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PubMed2003

The many faces of self-disclosure.

The contributions of eight authors to this issue of In Session are discussed, with emphasis on who discloses what to whom, in what ways, and for what reasons. The primary conclusions concern the varieties of self-disclosure, the motives for self-disclosure, the appropriate outcome variable in studying self-disclosure, the value of evidence, the importance of the context, and the crucial role of the relationship. Self-disclosure, properly used, can be a significant contributor to successful psychotherapy.

Affect↗

PubMed2004

Disclosure: what works now and what can work even better.

This three-part series on disclosure of unanticipated outcomes in health care is intended to provide an overview of the current thinking about disclosure and steps the organization can take to develop an approach to disclosure that is comprehensive and supportive of the needs of patients, families and providers. What should be apparent is that disclosure is not simply a requirement--it is a philosophy and part of a comprehensive approach to patient/family communication.

Cultural Diversity↗

PubMed1984

A patient self-disclosure instrument.

Four studies in which a patient self-disclosure questionnaire was developed and tested are reported. The instrument was designed to include only content judged by both patients and clinicians as important. Three areas of patient difficulty in disclosing to a health care provider were measured: personal problems and feelings, responses to health care, and life style. Patient difficulty in disclosure was assessed by 21 7-point rating scales, 7 for each disclosure area; ratings were summed to obtain scores. A correlation matrix of the ratings of 216 patients was subjected to a three-factor principal components analysis with varimax rotation; the solution accounted for 59% of the total variance. High internal consistency and test re-test reliability for the total scale and subscales were obtained; Cronbach's alpha .82-.83, n = 214; r = .81-.87, n = 66. In separate tests of construct validity patient self-disclosure was shown to be influenced by locus of control and perception of clinician empathy, and to covary with heart rate changes.

Adolescent↗

PubMed1998

Young people in transition: the relationship between homesickness and self-disclosure.

Whilst the majority of new students cope well with the transition to university, a number experience levels of homesickness which can adversely affect the process of adaptation. In this study the relationship between homesickness and self-disclosure, seen as a possible mediating factor, was assessed in a sample of 83 students (mean age 18.0541 years, s.d.=7.055 months) at the start of their first semester and then 6 weeks later. The results showed that homesickness declined during the semester whilst levels of self-disclosure increased. A significant negative association was found between levels of self-disclosure and homesickness at both time periods. High self-disclosers experienced a significantly greater reduction in homesickness than low self-disclosers. The results showed the importance of the socially-mediated and supportive benefits of self-disclosure during this life transition.

Adaptation, Psychological↗

PubMed1978

Self-disclosure in relation to psychotherapist expertise and ethnicity.

The self-disclosure styles of Mexican Americans and their possible role in the limited participation of Mexican Americans in mental health services were explored. Ninety-four Mexican American and 93 Anglo American junior college students listened to one of four therapist introductions, then responded to questionnaires designed to measure self disclosure and self acceptance. Both groups indicated a substantial willingness to disclose about themselves to therapists. Mexican Americans proved lower in self-disclosure scores than Anglo Americans. Mexican Americans were found to disclose less to Mexican American therapists than did Anglo Americans to Anglo American therapists. Sex differences in self-disclosure were negligible. Both Mexican Americans and Anglo Americans scored in the direction of high self-acceptance. The findings held for comparable socioeconomic levels.

Educational Status↗

PubMed2005

Predictors of serostatus disclosure to partners among young people living with HIV in the pre- and post-HAART eras.

Predictors of serostatus disclosure were identified among youth living with HIV pre- and post-introduction of highly active antiretroviral therapy (HAART). Two cohorts of HIV-positive youth, aged 13-24, in 1994-1996 (n = 351) and 1999-2000 (n = 253) in Los Angeles, New York, San Francisco, and Miami were sampled through medical providers and a variety of social service agencies. Data were collected on demographic, social, medical, and behavioral topics. Men who had sex with men were more likely to disclose serostatus to their partners. Moreover, a positive association with length of time since diagnosis and the likelihood of disclosure exists; across time, youth were less likely to disclose serostatus to casual partners or HIV-negative partners. Post-HAART, number of sex acts with a partner was associated with increased likelihood of disclosure. Interventions for HIV-positive youth must improve disclosure to casual and serodiscordant sexual partners.

Adolescent↗

PubMed1994

Adult disclosure of sexual abuse: a primary cause of psychological distress?

There is evidence for a high incidence of childhood sexual abuse among adult psychiatric populations and some practitioners have noted a worsening of psychiatric symptomatology around the time of disclosure. Disclosure of abuse can result in hostile and rejecting responses from significant others in the victim's social support network. This paper surveys research evidence relating to the disclosure of abuse, and it is argued that for some adults, the disclosure of sexual abuse may be a primary cause of psychological distress, resulting in the dissolution of social support systems and increasing the individual's vulnerability to psychiatric disorder. The implications of the model for therapeutic practice are discussed.

Adult↗

PubMed1996

How do children tell? The disclosure process in child sexual abuse.

Children's disclosure of sexual abuse has been described as a quasi-developmental process that includes stages of denial, reluctance, disclosure, recantation, and reaffirmation (Sorenson & Snow, 1991, Summit, 1983). It has been reported that nearly 75% of sexual abuse victims initially deny abuse, and that nearly 25% eventually recant their allegations (Sorenson & Snow, 1991). The present study examined disclosures in 234 sexual abuse cases validated by Protective Services in El Paso, Texas. Denial of abuse occurred in 6% of cases, and recantation in 4% of cases in which a child had already disclosed abuse. Four of the eight victims who recanted appeared to do so in response to pressure from a caretaker. The Child Sexual Abuse Accommodation Syndrome described by Summit (1983) seems to be infrequent among the types of cases seen by child protection agencies. The present findings do not support the view that disclosure is a quasi-developmental process that follows sequential stages.

Adolescent↗

PubMed2006

Predictors of disclosure of continued cocaine use.

Lack of disclosure of substance use is common in research and treatment settings and is frequently higher at follow-up than at baseline interviews. The aim of this study was to determine predictors of cocaine use disclosure at follow-up among 525 individuals who reported and tested positive for baseline use. Measurements included self-reported quantity and frequency of use, and hair analysis by radioimmune assay. Forty-two percent of individuals with biochemical evidence of continued cocaine use denied this use. In adjusted analyses, self-reported substance abuse treatment contact after enrollment was associated with lower disclosure (OR 0.63, 95% CI 0.43, 0.93). Other predictors were race, hair cocaine level, and opiates in hair. Failure to stop use after seeking treatment may result in reduced disclosure of continued use, possibly because of unwillingness to admit failure.

Adult↗

PubMed2005

Reporting possible sexual abuse: a qualitative study on children's perspectives and the context for disclosure.

OBJECTIVE: The present study investigated the context in which children were able to report their child sexual abuse experiences and the children's views as to what made it difficult to talk about abuse and what helped them in the disclosing process. The aim was to study disclosures as they were occurring in their natural settings. METHOD: Data were obtained from therapeutic sessions and follow-up interviews from 20 families with 22 children. These children had said something that made their caregivers concerned about ongoing child sexual abuse. Qualitative analysis was conducted to capture the children's and caregiver's perspectives of the disclosure process. RESULTS: The children felt it was difficult to find situations containing enough privacy and prompts that they could share their experiences. They also were sensitive to others reactions, and whether their disclosures would be misinterpreted. When the children did disclose they did it in situations where the theme of child sexual abuse was in some form addressed or activated. The results indicate that disclosure is a fundamentally dialogical process that becomes less difficult if the children perceive that there is an opportunity to talk, and a purpose for speaking, and a connection has been established to what they are talking about. CONCLUSIONS: It is difficult for children to initiate a conversation about something secret, confusing and distressful, and where there are few conversational routines in a family for talking about such themes. Children also are sensitive to the needs of their caregivers and fear consequences for their family and offender. Children need a supportive structure or scaffold in order to reveal their experiences of child sexual abuse.

Adolescent↗

PubMed2004

Quality of life in lung cancer: does disclosure of the diagnosis have an impact?

BACKGROUND: Quality of life (QOL) is an important component of evaluation in oncology. Usually, QOL is used in phase III studies to compare two treatments. The aim of this trial was to evaluate the impact of the disclosure of the diagnosis of cancer on QOL by using the European Organisation for Research and Treatment of Cancer core Quality of Life Questionnaire (EORTC QLQ)-C30 questionnaire and the supplemental lung cancer-specific module QLQ-LC13. PATIENTS AND METHODS: Patients hospitalised for exploration of an abnormal chest X-ray, with no previous history of cancer, a performance status < or =2, and able to fulfil the questionnaire were eligible. The patients answered the questionnaire two times: before (Q1) and after (Q2) the disclosure of the diagnosis. RESULTS: Seventy patients answered at Q1 and Q2. After the disclosure, some scores deteriorated: arm pain (P=0.009), physical functioning (P=0.01), role functioning (P=0.008), emotional functioning (P=0.0001) and social functioning (P=0.012), whereas the patients' own assessment of global QOL (item global QOL in functioning scales) did not show the same evolution. CONCLUSION: Disclosure of the diagnosis had an impact on social and emotional QOL. Patients with lung cancer need psychological support at the beginning of their disease.

Adult↗

PubMed2006

Disclosures of illness by doctors to their patients: a qualitative study of doctors with HIV and other serious disorders.

OBJECTIVE: To examine issues concerning doctor's disclosures of their illness to their patients. METHODS: We interviewed 50 health care providers who had serious illnesses concerning their experiences with disclosures of their illness to patients. RESULTS: With regard to their diagnoses, these doctors struggled with whether, when, how and what to tell patients. These issues were prominent, and had broader implications for doctor-patient communication and interactions among doctors with HIV, but arose among doctors with other diagnoses as well. Particularly with HIV, questions emerged concerning whether to: tell patients without being asked, respond only if asked, tell the truth, lie or misrepresent the information. Patients appeared to face dilemmas of whether to ask about a doctor's diagnosis, and whether they had a right to know. Some patients hesitated to ask or felt ambivalent about knowing, as the illness could threaten the doctor-patient relationship. At times, patients learned of a doctor's illness only after the latter had died. Disclosures could strengthen or skew the doctor-patient relationship. We present a model and framework--concerning the complexities of these communications--that can be useful in exploring other key aspects of doctor-patient interactions. CONCLUSION: These data raise larger questions of what information patients should be told about physicians. Medical education needs to address these issues better. PRACTICE IMPLICATIONS: Physicians should realize that patients may be anxious about these concerns, and may view the pros and cons of physicians' disclosures of illness differently than do these physicians themselves.

Adaptation, Psychological↗

PubMedDate not supplied

Primary care provider interventions for the delayed disclosure of adolescent sexual assault.

Acute sexual assault is a serious and underreported crime with the potential for causing grave physical and emotional harm to its victim. As a result of developmental and psychological factors, the adolescent victim may delay the disclosure of such an assault and therefore experience detrimental, acute, and long-term effects. By understanding the reasons for delayed disclosure and integrating this with currently established guidelines for acutely assaulted patients, primary care providers can better tailor the care they provide when faced with the delayed disclosure of adolescent sexual assault. Furthermore, based on this review, it becomes clear that standardized protocols are necessary to more efficiently care for these patients. Recommendations are provided to allow tailoring of primary care provider's interventions based on established protocols and new understandings when caring for adolescents who delay the disclosure of their sexual assault.

Adolescent↗

PubMed1998

Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation?

OBJECTIVE: To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. DESIGN: Cross-sectional study. SETTING: University teaching hospital. PATIENT(S): Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). INTERVENTION(S): Pretreatment psychosocial evaluation. MAIN OUTCOME MEASURE(S): Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. RESULT(S): There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. CONCLUSION(S): Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.

Adult↗

PubMed1997

Disclosure patterns of sexual abuse and psychological functioning at a 1-year follow-up.

This study describes the disclosure processes of a sample of 68 sexually abused girls, with a focus on the manner in which abuse was revealed--on purpose, accidentally, or resulting from a precipitating event. This categorization is a more descriptive conceptualization of the disclosure process than has been proposed or assessed in previous studies. The circumstances surrounding disclosure are found to be related to long term psychological functioning. Children who disclosed accidentally were younger, experienced abuse for shorter durations, and received the most therapy. At follow-up, children who purposely disclosed had greater anxiety and greater difficulties coping. Discussion focuses on ways in which identifying and encouraging the least traumatic methods of disclosure would contribute to better outcomes for victims of sexual abuse.

Analysis of Variance↗

PubMedDate not supplied

Disclosure of true diagnosis in Japanese cancer patients.

Full disclosure of medical diagnosis to cancer patients in Japan remains controversial. Some physicians in Japan believe that full disclosure may affect the outcome of treatment, create stress and psychiatric problems, or lead to suicide. Although the trend toward full disclosure is increasing in Japan, approximately 70% of current cancer patients are still not fully informed of their condition. In this study, the authors examined the psychiatric status and effects of full disclosure among 100 otolaryngology patients at Tokai University Hospital (50 with benign diseases, 50 with malignancy) using major depression and adjustment disorders criteria of the DSM-III-R Structured Clinical Interview (SCID). This demonstrated that 15 of 50 (30%) patients with benign diseases and 23 of 50 (46%) patients with malignant diseases met the criteria for depression and adjustment disorder; 29 of the 50 patients (58%) with malignant cancer were not informed of their true condition, according to the wishes of their families (21 were fully informed). The prevalence rate of psychiatric disorders was 42.9% among the informed group and 48.3% among the uninformed group. These findings suggest that concealing the true diagnosis was not related to the presence of psychiatric disorders in Japanese cancer patients.

Female↗

PubMed1999

Disclosure of the cancer diagnosis as it relates to the quality of pain management among patients with cancer pain in Taiwan.

This study was designed to explore: (1) who is responsible for disclosing to Taiwanese cancer patients the diagnosis of cancer, (2) the extent of disclosure, and (3) the relationship between the disclosure of the cancer diagnosis and the quality of cancer pain management as perceived by the patients experiencing cancer pain. One hundred twelve cancer patients with pain were recruited from three teaching hospitals in Taiwan. The major findings in this study were as follows: the majority of the patients with pain (79%) had been informed that the diagnosis was cancer, and for the majority (89%) the disclosure of cancer had been made by their physicians; older patients and those with lower levels of education were less likely to be told that they had been diagnosed with cancer; and patients to whom it was disclosed that the diagnosis was cancer tended to experience lower levels of pain intensity, lower levels of pain interference, and higher levels of satisfaction with pain management provided by clinicians. These findings provide significant implications for disclosure practice for Taiwanese oncology clinicians.

Adult↗

PubMed2000

The FDA's proposal for public disclosure of adverse events in gene therapy trials.

In January 2001, the Food and Drug Administration (FDA) proposed annual public disclosure of adverse events during gene therapy and xenotransplantation trials. The proposed policy raises the following questions: (1) Is the reformed policy in accord with the FDA's long-standing informed consent policies? (2) Why pair gene therapy trials and xenotransplantation trials in the revised guidelines? (3) Why single out these trials for public disclosure of adverse events? Each question is examined, and three conclusions are drawn. First, the FDA's own policies on informed consent require prompter public disclosure of adverse events. Second, the coupling of gene therapy and xenotransplantation trials entails a conceptual mistake in the types of communities that are harmed by each therapy's related adverse events. Third, all clinical trials merit such public disclosure of adverse events, not only gene therapy and xenotransplantation trials.

Animals↗