of Medicine, Burlington, Vermont. "Beyond this, a broader assessment of executive function and functional abilities always occurs at some point during a hospital admission as discharge location and situation depends on this."
While it's relatively easy to identify signs of dementia using information from collateral sources, she also noted it's often difficult to determine whether a patient is experiencing progressive dementia or a more acute encephalopathy such as delirium if collateral sources are not available.
"Once a baseline has been established, hospitalists are in a unique position to identify subtle and acute shifts in mental acuity over the course of a hospital stay," Scribner said. "Unlike our primary care colleagues, who are well-positioned to observe for signs of dementia, we see our patients on a daily basis, sometimes more than once daily, and can track changes which occur over a matter of hours or days."
What Are Signs to Watch
During examinations and assessments, pay attention to shifts in the behavior of patients.
"Subtle signs of delirium and/or declining mental awareness can include disorientation about date, location, reason for admission," said Meghana R. Medavaram, MD, associate director of Consultation Liaison and Emergency Psychiatry, Weiler Hospital at Montefiore Health System in Bronx, New York.
Another sign would be mild inattention, such as drifting off during conversations or even having a hard time understanding and following multistep commands, she also said.
"We can also see sudden irritability or even the opposite, odd politeness or familiarity. We notice these changes occur as fluctuations throughout the day, sometimes with a clinician seeing a different 'personality' in the morning vs afternoon or evening," Medavaram said. "A key message we emphasize for our hospitalist colleagues is to not wait for overt agitation, or hallucinations to step in when assessing a patient and coming up with a treatment plan."
How Would Diet Play a Role
Excess consumption of alcohol is the most common way a patient's diet can affect changes in mental status, said Scribner. "Excess alcohol use has been linked to a significantly increased risk of dementia including both Alzheimer's and to alcohol-related brain damage including Korsakoff syndrome, as well as to the more acute Wernicke encephalopathy through vitamin B1 deficiency."
Also, vitamin deficiencies such as B12 have been linked to development of dementia and other cognitive impairment and can be related to alcohol consumption as well as to dietary habits such as vegetarianism, even in the absence of alcohol intake. Identification and treatment of B12 deficiency is a potentially reversible cause of cognitive impairment, she also said.
Do Medications Affect Mental State
Medications can be a significant cause of acute changes in mental status. "These changes are often reversible and include somnolence and both hypoactive and hyperactive delirium. Adjustment of a patient's usual medications is often necessary in hospitalized patients experiencing acute encephalopathy," Scribner said.
What About Depression
The relationship between dementia and development of dementia is complex and poorly understood, she said, however, those who deal with depression are at a higher risk of developing dementia, and also that patients with dementia are at a higher risk for development of depression.
How to Distinguish Between Short- and Long-term Issues
A thorough hospitalist is typically able to identify the acuity of mental status changes by the time of discharge and therefore predict the likelihood of recovery.
Progressive mental status changes occurring over months to years are almost always representative of dementia and are irreversible, whereas most (but not all) acute encephalopathies are recoverable over days to weeks or months.
Determining which of these is present involves interrogation of collateral sources such as family and friends, assessment of orientation and other signs of delirium, and observation of recovery during the period of hospital admission. It is worth noting that episodes of delirium are associated with a higher risk for long-term cognitive decline and development of dementia.
Written by Erica Lamberg.
A version of this article first appeared on Medscape.com.
The role of the hospitalist is multidisciplinary and one of the primary responsibilities in your role is to notice and act on the changes you notice regarding your patients, including mental awareness and acuity.
"Evaluation of orientation and level of awareness is a core component of any hospitalist's daily evaluation," said Tara Scribner, MD, an internal medicine hospitalist, The University of Vermont Medical Center; associate program director for POCUS and Procedure Curriculum, UVMMC Internal Medicine Residency Program; and an assistant professor, Robert Larner, M.D. College of Medicine, Burlington, Vermont. "Beyond this, a broader assessment of executive function and functional abilities always occurs at some point during a hospital admission as discharge location and situation depends on this."
While it's relatively easy to identify signs of dementia using information from collateral sources, she also noted it's often difficult to determine whether a patient is experiencing progressive dementia or a more acute encephalopathy such as delirium if collateral sources are not available.
"Once a baseline has been established, hospitalists are in a unique position to identify subtle and acute shifts in mental acuity over the course of a hospital stay," Scribner said. "Unlike our primary care colleagues, who are well-positioned to observe for signs of dementia, we see our patients on a daily basis, sometimes more than once daily, and can track changes which occur over a matter of hours or days."
What Are Signs to Watch
During examinations and assessments, pay attention to shifts in the behavior of patients.
"Subtle signs of delirium and/or declining mental awareness can include disorientation about date, location, reason for admission," said Meghana R. Medavaram, MD, associate director of Consultation Liaison and Emergency Psychiatry, Weiler Hospital at Montefiore Health System in Bronx, New York.
Another sign would be mild inattention, such as drifting off during conversations or even having a hard time understanding and following multistep commands, she also said.
"We can also see sudden irritability or even the opposite, odd politeness or familiarity. We notice these changes occur as fluctuations throughout the day, sometimes with a clinician seeing a different 'personality' in the morning vs afternoon or evening," Medavaram said. "A key message we emphasize for our hospitalist colleagues is to not wait for overt agitation, or hallucinations to step in when assessing a patient and coming up with a treatment plan."
How Would Diet Play a Role
Excess consumption of alcohol is the most common way a patient's diet can affect changes in mental status, said Scribner. "Excess alcohol use has been linked to a significantly increased risk of dementia including both Alzheimer's and to alcohol-related brain damage including Korsakoff syndrome, as well as to the more acute Wernicke encephalopathy through vitamin B1 deficiency."
Also, vitamin deficiencies such as B12 have been linked to development of dementia and other cognitive impairment and can be related to alcohol consumption as well as to dietary habits such as vegetarianism, even in the absence of alcohol intake. Identification and treatment of B12 deficiency is a potentially reversible cause of cognitive impairment, she also said.
Do Medications Affect Mental State
Medications can be a significant cause of acute changes in mental status. "These changes are often reversible and include somnolence and both hypoactive and hyperactive delirium. Adjustment of a patient's usual medications is often necessary in hospitalized patients experiencing acute encephalopathy," Scribner said.
What About Depression
The relationship between dementia and development of dementia is complex and poorly understood, she said, however, those who deal with depression are at a higher risk of developing dementia, and also that patients with dementia are at a higher risk for development of depression.
How to Distinguish Between Short- and Long-term Issues
A thorough hospitalist is typically able to identify the acuity of mental status changes by the time of discharge and therefore predict the likelihood of recovery.
Progressive mental status changes occurring over months to years are almost always representative of dementia and are irreversible, whereas most (but not all) acute encephalopathies are recoverable over days to weeks or months.
Determining which of these is present involves interrogation of collateral sources such as family and friends, assessment of orientation and other signs of delirium, and observation of recovery during the period of hospital admission. It is worth noting that episodes of delirium are associated with a higher risk for long-term cognitive decline and development of dementia.
Written by Erica Lamberg.
A version of this article first appeared on Medscape.com.
The role of the hospitalist is multidisciplinary and one of the primary responsibilities in your role is to notice and act on the changes you notice regarding your patients, including mental awareness and acuity.
"Evaluation of orientation and level of awareness is a core component of any hospitalist's daily evaluation," said Tara Scribner, MD, an internal medicine hospitalist, The University of Vermont Medical Center; associate program director for POCUS and Procedure Curriculum, UVMMC Internal Medicine Residency Program; and an assistant professor, Robert Larner, M.D. College of Medicine, Burlington, Vermont. "Beyond this, a broader assessment of executive function and functional abilities always occurs at some point during a hospital admission as discharge location and situation depends on this."
While it's relatively easy to identify signs of dementia using information from collateral sources, she also noted it's often difficult to determine whether a patient is experiencing progressive dementia or a more acute encephalopathy such as delirium if collateral sources are not available.
"Once a baseline has been established, hospitalists are in a unique position to identify subtle and acute shifts in mental acuity over the course of a hospital stay," Scribner said. "Unlike our primary care colleagues, who are well-positioned to observe for signs of dementia, we see our patients on a daily basis, sometimes more than once daily, and can track changes which occur over a matter of hours or days."
What Are Signs to Watch
During examinations and assessments, pay attention to shifts in the behavior of patients.
"Subtle signs of delirium and/or declining mental awareness can include disorientation about date, location, reason for admission," said Meghana R. Medavaram, MD, associate director of Consultation Liaison and Emergency Psychiatry, Weiler Hospital at Montefiore Health System in Bronx, New York.
Another sign would be mild inattention, such as drifting off during conversations or even having a hard time understanding and following multistep commands, she also said.
"We can also see sudden irritability or even the opposite, odd politeness or familiarity. We notice these changes occur as fluctuations throughout the day, sometimes with a clinician seeing a different 'personality' in the morning vs afternoon or evening," Medavaram said. "A key message we emphasize for our hospitalist colleagues is to not wait for overt agitation, or hallucinations to step in when assessing a patient and coming up with a treatment plan."
How Would Diet Play a Role
Excess consumption of alcohol is the most common way a patient's diet can affect changes in mental status, said Scribner. "Excess alcohol use has been linked to a significantly increased risk of dementia including both Alzheimer's and to alcohol-related brain damage including Korsakoff syndrome, as well as to the more acute Wernicke encephalopathy through vitamin B1 deficiency."
Also, vitamin deficiencies such as B12 have been linked to development of dementia and other cognitive impairment and can be related to alcohol consumption as well as to dietary habits such as vegetarianism, even in the absence of alcohol intake. Identification and treatment of B12 deficiency is a potentially reversible cause of cognitive impairment, she also said.
Do Medications Affect Mental State
Medications can be a significant cause of acute changes in mental status. "These changes are often reversible and include somnolence and both hypoactive and hyperactive delirium. Adjustment of a patient's usual medications is often necessary in hospitalized patients experiencing acute encephalopathy," Scribner said.
What About Depression
The relationship between dementia and development of dementia is complex and poorly understood, she said, however, those who deal with depression are at a higher risk of developing dementia, and also that patients with dementia are at a higher risk for development of depression.
How to Distinguish Between Short- and Long-term Issues
A thorough hospitalist is typically able to identify the acuity of mental status changes by the time of discharge and therefore predict the likelihood of recovery.
Progressive mental status changes occurring over months to years are almost always representative of dementia and are irreversible, whereas most (but not all) acute encephalopathies are recoverable over days to weeks or months.
Determining which of these is present involves interrogation of collateral sources such as family and friends, assessment of orientation and other signs of delirium, and observation of recovery during the period of hospital admission. It is worth noting that episodes of delirium are associated with a higher risk for long-term cognitive decline and development of dementia.
Written by Erica Lamberg.
A version of this article first appeared on Medscape.com.
Signs Your Hospital Patient May Have Lost Some Mental Acuity
Signs Your Hospital Patient May Have Lost Some Mental Acuity
Veterans and Loneliness: More Than Just Isolation
According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.
Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.
An Epidemic
In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.
Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.
A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”
The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.
Addressing Loneliness
Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.
Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.
The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse.
Rural Veterans
The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.
A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.
VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress.
Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.
In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.
The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.
According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.
Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.
An Epidemic
In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.
Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.
A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”
The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.
Addressing Loneliness
Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.
Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.
The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse.
Rural Veterans
The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.
A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.
VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress.
Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.
In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.
The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.
According to the National Institute on Drug Abuse, > 1 in 10 veterans have been diagnosed with substance use disorder (SUD). Additionally, 7 out of every 100 veterans will have posttraumatic stress disorder (PTSD) at some point in their life, per research from the US Department of Veterans Affairs (VA). However, a common and perhaps unsuspected parallel is found in those statistics: loneliness.
Of the 4069 veterans who participated in the 2019-2020 National Health and Resilience in Veterans Survey, 56.9% reported they felt lonely sometimes or often, while 1 in 5 reported feeling lonely often.
An Epidemic
In his 2023 advisory, Former US Surgeon General Vivek Murthy called it an epidemic noting that when he spoke with veterans during a cross-country listening tour, he heard how they felt “isolated, invisible, and insignificant.” About 1 in 2 adults in America experience loneliness, even before the COVID-19 pandemic isolation.
Loneliness can have individual and synergistic ill effects, including a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. It also can both trigger and exacerbate substance use and PTSD.
A study using data from the RAND Health and Retirement Study Longitudinal File 2020 (N = 5259) found significant associations between loneliness and being unmarried/unpartnered, and greater depressive symptoms for both veterans and civilians, as well as significant negative associations between loneliness and greater life satisfaction and positive affect. Health conditions that limited an individual's ability to work was a “unique risk factor for loneliness among veterans.”
The National Health and Resilience in Veterans Study found that those aged ≤ 50 years were 3 times more likely to screen positive for PTSD compared to older veterans. In a survey of 409 veterans, many who engaged in problematic substance use during the COVID-19 pandemic reported that despite having social supports they still felt lonely. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning.
Addressing Loneliness
Researchers believe an answer to some mental health and substance abuse problems may lie in addressing loneliness. Positive psychology is providing promising results in the treatment of SUD. Bryant Stone, from the Johns Hopkins Bloomberg School of Public Health, emphasizes focusing on well-being and quality of life rather than solely on abstinence with “positive psychological interventions,” or activities and behavioral interventions that target positive variables to promote adaptive functioning.
Veterans can face tough challenges as they rejoin civilian life. How successfully they meet and conquer those challenges, especially if they include drug problems, may directly relate to their general feeling of well-being.
The PERMA model outlines 5 core elements to assess well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. A study based on that model found loneliness to be a “particularly significant factor” among key variables influencing the prevention and treatment of SUDs. The study of 156 veterans with self-reported mental health conditions found the ability to engage in social roles and activities was positively correlated with overall well-being and negatively correlated with degree of problems related to drug abuse.
Rural Veterans
The estimated 4.4 million veterans living in rural communities may benefit most from interventions that tackle isolation. Compared with urban counterparts, they’re more likely to be older, have more complex medical issues, have a service-connected disability, and be unemployed. Those factors, compounded by geographical and social isolation, can have a substantial impact on well-being.
A study centered on the initial validation of a short (5-item) version of PERMA found that individuals who scored higher on the short form tended to report higher levels of optimism, resilience, and happiness. Thus, the short form may be particularly useful for rural veterans who do not always have easy access to health care.
VA has instituted a variety of programs to encourage and support social connection. During the COVID-19 pandemic, telehealth interventions targeted social support and loneliness among veterans—albeit with mixed results. VA CONNECT, a 10-session group telehealth intervention that integrated peer support, did not show significant changes in loneliness, but did significantly reduce perceived stress.
Another initiative, Compassionate Contact Corps, trained volunteers made weekly phone calls aimed at reducing loneliness and fostering social connection. Started in Columbus, Ohio, in 2020, > 80 sites had adopted the initiative by 2021, with 310 volunteers, 5320 visits, and 4757 hours spent with veterans.
In 2014, VA peer specialists developed and co-hosted Veterans Socials through community partnerships between VA, veteran-serving organizations, and veteran community leaders. As of 2025, 178 known Veterans Socials were spread across 26 states and territories.
The researchers say their case examples collectively demonstrate that Veterans Socials have the potential to serve as a vital platform for peer support, resource sharing, and health service use among veterans. Virtual Veterans Socials also provided hosts with a channel to reach potentially isolated veterans who might not otherwise access services while simultaneously offering veterans an opportunity for social connection.
About Half of Canadian Physicians Report High Burnout Levels
About Half of Canadian Physicians Report High Burnout Levels
Nearly half of physicians in Canada report high levels of burnout, according to preliminary data from the 2025 National Physician Health Survey (NPHS). The new data show that 46% of physicians report high levels of burnout, down from 2021 (53%) but significantly above the level of 2017 (30%), when the first survey was conducted. The full NPHS 2025 Foundational Report will be released later this year.
Other significant findings include the following:
- 74% of physicians reported experiencing bullying, harassment, microaggressions, or discrimination, a slight but meaningful reduction form 78% in 2021.
- 64% of physicians reported spending significant time on electronic medical records outside regular hours.
- 46% of physicians said that their mental health is worse than it was before the start of the pandemic, down 14% from 2021.
- 60% reported being satisfied or very satisfied with work-life balance, an improvement from 49% in 2021, though slightly below 2017 (62%).
- 37% of physicians plan to reduce their clinical hours in the next 2 years.
Margot Burnell, MD, president of the Canadian Medical Association (CMA), told Medscape Medical News that she was "disappointed" with the results.
"I hoped that the burnout numbers would decrease more than they have," she said. "Physicians are still under extreme stress in trying to provide the care for patients that they wish to give."
Reductions in Hours
The most distressing finding is that > one-third of physicians (37%) plan to reduce their hours within 24 hours -- at a time of growing physician shortages -- said Burnell.
"The one positive (finding) that stands out is that physicians are taking care of their own health and wellness and report that it's helping," she said. About 65% of physicians reported having accessed at least 1 wellness support in the past 5 years, up 11% since 2021.
The NPHS includes responses from about 3300 practicing physicians, medical residents, and fellows who were surveyed from March 14 to April 15.
Among the CMA's top priorities is to reduce the administrative burden because that tops the list of what physicians say would help them with burnout, said Burnell.
"The other area is to provide and encourage team-based care," she continued. "That provides some relief for physicians." It also is important to promote the approaches that seem to be helping, such as wellness support and artificial intelligence (AI), she said. In this survey, 59% of respondents who used AI said that it decreased their time spent on administrative tasks.
Burnout by Specialty
Future analyses will examine burnout by specialty, Burnell said. Burnout is particularly high among emergency physicians, regardless of province, according to previous work by Kerstin de Wit, MD, emergency physician and research director for the Department of Emergency Medicine at Queen's University in Kingston, Ontario, and colleagues.
The NPHS findings are not surprising, she told Medscape Medical News. "We resurveyed all our emergency physicians in January and found similar results, in that the levels of burnout were marginally less than they were in 2022 but still significantly higher than they were in 2020. Still, a majority of (emergency department) physicians qualify as having high burnout levels."
The Pandemic's Role
A telling finding of her team's research is that emergency physician burnout levels are now higher than they were in December 2020, the first year of the COVID pandemic, said De Wit. "I don't think you can say burnout is because of COVID. It's because of the problems in the medical system."
Among those problems in hospitals are a shortage of beds, physicians, and nurses and inadequate numbers of physicians in outpatient clinics "so patients are waiting for years" for conditions to be treated, she added.
"We don't have the resources that we need to maintain the standards that we had even 10, 15 years ago. The whole system is collapsing. Government underfunding is huge. Routinely, our emergency department is 100% full of ward patients, so we don't have a room with a door or a curtain to see patients in. All the emergency patients are seen in corridors or the waiting room in full view of everyone else. We have people with serious medical conditions who are dying in waiting rooms because we can't get them in."
The issues are complex, but the overarching problem is chronic underfunding that results in physicians "feeling overworked and powerless to help patients," said De Wit.
Burnell and de Wit reported having no relevant financial relationships.
Marcia Frellick is an independent health care journalist and a regular contributor to Medscape Medical News.
A version of this article first appeared on Medscape.com.
Nearly half of physicians in Canada report high levels of burnout, according to preliminary data from the 2025 National Physician Health Survey (NPHS). The new data show that 46% of physicians report high levels of burnout, down from 2021 (53%) but significantly above the level of 2017 (30%), when the first survey was conducted. The full NPHS 2025 Foundational Report will be released later this year.
Other significant findings include the following:
- 74% of physicians reported experiencing bullying, harassment, microaggressions, or discrimination, a slight but meaningful reduction form 78% in 2021.
- 64% of physicians reported spending significant time on electronic medical records outside regular hours.
- 46% of physicians said that their mental health is worse than it was before the start of the pandemic, down 14% from 2021.
- 60% reported being satisfied or very satisfied with work-life balance, an improvement from 49% in 2021, though slightly below 2017 (62%).
- 37% of physicians plan to reduce their clinical hours in the next 2 years.
Margot Burnell, MD, president of the Canadian Medical Association (CMA), told Medscape Medical News that she was "disappointed" with the results.
"I hoped that the burnout numbers would decrease more than they have," she said. "Physicians are still under extreme stress in trying to provide the care for patients that they wish to give."
Reductions in Hours
The most distressing finding is that > one-third of physicians (37%) plan to reduce their hours within 24 hours -- at a time of growing physician shortages -- said Burnell.
"The one positive (finding) that stands out is that physicians are taking care of their own health and wellness and report that it's helping," she said. About 65% of physicians reported having accessed at least 1 wellness support in the past 5 years, up 11% since 2021.
The NPHS includes responses from about 3300 practicing physicians, medical residents, and fellows who were surveyed from March 14 to April 15.
Among the CMA's top priorities is to reduce the administrative burden because that tops the list of what physicians say would help them with burnout, said Burnell.
"The other area is to provide and encourage team-based care," she continued. "That provides some relief for physicians." It also is important to promote the approaches that seem to be helping, such as wellness support and artificial intelligence (AI), she said. In this survey, 59% of respondents who used AI said that it decreased their time spent on administrative tasks.
Burnout by Specialty
Future analyses will examine burnout by specialty, Burnell said. Burnout is particularly high among emergency physicians, regardless of province, according to previous work by Kerstin de Wit, MD, emergency physician and research director for the Department of Emergency Medicine at Queen's University in Kingston, Ontario, and colleagues.
The NPHS findings are not surprising, she told Medscape Medical News. "We resurveyed all our emergency physicians in January and found similar results, in that the levels of burnout were marginally less than they were in 2022 but still significantly higher than they were in 2020. Still, a majority of (emergency department) physicians qualify as having high burnout levels."
The Pandemic's Role
A telling finding of her team's research is that emergency physician burnout levels are now higher than they were in December 2020, the first year of the COVID pandemic, said De Wit. "I don't think you can say burnout is because of COVID. It's because of the problems in the medical system."
Among those problems in hospitals are a shortage of beds, physicians, and nurses and inadequate numbers of physicians in outpatient clinics "so patients are waiting for years" for conditions to be treated, she added.
"We don't have the resources that we need to maintain the standards that we had even 10, 15 years ago. The whole system is collapsing. Government underfunding is huge. Routinely, our emergency department is 100% full of ward patients, so we don't have a room with a door or a curtain to see patients in. All the emergency patients are seen in corridors or the waiting room in full view of everyone else. We have people with serious medical conditions who are dying in waiting rooms because we can't get them in."
The issues are complex, but the overarching problem is chronic underfunding that results in physicians "feeling overworked and powerless to help patients," said De Wit.
Burnell and de Wit reported having no relevant financial relationships.
Marcia Frellick is an independent health care journalist and a regular contributor to Medscape Medical News.
A version of this article first appeared on Medscape.com.
Nearly half of physicians in Canada report high levels of burnout, according to preliminary data from the 2025 National Physician Health Survey (NPHS). The new data show that 46% of physicians report high levels of burnout, down from 2021 (53%) but significantly above the level of 2017 (30%), when the first survey was conducted. The full NPHS 2025 Foundational Report will be released later this year.
Other significant findings include the following:
- 74% of physicians reported experiencing bullying, harassment, microaggressions, or discrimination, a slight but meaningful reduction form 78% in 2021.
- 64% of physicians reported spending significant time on electronic medical records outside regular hours.
- 46% of physicians said that their mental health is worse than it was before the start of the pandemic, down 14% from 2021.
- 60% reported being satisfied or very satisfied with work-life balance, an improvement from 49% in 2021, though slightly below 2017 (62%).
- 37% of physicians plan to reduce their clinical hours in the next 2 years.
Margot Burnell, MD, president of the Canadian Medical Association (CMA), told Medscape Medical News that she was "disappointed" with the results.
"I hoped that the burnout numbers would decrease more than they have," she said. "Physicians are still under extreme stress in trying to provide the care for patients that they wish to give."
Reductions in Hours
The most distressing finding is that > one-third of physicians (37%) plan to reduce their hours within 24 hours -- at a time of growing physician shortages -- said Burnell.
"The one positive (finding) that stands out is that physicians are taking care of their own health and wellness and report that it's helping," she said. About 65% of physicians reported having accessed at least 1 wellness support in the past 5 years, up 11% since 2021.
The NPHS includes responses from about 3300 practicing physicians, medical residents, and fellows who were surveyed from March 14 to April 15.
Among the CMA's top priorities is to reduce the administrative burden because that tops the list of what physicians say would help them with burnout, said Burnell.
"The other area is to provide and encourage team-based care," she continued. "That provides some relief for physicians." It also is important to promote the approaches that seem to be helping, such as wellness support and artificial intelligence (AI), she said. In this survey, 59% of respondents who used AI said that it decreased their time spent on administrative tasks.
Burnout by Specialty
Future analyses will examine burnout by specialty, Burnell said. Burnout is particularly high among emergency physicians, regardless of province, according to previous work by Kerstin de Wit, MD, emergency physician and research director for the Department of Emergency Medicine at Queen's University in Kingston, Ontario, and colleagues.
The NPHS findings are not surprising, she told Medscape Medical News. "We resurveyed all our emergency physicians in January and found similar results, in that the levels of burnout were marginally less than they were in 2022 but still significantly higher than they were in 2020. Still, a majority of (emergency department) physicians qualify as having high burnout levels."
The Pandemic's Role
A telling finding of her team's research is that emergency physician burnout levels are now higher than they were in December 2020, the first year of the COVID pandemic, said De Wit. "I don't think you can say burnout is because of COVID. It's because of the problems in the medical system."
Among those problems in hospitals are a shortage of beds, physicians, and nurses and inadequate numbers of physicians in outpatient clinics "so patients are waiting for years" for conditions to be treated, she added.
"We don't have the resources that we need to maintain the standards that we had even 10, 15 years ago. The whole system is collapsing. Government underfunding is huge. Routinely, our emergency department is 100% full of ward patients, so we don't have a room with a door or a curtain to see patients in. All the emergency patients are seen in corridors or the waiting room in full view of everyone else. We have people with serious medical conditions who are dying in waiting rooms because we can't get them in."
The issues are complex, but the overarching problem is chronic underfunding that results in physicians "feeling overworked and powerless to help patients," said De Wit.
Burnell and de Wit reported having no relevant financial relationships.
Marcia Frellick is an independent health care journalist and a regular contributor to Medscape Medical News.
A version of this article first appeared on Medscape.com.
About Half of Canadian Physicians Report High Burnout Levels
About Half of Canadian Physicians Report High Burnout Levels
Why Veterans May Conceal Suicidal Thoughts
Veterans at risk of suicide may not share their suicidal ideation with their psychotherapists or may choose not to disclose enough detail to illustrate the depths of those thoughts due to feelings of shame or embarrassment, according to a newly published study. These individuals may view suicidal thoughts as a sign of weakness, fear involuntary hospitalization or prescriptions, or belong to marginalized groups who do not feel comfortable (or safe) to reveal their thoughts or intentions. This can make it difficult for mental health professionals to identify the exact details of a patient’s mindset and provide appropriate care.
A veteran’s first—and sometimes only—stop may be their primary care practitioner (PCPs) rather than a mental health professional. A review of 40 studies found that although 45% of individuals who died by suicide had contact with PCPs within 1 month of their death, only 19% had contact with mental health services. Studies have also found that veterans disclose suicidal ideation during primary care visits closest to the actual suicide less than half the time.
Patients may have an appointment for medical, but not psychological reasons. In a study conducted at Portland Veterans Affairs Medical Center (VAMC), researchers reviewed the medical records of 112 veterans who died by suicide and had contact with a VAMC within 1 year prior to death. Of those last contacts, 32% were patient-initiated for new or exacerbated medical concerns, and 68% were follow-ups.
In that study, health care professionals (HCPs) noted that 41 patients (37%) were experiencing emotional distress at the last contact, but 13 of 18 patients (72%) who were assessed for suicidal ideation at their last contact denied such thoughts. The study says this finding “highlights the complexity of addressing suicidal ideation and associated risk factors in health care settings.” Additionally, a number of veterans who died by suicide either did not have suicidal thoughts at the time of their last contact with HCPs or denied such thoughts even when questioned.
In 2018, the Veterans Health Administration (VHA) implemented the Suicide Risk Identification Strategy (Risk ID), an evidence-informed assessment that includes initial screening and subsequent evaluation. Veterans receiving VHA care are screened annually for suicidal ideation and behaviors. Most screening takes place in primary care and mental health specialty settings, but timely screening may not be enough to assess who is at risk if the patients aren’t being forthcoming about their thoughts and plans.
A recent cross-sectional national survey examined the frequency of self-reported “inaccurate disclosure” of suicidal ideation during initial screening and subsequent evaluation among 734 VHA patients screened in primary care.
Using the Risk ID process with the Columbia Suicide Severity Rating Scale Screener (C-SSRS), the study asked respondents about their previous suicide screening in 2021. Of the 734 respondents, 306 screened positive and 428 screened negative. One survey item asked about the extent to which veterans had accurately responded to the HCP when asked about suicidal thoughts, while another asked how likely they would discuss when they felt suicidal with their PCP.
The study found that inaccurate disclosure is not uncommon: When asked about suicidal thoughts, about one-fifth of screen-negative participants and two-fifths of screen-positive participants said they responded, “less than very accurately.”
In the screen-positive group, women and those who reported more barriers to care were less likely to discuss feeling suicidal. Veterans who had lower ratings of satisfaction with the screening process, patient-staff communication, and the therapeutic relationship reported being less likely to discuss times they were suicidal. Notably, among C-SSRS-negative patients, Black, American Indian/Alaska Native, Hispanic, Asian, and multiracial veterans were more likely than White veterans to inaccurately report suicidal thoughts.
This is consistent with studies on medical mistrust and other research suggesting that veterans who have experienced identity-based discrimination may be less inclined to discuss suicidal thoughts with VHA HCPs. A large 2023 study surveyed veterans about why they might hold back such information. One Gulf War-era veteran, a Black woman, had encountered discrimination when filing her VA benefits claim, leading her to feel like the care system was not interested in helping her.
“It’s one of the main reasons why when I do go in, they don’t get an honest response,” she wrote in her survey response. “I feel that you’re not for me, you’re not trying to help me, you don’t wanna help me, and why even go through it, go through the motions it seems. So, I can come in feeling suicidal and I leave out feeling suicidal then.”
Veterans typically welcome screening for suicidal risk. In a 2023 study, > 90% of veterans reported that it is appropriate to be asked about thoughts of suicide during primary care visits, and about one-half agreed that veterans should be asked about suicidal thoughts at every visit.
For many, though, the level of trust they have with HCPs makes or breaks whether they discuss their suicidal ideation. Higher ratings of the therapeutic relationship with clinicians are associated with more frequent disclosure. However, the screen-positive group demonstrated higher rates of inaccurate disclosure than the screen-negative group. While this may seem counterintuitive, it is possible that screen-positive individuals did not fully disclose their thoughts on the initial screen, or did not fully disclose the severity of their thoughts during follow-up evaluations. Individuals who disclose suicidal thoughts during initial screening may be ambivalent about disclosure and/or become more concerned about consequences of disclosure as additional evaluation ensues.
A 2013 study of 34 Operation Enduring Freedom/Operation Iraqi Freedom veterans found that veterans felt trying to suppress and avoid thoughts of suicide was “burdensome and exhausting.” Despite this, they often failed to disclose severe and pervasive suicidal thoughts when screened. Among the reasons was that they perceived the templated computer reminder process as “perfunctory and disrespectful.”
Research has found that HCPs who focuses on building relationships, demonstrates genuineness and empathy, and uses straightforward and understandable language promotes the trust that can result in more honest disclosure of suicidal thoughts. In the “inaccurate disclosure” study, some veterans reported they did not understand the screening questions, or the questions did not make sense to them. This aligns with prior research, which demonstrates that how HCPs and researchers conceptualize suicidal thoughts may not fit with patients’ experiences. A lack of shared terminology, they note, “may confound how we think about ‘under-disclosure,’ such that perhaps patients may not be trying to hide their thoughts so much as not finding screening questions applicable to their unique situations or experiences.”
Veterans at risk of suicide may not share their suicidal ideation with their psychotherapists or may choose not to disclose enough detail to illustrate the depths of those thoughts due to feelings of shame or embarrassment, according to a newly published study. These individuals may view suicidal thoughts as a sign of weakness, fear involuntary hospitalization or prescriptions, or belong to marginalized groups who do not feel comfortable (or safe) to reveal their thoughts or intentions. This can make it difficult for mental health professionals to identify the exact details of a patient’s mindset and provide appropriate care.
A veteran’s first—and sometimes only—stop may be their primary care practitioner (PCPs) rather than a mental health professional. A review of 40 studies found that although 45% of individuals who died by suicide had contact with PCPs within 1 month of their death, only 19% had contact with mental health services. Studies have also found that veterans disclose suicidal ideation during primary care visits closest to the actual suicide less than half the time.
Patients may have an appointment for medical, but not psychological reasons. In a study conducted at Portland Veterans Affairs Medical Center (VAMC), researchers reviewed the medical records of 112 veterans who died by suicide and had contact with a VAMC within 1 year prior to death. Of those last contacts, 32% were patient-initiated for new or exacerbated medical concerns, and 68% were follow-ups.
In that study, health care professionals (HCPs) noted that 41 patients (37%) were experiencing emotional distress at the last contact, but 13 of 18 patients (72%) who were assessed for suicidal ideation at their last contact denied such thoughts. The study says this finding “highlights the complexity of addressing suicidal ideation and associated risk factors in health care settings.” Additionally, a number of veterans who died by suicide either did not have suicidal thoughts at the time of their last contact with HCPs or denied such thoughts even when questioned.
In 2018, the Veterans Health Administration (VHA) implemented the Suicide Risk Identification Strategy (Risk ID), an evidence-informed assessment that includes initial screening and subsequent evaluation. Veterans receiving VHA care are screened annually for suicidal ideation and behaviors. Most screening takes place in primary care and mental health specialty settings, but timely screening may not be enough to assess who is at risk if the patients aren’t being forthcoming about their thoughts and plans.
A recent cross-sectional national survey examined the frequency of self-reported “inaccurate disclosure” of suicidal ideation during initial screening and subsequent evaluation among 734 VHA patients screened in primary care.
Using the Risk ID process with the Columbia Suicide Severity Rating Scale Screener (C-SSRS), the study asked respondents about their previous suicide screening in 2021. Of the 734 respondents, 306 screened positive and 428 screened negative. One survey item asked about the extent to which veterans had accurately responded to the HCP when asked about suicidal thoughts, while another asked how likely they would discuss when they felt suicidal with their PCP.
The study found that inaccurate disclosure is not uncommon: When asked about suicidal thoughts, about one-fifth of screen-negative participants and two-fifths of screen-positive participants said they responded, “less than very accurately.”
In the screen-positive group, women and those who reported more barriers to care were less likely to discuss feeling suicidal. Veterans who had lower ratings of satisfaction with the screening process, patient-staff communication, and the therapeutic relationship reported being less likely to discuss times they were suicidal. Notably, among C-SSRS-negative patients, Black, American Indian/Alaska Native, Hispanic, Asian, and multiracial veterans were more likely than White veterans to inaccurately report suicidal thoughts.
This is consistent with studies on medical mistrust and other research suggesting that veterans who have experienced identity-based discrimination may be less inclined to discuss suicidal thoughts with VHA HCPs. A large 2023 study surveyed veterans about why they might hold back such information. One Gulf War-era veteran, a Black woman, had encountered discrimination when filing her VA benefits claim, leading her to feel like the care system was not interested in helping her.
“It’s one of the main reasons why when I do go in, they don’t get an honest response,” she wrote in her survey response. “I feel that you’re not for me, you’re not trying to help me, you don’t wanna help me, and why even go through it, go through the motions it seems. So, I can come in feeling suicidal and I leave out feeling suicidal then.”
Veterans typically welcome screening for suicidal risk. In a 2023 study, > 90% of veterans reported that it is appropriate to be asked about thoughts of suicide during primary care visits, and about one-half agreed that veterans should be asked about suicidal thoughts at every visit.
For many, though, the level of trust they have with HCPs makes or breaks whether they discuss their suicidal ideation. Higher ratings of the therapeutic relationship with clinicians are associated with more frequent disclosure. However, the screen-positive group demonstrated higher rates of inaccurate disclosure than the screen-negative group. While this may seem counterintuitive, it is possible that screen-positive individuals did not fully disclose their thoughts on the initial screen, or did not fully disclose the severity of their thoughts during follow-up evaluations. Individuals who disclose suicidal thoughts during initial screening may be ambivalent about disclosure and/or become more concerned about consequences of disclosure as additional evaluation ensues.
A 2013 study of 34 Operation Enduring Freedom/Operation Iraqi Freedom veterans found that veterans felt trying to suppress and avoid thoughts of suicide was “burdensome and exhausting.” Despite this, they often failed to disclose severe and pervasive suicidal thoughts when screened. Among the reasons was that they perceived the templated computer reminder process as “perfunctory and disrespectful.”
Research has found that HCPs who focuses on building relationships, demonstrates genuineness and empathy, and uses straightforward and understandable language promotes the trust that can result in more honest disclosure of suicidal thoughts. In the “inaccurate disclosure” study, some veterans reported they did not understand the screening questions, or the questions did not make sense to them. This aligns with prior research, which demonstrates that how HCPs and researchers conceptualize suicidal thoughts may not fit with patients’ experiences. A lack of shared terminology, they note, “may confound how we think about ‘under-disclosure,’ such that perhaps patients may not be trying to hide their thoughts so much as not finding screening questions applicable to their unique situations or experiences.”
Veterans at risk of suicide may not share their suicidal ideation with their psychotherapists or may choose not to disclose enough detail to illustrate the depths of those thoughts due to feelings of shame or embarrassment, according to a newly published study. These individuals may view suicidal thoughts as a sign of weakness, fear involuntary hospitalization or prescriptions, or belong to marginalized groups who do not feel comfortable (or safe) to reveal their thoughts or intentions. This can make it difficult for mental health professionals to identify the exact details of a patient’s mindset and provide appropriate care.
A veteran’s first—and sometimes only—stop may be their primary care practitioner (PCPs) rather than a mental health professional. A review of 40 studies found that although 45% of individuals who died by suicide had contact with PCPs within 1 month of their death, only 19% had contact with mental health services. Studies have also found that veterans disclose suicidal ideation during primary care visits closest to the actual suicide less than half the time.
Patients may have an appointment for medical, but not psychological reasons. In a study conducted at Portland Veterans Affairs Medical Center (VAMC), researchers reviewed the medical records of 112 veterans who died by suicide and had contact with a VAMC within 1 year prior to death. Of those last contacts, 32% were patient-initiated for new or exacerbated medical concerns, and 68% were follow-ups.
In that study, health care professionals (HCPs) noted that 41 patients (37%) were experiencing emotional distress at the last contact, but 13 of 18 patients (72%) who were assessed for suicidal ideation at their last contact denied such thoughts. The study says this finding “highlights the complexity of addressing suicidal ideation and associated risk factors in health care settings.” Additionally, a number of veterans who died by suicide either did not have suicidal thoughts at the time of their last contact with HCPs or denied such thoughts even when questioned.
In 2018, the Veterans Health Administration (VHA) implemented the Suicide Risk Identification Strategy (Risk ID), an evidence-informed assessment that includes initial screening and subsequent evaluation. Veterans receiving VHA care are screened annually for suicidal ideation and behaviors. Most screening takes place in primary care and mental health specialty settings, but timely screening may not be enough to assess who is at risk if the patients aren’t being forthcoming about their thoughts and plans.
A recent cross-sectional national survey examined the frequency of self-reported “inaccurate disclosure” of suicidal ideation during initial screening and subsequent evaluation among 734 VHA patients screened in primary care.
Using the Risk ID process with the Columbia Suicide Severity Rating Scale Screener (C-SSRS), the study asked respondents about their previous suicide screening in 2021. Of the 734 respondents, 306 screened positive and 428 screened negative. One survey item asked about the extent to which veterans had accurately responded to the HCP when asked about suicidal thoughts, while another asked how likely they would discuss when they felt suicidal with their PCP.
The study found that inaccurate disclosure is not uncommon: When asked about suicidal thoughts, about one-fifth of screen-negative participants and two-fifths of screen-positive participants said they responded, “less than very accurately.”
In the screen-positive group, women and those who reported more barriers to care were less likely to discuss feeling suicidal. Veterans who had lower ratings of satisfaction with the screening process, patient-staff communication, and the therapeutic relationship reported being less likely to discuss times they were suicidal. Notably, among C-SSRS-negative patients, Black, American Indian/Alaska Native, Hispanic, Asian, and multiracial veterans were more likely than White veterans to inaccurately report suicidal thoughts.
This is consistent with studies on medical mistrust and other research suggesting that veterans who have experienced identity-based discrimination may be less inclined to discuss suicidal thoughts with VHA HCPs. A large 2023 study surveyed veterans about why they might hold back such information. One Gulf War-era veteran, a Black woman, had encountered discrimination when filing her VA benefits claim, leading her to feel like the care system was not interested in helping her.
“It’s one of the main reasons why when I do go in, they don’t get an honest response,” she wrote in her survey response. “I feel that you’re not for me, you’re not trying to help me, you don’t wanna help me, and why even go through it, go through the motions it seems. So, I can come in feeling suicidal and I leave out feeling suicidal then.”
Veterans typically welcome screening for suicidal risk. In a 2023 study, > 90% of veterans reported that it is appropriate to be asked about thoughts of suicide during primary care visits, and about one-half agreed that veterans should be asked about suicidal thoughts at every visit.
For many, though, the level of trust they have with HCPs makes or breaks whether they discuss their suicidal ideation. Higher ratings of the therapeutic relationship with clinicians are associated with more frequent disclosure. However, the screen-positive group demonstrated higher rates of inaccurate disclosure than the screen-negative group. While this may seem counterintuitive, it is possible that screen-positive individuals did not fully disclose their thoughts on the initial screen, or did not fully disclose the severity of their thoughts during follow-up evaluations. Individuals who disclose suicidal thoughts during initial screening may be ambivalent about disclosure and/or become more concerned about consequences of disclosure as additional evaluation ensues.
A 2013 study of 34 Operation Enduring Freedom/Operation Iraqi Freedom veterans found that veterans felt trying to suppress and avoid thoughts of suicide was “burdensome and exhausting.” Despite this, they often failed to disclose severe and pervasive suicidal thoughts when screened. Among the reasons was that they perceived the templated computer reminder process as “perfunctory and disrespectful.”
Research has found that HCPs who focuses on building relationships, demonstrates genuineness and empathy, and uses straightforward and understandable language promotes the trust that can result in more honest disclosure of suicidal thoughts. In the “inaccurate disclosure” study, some veterans reported they did not understand the screening questions, or the questions did not make sense to them. This aligns with prior research, which demonstrates that how HCPs and researchers conceptualize suicidal thoughts may not fit with patients’ experiences. A lack of shared terminology, they note, “may confound how we think about ‘under-disclosure,’ such that perhaps patients may not be trying to hide their thoughts so much as not finding screening questions applicable to their unique situations or experiences.”
