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. 2024 Apr 3;31(4):1025-1035.
doi: 10.1093/jamia/ocae023.

Stressful life events in electronic health records: a scoping review

Dmitry Scherbakov  1 , Abolfazl Mollalo  1 , Leslie Lenert  1
Affiliations

Stressful life events in electronic health records: a scoping review

Dmitry Scherbakov et al. J Am Med Inform Assoc. .

Abstract

Objectives: Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer 2 major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care.

Materials and methods: Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by 2 independent reviewers.

Results: Five hundred fifty-seven unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n = 36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n = 15, 21.4%), extraction of events from free-text notes (n = 12, 17.1%), discussing privacy and other issues of storing life events (n = 5, 7.1%), and new EHR features related to life events (n = 4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n = 7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n = 7, 46.7%) were discussing interventions related to social determinants of health in general.

Discussion and conclusions: Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.

Keywords: EHR; electronic health records; life-change events; negative life events; social determinants of health; stressful life events.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1.
Figure 1.
Flow diagram of the scoping review process.
Figure 2.
Figure 2.
Citations by country of origin. A: by country; B: by US state.
Figure 3.
Figure 3.
A: Citations by area of focus; B: citations classified by source of stressful life events; C: citations by EHR data types and methods of extraction; D: outcome variables in statistical studies by their area.
Figure 4.
Figure 4.
Stressful life events by number of citations in which they are mentioned (excluding events mentioned by only one citation).
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