Published in:
Open Access
01-12-2020 | Child Abuse | Research article
Physicians’ knowledge and practices regarding screening adult patients for adverse childhood experiences: a survey
Authors:
Robert G. Maunder, Jonathan J. Hunter, David W. Tannenbaum, Thao Lan Le, Christine Lay
Published in:
BMC Health Services Research
|
Issue 1/2020
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Abstract
Background
Adverse Childhood Experiences (ACEs) are common and associated with many illnesses. Most physicians do not routinely screen for ACEs. We aimed to determine if screening is related to knowledge or medical specialty, and to assess perceived barriers.
Methods
Physicians in Ontario, Canada completed an online survey in 2018–2019. Data were analyzed in 2019.
Results
Participants were 89 family physicians, 46 psychiatrists and 48 other specialists. Participants screened for ACEs “never or not usually” (N = 58, 31.7%), “when indicated” (N = 67, 36.6%), “routinely” (N = 50, 27.3%) or “other” (N = 5, 2.7%). Screening was strongly associated with specialty (Chi2 = 181.0, p < .001). The modal responses were: family physicians - “when indicated” (66.3%), psychiatrists - “routinely” (91.3%), and other specialists - “never or not usually” (77.1%). Screening was not related to knowledge of prevalence of ACEs, or of the link between ACEs and mental health, but was significantly associated with knowing that ACEs are associated with physical health. Knowing that ACEs are linked to stroke, ischemic heart disease, COPD, and diabetes predicted greater screening (Chi2 15.0–17.7, each p ≤ .001). The most prevalent perceived barriers to screening were lack of mental health resources (59.0%), lack of time (59.0%), concern about causing distress (49.7%) and lack of confidence (43.7%).
Conclusions
Enhancing knowledge about ACEs’ negative influence on physical illness may increase screening. Efforts to promote screening should address concerns that screening is time-consuming and will increase referrals to mental health resources. Education should focus on increasing confidence with screening and with managing patient distress.