Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats

• Published in: JAMA network open Vol. 2; no. 8; p. e199277
• Main Authors: Levy, Andrea Gurmankin, Scherer, Aaron M, Zikmund-Fisher, Brian J, Larkin, Knoll, Barnes, Geoffrey D, Fagerlin, Angela
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 02-08-2019
• Subjects: Medical Education; Nondisclosure; Online Only; Original Investigation; Patients; Sex crimes
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2019.9277

Patient disclosure to their clinician about experiencing an imminent threat is a critical step toward receiving support or assistance.
To examine the frequency of patients not disclosing their experience of imminent threats to their clinician and their reasons for doing so.
Survey study incorporating results from 2 national, nonprobability samples of 2011 US adults recruited from Amazon's Mechanical Turk (MTurk) from March 16 to 30, 2015, and 2499 recruited from Survey Sampling International (SSI) from November 6 to 17, 2015. Data analysis was conducted from December 20 to 28, 2018.
Self-reported nondisclosure of 4 types of imminent threats (depression, suicidality, abuse, and sexual assault) to their clinician and reasons for nondisclosure.
There were 2011 participants in the MTurk sample (1210 [60.3%] female; 1696 [60.2%] white; mean [SD] age, 35.7 [12.4] years; age range, 18-79 years) and 2499 participants (1273 [51.0%] female; 1968 [78.8%] white; mean [SD] age, 61.0 [7.6] years; age range, 50-91 years) in the SSI sample. Among those who reported experiencing at least 1 of the 4 imminent threats, 613 of 1292 MTurk participants (47.5%) and 581 of 1453 SSI participants (40.0%) withheld information from their clinician. The most commonly endorsed reasons for withholding this information included being embarrassed (MTurk: 72.7%; SSI: 70.9%), not wanting to be judged or lectured (MTurk: 66.4%; SSI: 53.4%), and not wanting to engage in a difficult follow-up behavior (MTurk: 62.4%; SSI: 51.1%). Respondents who experienced at least 1 of the 4 imminent threats had significantly higher odds of nondisclosure in both samples if they were female (MTurk: odds ratio [OR], 1.66 [95% CI, 1.30-2.11]; and SSI: OR, 1.33 [95% CI, 1.07-1.67]) or younger (MTurk: OR, 0.99 [95% CI, 0.98-1.00]; and SSI: OR, 0.98 [95% CI, 0.97-1.00]). Worse self-rated health was also associated with nondisclosure, but only in the SSI sample (OR, 0.85 [95% CI, 0.74-0.96]).
This study suggests that many people withhold information from their clinicians about imminent health threats that they face. A better understanding of how to increase patients' comfort with reporting this information is critical to allowing clinicians to help patients mitigate these potentially life-threatening risks.