District Hospital Trauma Mental Health Screening Shared Consultation Room Acoustic Leakage and Post-Traumatic Stress Disorder Disclosure Suppression in South African Referral Clinics: A Cluster-Randomised Evaluation of Privacy Architecture

Shared consultation rooms in South African district hospital trauma units expose patients to acoustic leakage from adjacent clinical encounters, a design feature that may suppress disclosure of post-traumatic stress symptoms during routine screening. The primary outcome was disclosure suppression, operationalised as the ratio of screen-detected probable PTSD cases to validated diagnostic assessments. Secondary outcomes included patient-reported comfort with disclosure and screening completion rates. The intervention reduced disclosure suppression by 34% (95% CI: 18–48%, p < 0.001) relative to standard shared-room architecture. Screening completion increased from 71% to 86% in intervention clusters (p = 0.003). The findings suggest that acoustic privacy is a modifiable determinant of trauma disclosure and that architectural interventions warrant consideration in trauma-informed care design.