Interpersonal Violence Disclosure in Healthcare Settings: Comparing the Impact of Negative Provider Disclosure Responses on Survivor Engagement Across Mental and Physical Healthcare Systems

Abstract

Interpersonal violence (IV) survivors often report heightened mental and physical healthcare needs, yet many experience challenges to continued engagement with needed healthcare services. Survivors' perceptions of how healthcare providers respond when they disclose IV may be one important factor influencing subsequent healthcare engagement. Although negative disclosure responses have been linked to adverse psychological outcomes and future disclosure decisions, little is known about how IV survivors' disclosure experiences with healthcare providers relate to subsequent healthcare engagement or differ across mental and physical healthcare settings. Among undergraduate IV survivors (N = 522), the present study characterized patterns of IV disclosure to mental and physical healthcare providers, compared perceived negative provider disclosure responses and post-disclosure healthcare engagement across healthcare systems, and examined associations between overall and specific negative provider disclosure responses and subsequent healthcare engagement within each system. Overall, 205 survivors (39.3%) disclosed to a mental healthcare provider and 69 (13.2%) disclosed to a physical healthcare provider, with 57 disclosing to both. Disclosure was more frequent to mental than physical healthcare providers across all IV victimization types. While perceived negative provider disclosure responses did not significantly differ across healthcare systems (Pillai's trace = .031, F(5, 264) = 1.67, p = .143, η²p = .031), healthcare engagement outcomes did (Pillai's trace = .035, F(3, 261) = 3.20, p = .024, η²p = .035), with survivors who disclosed to mental healthcare providers reporting greater reductions in healthcare utilization than those who disclosed to physical healthcare providers, F(1, 263) = 5.68, p = .018, η²p = .021. In separate Firth penalized logistic regression analyses, greater overall negative provider disclosure responses were associated with greater odds of mental healthcare avoidance (OR = 1.15, 95% CI [1.05, 1.28]), reduced mental (OR = 1.14, 95% CI [1.04, 1.28]) and physical healthcare utilization (OR = 1.15, 95% CI [1.00, 1.38]), and uncertain or negative future mental (OR = 1.30, 95% CI [1.17, 1.49]) and physical healthcare-seeking intentions (OR = 1.18, 95% CI [1.02, 1.43]). Perceived minimization (OR = 1.78, 95% CI [1.02, 3.54]) and judgment (OR = 1.75, 95% CI [1.02, 3.23]) were uniquely associated with greater odds of mental healthcare avoidance, whereas minimization was uniquely associated with uncertain or negative future physical healthcare-seeking intentions (OR = 5.23, 95% CI [1.08, 27.79]). These findings identify healthcare engagement as an important behavioral outcome associated with survivors' perceptions of provider disclosure responses and highlight the continued need to train mental and physical healthcare providers to respond to trauma disclosures in trauma-informed ways.