Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats | Depressive Disorders | JAMA Network Open | JAMA Network
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    Original Investigation
    Medical Education
    August 14, 2019

    Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats

    Author Affiliations
    • 1Department of Social Science, Middlesex Community College, Middletown, Connecticut
    • 2Department of Internal Medicine, University of Iowa, Iowa City
    • 3School of Public Health, University of Michigan, Ann Arbor
    • 4Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
    • 5University of Michigan Health System, Cardiovascular Medicine and Vascular Medicine, Ann Arbor
    • 6Department of Population Health Sciences, University of Utah, Salt Lake City
    • 7VA Salt Lake City Health Care System, Salt Lake City, Utah
    JAMA Netw Open. 2019;2(8):e199277. doi:10.1001/jamanetworkopen.2019.9277
    Key Points español 中文 (chinese)

    Question  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?

    Findings  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.

    Meaning  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.


    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.