Patient And Provider Factors That Increase Disclosure Of Psychosocial Problems
BACKGROUND: Psychosocial risks such as domestic violence (DV), mental illness (MH) and substance abuse (SA) are common and harmful to health, especially during pregnancy. Both providers and patients face multiple barriers to disclosure.
Goal. Describe rates of prenatal disclosure and the factors associated with disclosure.
METHODS: The Mom's Health Experiences study is a prospective mixed-methods study of 244 women recruited during their postpartum hospital stay. Based upon their phone survey responses and prenatal medical records, participants were categorized into: (1) Do NOT have problem, (2) Problem, but not disclosed, (3) Problem, disclosed. "Problems" were defined using validated screeners (DV, MH, SA). Disclosure was defined as medical record documentation of a positive result. Demographic and provider predictors were assessed using logistic regression.
RESULTS: In total, 57.3% (140 of 244) of women screened positive for one or more problems: 38.5% prenatal depression (MH), 28.7% past-year problem drinking (SA), 5.3% DV. Most (41.3%) had a single problem, but 13.5% had two problems and a couple (0.8%) had all three problems. Disclosure rates varied by problem type, and were highest for MH (51.1%), followed by DV (38.5%) and lowest for SA (11.4%). Logistic regression revealed two factors that increased disclosure: having multiple problems (aOR 2.40, CI 1.08 & 5.38, p=.033), and having lower income (aOR 2.17, CI 1.06 & 4.37, p=.033). Provider factors (medical home, primary care provider, provider relationship) were not significantly associated with disclosure.
CONCLUSION: Disclosure of psychosocial problems, which are common among pregnant women, was more related to patient circumstances than to provider characteristics.