Abstract
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.
Highlights
Gathering information from patients is essential to clinicians’ ability to help promote, maintain, and restore patients’ health
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 [odds ratios (ORs)], 1.66 [95% CI, 1.30-2.11]; and Survey Sampling International (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 associated with nondisclosure, but only in the SSI sample (OR, 0.85 [95% CI, 0.74-0.96])
Summary
Gathering information from patients is essential to clinicians’ ability to help promote, maintain, and restore patients’ health. Previous research has demonstrated that patients frequently withhold relatively mundane, non–life-threatening information (eg, lack of exercise) from clinicians,[1,2] but little is known about patient nondisclosure of information about experiencing an imminent threat to their lives (eg, being abused or suicidal) Prior research in this area has primarily been conducted outside of the United States and has a number of limitations: the study samples were constrained to a specific age range, sex, or geographic area; only 1 imminent threat was examined; and/or the scenarios were hypothetical.[3,4,5,6,7,8,9] In this study, we examined the prevalence of US patients’ self-reported nondisclosure of information to their clinician about 4 imminent threats and their reasons for nondisclosure
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