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How common is it for patients to withhold information from clinicians about imminent threats that they face (depression, suicidality, abuse, or sexual assault), and what are common reasons for nondisclosure?
This survey study, incorporating 2 national, nonprobability, online surveys of a total of 4510 US adults, found that at least one-quarter of participants who experienced each imminent threat reported withholding this information from their clinician. The most commonly endorsed reasons for nondisclosure included potential embarrassment, being judged, or difficult follow-up behavior.
These findings suggest that concerns about potential negative repercussions may lead many patients who experience imminent threats to avoid disclosing this information to their clinician.
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.
Design, Setting, and Participants
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.
Main Outcomes and Measures
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]).
Conclusions and Relevance
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.
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Accepted for Publication: June 25, 2019.
Published: August 14, 2019. doi:10.1001/jamanetworkopen.2019.9277
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Levy AG et al. JAMA Network Open.
Corresponding Author: Andrea Gurmankin Levy, PhD, MBe, Middlesex Community College, 100 Training Hill Rd, Middletown, CT 06457 (firstname.lastname@example.org).
Author Contributions: Drs Levy and Scherer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Levy, Fagerlin.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Levy.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Levy, Scherer, Larkin.
Obtained funding: Fagerlin.
Administrative, technical, or material support: Levy, Barnes.
Supervision: Barnes, Fagerlin.
Conflict of Interest Disclosures: Dr Barnes reported grants and personal fees from Pfizer and Bristol-Myers Squibb; personal fees from Janssen, Portola, and AMAG Pharmaceuticals; and grants from the National Heart, Lung, and Blood Institute and Blue Cross-Blue Shield of Michigan outside the submitted work. No other disclosures were reported.
Funding/Support: This work was funded by Dr Fagerlin’s faculty research funds, which were provided by the University of Michigan Division of General Medicine.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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