Silence might be golden, but not in your doctor’s office.

New research has found that nearly half of all patients who face four difficult topics do not tell their health care providers about them. These include suicidal thoughts, struggling with depression, the threat of domestic violence, and being a sexual assault survivor.

The reasons for staying quiet about such issues varies, although they typically include embarrassment about the situation or a fear of being judged.

Scientists at the universities of Iowa, Michigan and Utah collaborated on the study, which was published recently in an American Medical Association journal.

The researchers analyzed responses from more than 4,500 people in two online polls. The participants in one poll were 36 years old on average, whereas those in the other poll averaged 61. They were given a list of medically relevant information and asked if they had ever withheld such facts from their doctor. They were also asked why they didn’t disclose the details.Nearly 48% of the respondents said they had held back information about one or more of the four subjects. Nearly three-fourths of them said it was because they were worried about being judged or embarrassed.

Women and younger patients, the researchers found, were more likely to withhold information.

How can doctors overcome this lack of disclosure? The authors said helping patients feel more comfortable with their health care providers is crucial.

One possible solution is to have patients fill out a questionnaire. Some people might feel more comfortable writing down sensitive information rather than talking about it.