Mental Health

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.

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.

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.

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.”

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.

This article has been updated with a response from the US Department of Veterans Affairs.

The number of US Department of Veterans Affairs (VA) geriatric mental health professionals is failing to keep pace with a growing population of older veterans: nearly 8 million are aged ≥ 65 years. VA psychologists may treat older veterans in primary care settings or community living centers, but many lack formal training in geropsychology.

Some psychologists with the proper training to treat this population are leaving the workforce; a survey by the VA Office of Inspector General found psychology was the most frequently reported severe clinical occupational staffing shortage and the most frequently reported Hybrid Title 38 severe shortage occupation, with 57% of 139 facilities reporting it as a shortage. According to the September Workforce Dashboard, the VA has lost > 200 psychologists in 2025.

Veterans aged ≥ 65 years have higher rates of combined medical and mental health diagnoses than younger veterans and older nonveterans. Nearly 1 of 5 older veterans enrolled in US Department of Veterans Affairs (VA) health care services have confirmed mental health diagnoses, and another 26% have documented mental health concerns without a formal diagnosis in their health record. 

Older veterans also tend to have more complex mental health issues than younger adults. Posttraumatic stress nearly doubles their risk of dementia, and their psychiatric diagnoses may be complicated by co-occurring delirium, social isolation/loneliness, and polypharmacy.

According to reporting by The War Horse, the VA has been instituting limits on one-on-one mental health therapy and transitioning veterans to lower levels of treatment after having been told to stop treating them for long, indeterminate periods prior to referring them to group therapy, primary care, or discharging them altogether. In a statement to Federal Practitioner, VA Press Secretary Pete Kasperowicz refuted the reporting from The War Horse.

"The War Horse story is false. VA does not put caps on one-on-one mental health sessions for veterans with clinical care needs," he told Federal Practitioner. "VA works with veterans over an initial eight to 15 mental health sessions, and collaboratively plans any needed follow-on care. As part of this process, veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy."

The smaller pool of qualified mental health practitioners also may be due to medical students not knowing enough about the category. A study of 136 medical students and 61 internal medicine residents at an academic health center evaluated their beliefs and attitudes regarding 25 content areas essential to the primary care of older adults. Students and residents expressed similar beliefs about the importance of content areas, and attitudes toward aging did not appreciably differ. However, students rated lower in knowledge in areas surrounding general primary care, such as chronic conditions and medications. Residents reported larger gap scores in areas that reflected specialists’ expertise (eg, driving risk, cognition, and psychiatric symptoms).

VA does have channels for filling the gap in geriatric health care. Established in 1975, Geriatric Research, Education, and Clinical Centers (GRECCs), are the department’s centers of excellence focused on aging. Currently, there are 20 GRECCs across the country, each connected with a major research university. Studies focus on aging, for example, examining the effects of Alzheimer’s disease or traumatic brain injuries. 

Geriatric Scholars 

To specifically fill the gap in mental health care, the Geriatric Scholars Program (GSP) was developed in 2008. Initially focused on primary care physicians, nurse practitioners, physician assistants, and pharmacists, the program later expanded to include other disciplines, including psychiatrists. In 2013, the GSP–Psychology Track (GSP-P) was developed because there were no commercially available training in geropsychology for licensed psychologists. GSP-P is based on an evidence-based educational model for the VA primary care workforce and includes a stepwise curriculum design, pilot implementation, and program evaluation. 

A recent survey that assessed the track’s effectiveness found respondents “strongly agreed” that participation in the program improved their geropsychology knowledge and skills. That positive reaction led to shifts in practice that had a positive impact on VA organizational goals. Several GSP-P graduates have become board certified in geropsychology and many proceed to supervise geropsychology-focused clinical rotations for psychology practicum students, predoctoral interns, and postdoctoral fellows.

Whether programs such as GSP-P can adequately address the dwindling number of VA mental health care professionals remains to be seen. More than 160 doctors, psychologists, nurses, and researchers sent a letter to VA Secretary Doug Collins, the VA inspector general, and congressional leaders on Sept. 24 warning that workforce reductions and moves to outsource care will harm veterans.

“We have witnessed these ongoing harms and can provide evidence and testimony of their impacts,” the letter read. By the next day, the number of signees had increased to 350. 

Though these shortages may impact their mental health care, older veterans could have an edge in mental resilience. While research in younger adults has found positive linear associations between physical health difficulties and severity of psychiatric symptoms, older veterans may benefit from what researchers have called an “aging paradox,” in which mental health improves later in life despite declining physical and cognitive function. A 2021 study suggests that prevention and treatment strategies designed to foster attachment security, mindfulness, and purpose in life may help enhance psychological resilience to physical health difficulties in older veterans.