Leibowitz RQ (VERDICT)
Jeffries M (University of Texas Health Sciences Center, San Antonio)
Dunn D (South Texas Veterans Administration Healthcare System)
Huerta Y (South Texas Veterans Administration Healthcare System)
Casada J (University of Texas Health Sciences Center, San Antonio)
Noel PH (VERDICT)
To explore contexts under which veterans with DSM-IV Criterion A trauma histories decide whether to disclose trauma-related experiences and distress to health providers.
Mixed quantitative/qualitative design. Surveys of veterans in PTSD treatment assess medical conditions, lifetime traumas, current distress, and trauma disclosure. Semi-structured interviews explore disclosure experiences, beliefs, and perceived short- and long-term outcomes. These queries form part of a larger study including primary care patients and providers, and mental health specialists.
Participants were predominantly male, ethnically diverse, Vietnam-era veterans reporting an average of 3.6 lifetime traumas. Analyses of 61 of >200 planned surveys indicate the most frequently-reported traumas involved combat (83.6%), serious accident (41%), toxic substance exposure (32.8%), and atrocity (31.1%). The average number of comorbid conditions was 5.62, including depression (91.8%) and hypertension (57.4%). Most participants disclosed to health providers more than five years ago. 11.5% disclosed within the past year. 83.6% did not connect their symptoms or trauma history to PTSD at time of disclosure. For 59%, disclosure was prompted by a friend or family member. 37.7% disclosed in response to screening. Veterans most frequently disclosed to psychologists (39.3%) and physicians (32.8%). Although they primarily reported helpful responses, 31.1% reported the provider appeared shocked, 19.7% recalled the provider appeared not to believe the veteran, and 13.1% reported the provider had ignored the disclosure and changed the topic. Emerging themes from 11 of 45 projected interviews suggest that provider age, expertise, manner (e.g., personal vs. “professional,”; receptive, listening stance), one-on-one communication, privacy of setting, veteran’s perceived stigma, fears regarding employment, family issues, and feeling out of control are among the variables that most contributed to veterans’ willingness to disclose.
Patients disclose trauma to providers for a variety of reasons. They often do not realize the connection between past trauma and disturbing symptoms until a provider recognizes it. Specific provider behaviors and attitudes may affect veterans’ willingness to disclose.
Clarifying contexts within the medical environment that hinder or encourage patients to disclose trauma and its attendant distress will help us better serve veterans of previous conflicts and those returning from Iraq and Afghanistan.