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Article History

Received: 12 March 2026

Accepted: 22 May 2026

First Online: 31 May 2026

Declarations

Ethics approval and consent to participate: This research study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to initiating study procedures. The Colorado Multiple Institutional Review Board (COMIRB# 20–0719) and VA Eastern Colorado Healthcare System Research and Development Committee provided ethics approval to conduct this study.

Consent for publication: Not applicable.

Human ethics and consent to participate: All participants provided informed consent to participate in the ASCEND study.

Competing interests: Authors report funding from the U.S. Department of Veterans Affairs (VA) Office of Suicide Prevention (Monteith, Simonetti, Kittel, Holliday, Barnes, Polzer, Hoffmire), VA Health Systems Research (Monteith, Simonetti, Kittel, Holliday, Polzer, Hoffmire), VA Rehabilitation Research Development and Translation (Holliday, Barnes), VA National Center for Patient Safety (Monteith), VA Office of Health Equity (Monteith, Holliday), VA Office of Rural Health (Holliday), VA LGBTQ+ Health Program (Monteith), the U.S. Department of Defense, Congressionally Directed Medical Research Programs (Monteith, Simonetti, Holliday, Barnes, Polzer, Hoffmire), Face the Fight against Veteran Suicide (Monteith, Holliday, Simonetti), the National Institutes of Health (Simonetti), the Centers for Disease Control and Prevention (Simonetti), Fund for a Safer Future (Simonetti), Anschutz Family Foundation (Simonetti), Colorado Department of Public Health and Environment (Simonetti), and the State of Colorado (Holliday). All authors also report employment by the VA.