Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats

Abstract

Importance: Patient disclosure to their clinician about experiencing an imminent threat is a critical step toward receiving support or assistance.

Objective: 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.

Results: 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.

Figure 1.. Nondisclosure and Disclosure Frequencies Among Respondents Who Experienced Each Imminent Threat

Sample size was 2011 for Amazon’s Mechanical Turk (A) and 2499 for Survey Sampling International (B).

Figure 2.. Percentage of Times a Reason Was Endorsed for Nondisclosure Across Types of Information

Denominators were the total number of reasons for nondisclosure selected for each threat. Column totals may exceed 100% because participants could check multiple reasons. Error bars indicate 95% confidence intervals; MTurk, Amazon’s Mechanical Turk; and SSI, Survey Sampling International. ^aExamples of potentially difficult behaviors were provided in this response option for each threat (eg, “take antidepressants or see a therapist” for suicidal thoughts). ^bReason only offered for nondisclosure of depression.

Figure 3.. Odds of Nondisclosure of Imminent Threats

The graphs show adjusted log odds ratios (ORs) for nondisclosure and the columns show ORs for nondisclosure in 1264 participants from the Amazon Mechanical Turk sample (A) and 1398 participants from the Survey Sampling International sample (B). ^aP < .001. ^bP < .05.