Patient comfort discussing sensitive behavioral health topics

ABSTRACT

Background

: Following implementation of routine screening for depression in primary care, screening for other behavioral health issues is expanding. However, prior to implementing additional screening it is important to consider patient comfort answering sensitive questions related to behavioral health topics to determine screening acceptability and effectiveness.

Methods

: A self-report survey was completed by U.S. adults over the age of 18 (n = 378) using Amazon Mechanical Turk. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with medical providers. Comfort levels of behavioral health topics were compared to comfort discussing depression symptoms and reasons for discomfort discussing topics were also surveyed.

Results

: There were significant differences in comfort level discussing various behavioral health issues (F(8) = 51.70, P < .001). Participants reported being more comfortable discussing cigarette smoking and less comfortable discussing trauma, intimate partner violence (IPV) and gun ownership compared to depression. Privacy and perceived irrelevance were the most common reasons for discomfort.

Conclusions

: Accurate indices of patient behavioral health are essential for patient care. However, patients may be uncomfortable discussing some topics such as trauma, IPV, and gun ownership that patients view as private and/or unrelated to their treatment. Patient comfort may increase through provider trainings that focus on communication skills training, clear administrative procedures that allow for privacy and adequate time for discussions, and community education that underscores how these issues impact physical health.

KEYWORDS:

• Behavioral health
• screening
• comfort
• depression
• trauma
• disclosure
• health communication

Ethical approval

The study was approved by the University of Illinois at Chicago Institutional Review Board, Chicago, IL, U.S.A. on July 26, 2017 (Reference Number 2017-0716).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

Dr. Marcio da Fonseca’s (project co-Investigator) Underrepresented Minority Recruitment Funds from the University of Illinois Chicago College of Dentistry.

Notes on contributors

Sheela Raja

Sheela Raja, PhD is an Associate Professor, Clinical Psychologist, and the Director of the UIC College of Dentistry Resilience Center. She is the author of 4 books: Overcoming Trauma and PTSD, The PTSD Survival Guide for Teens, The Sexual Trauma For Teens Girls and The Resilient Teen: 10 Key Skills to Bounce Back from Setbacks and Turn Stress into Success (New Harbinger Presss). She also serves as a consultant to the Office on Women’s Health (US Department of Health and Human Services) on trauma informed healthcare initiatives.

Emily P. Rabinowitz

Emily Paige Rabinowitz is currently a doctoral candidate in Clinical Psychology. Her current research focus is on psychological mechanisms of chronic pain, PTSD, and trauma informed care.

MacKenzie A. Sayer

MacKenzie Ann Sayer is currently a doctoral candidate in Clinical Psychology. Her current research focus is on identifying early biopsychosocial risk factors for persist psychopathology following trauma exposure. She also has a specific interest in women’s health and the influence of sex hormones on psychological phenomenon.

Marcio da Fonseca

Marcio da Fonseca, has extensive clinical experience in dental care for medically compromised children and adolescents. His research interests include oral-systemic health connections, dental education and poverty.