Stressful life events in electronic health records: a scoping review

OBJECTIVE. Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer two major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. MATERIALS AND METHODS. Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by two independent reviewers. RESULTS. 527 unique papers were retrieved, and of these 60 were eligible for data extraction. Most articles (n=24, 40%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n=14, 23.3%), extraction of events from free-text notes (n=8, 13.3%), discussing privacy and other issues of storing life events (n=5, 8.3%), and new EHR features related to life events (n=4, 6.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, divorce/relationship breakup. Half of the papers (n=7) that analyzed clinical utility were focused on decision support systems for child abuse and neglect, while the other half (n=7) were discussing clinical interventions related to social determinants of health in general. DISCUSSION AND CONCLUSIONS. Few studies are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storage of stressful life events.