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PubMedDate not supplied

Disclosure decisions of rural African American men living with HIV disease.

A qualitative study was conducted to explore disclosure decisions of rural African American men living with HIV disease. The sample consisted of 20 HIV-infected African American men living in the rural South who had been diagnosed with HIV for at least 6 months. Audiotaped semistructured interviews were used for data determination. The men were questioned about who they had told about their disease, reactions to their disclosures, and their advice to others about disclosing. Results showed that initially the men did not disclose their disease to others, and many of them continued not to disclose. They were concerned about negative consequences such as rejection, fear of contagion, and the recipients telling others. If and when they disclosed, it was likely to be to sexual partners, immediate family members, and health care providers. Their decision not to disclose protected them from the possible negative reactions, but it also limited the amount of social and emotional support they received related to their HIV disease.

Adult↗

PubMed2006

Truth-telling and Turner Syndrome: the importance of diagnostic disclosure.

OBJECTIVE: A targeted analysis with transcript data from previous research was designed to study the perceived effects of secret-keeping on individuals with Turner syndrome (TS). STUDY DESIGN: Girls and women (n = 97) and 21 parents participated in the initial interview study. Transcripts were coded and analyzed for constructs related to secret-keeping. RESULTS: Thirty percent of participants spontaneously mentioned that their health care providers (HCP) or parents had withheld all or part of their TS diagnosis. Of those, 15 individuals were not informed of the infertility component of their diagnosis. Individuals reporting secret-keeping were more likely to have had a negative perception of the HCP's role in the disclosure process compared with those participants who did not report that a secret had been kept (P < .025). CONCLUSION: The prevalence of secret-keeping within this sample population suggests it is likely an existing concern in the greater TS population. How HCPs disclose a TS diagnosis may affect whether secrets are kept. Conversely, secret-keeping may result in a negative disclosure experience. These observations suggest the need for interventions aimed at helping HCPs disclose health-related information to parents and their children in a timely, caring, and sensitive manner.

Adolescent↗

PubMed2004

Ambivalent tales of HIV disclosure in San Francisco.

In light of rising levels of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in San Francisco, we sought to understand disclosure practices, the calculus of risk and attitudes about HIV seroconversion. In 2000, 150 MSM participated in interviews pivoting around a detailed narrative of a recent incident of UAI. In order to understand the relationship between individual and community norms, we analyzed the narratives as accounts situated within the respondents' experience of the HIV epidemic and the gay community in San Francisco. In justifying their risky sexual practices, MSM cited a community-wide shift toward non-disclosure and barebacking since the advent of highly active anti-retroviral therapy (HAART). Fearing rejection by HIV-positive partners who refuse to use condoms, HIV-negative men saw little advantage in disclosing to casual partners whom they perceived as overwhelmingly HIV-positive. By contrast, HIV-positive men appeared eager to disclose their positive status to release themselves from responsibility for transmission and facilitate "bareback" or unprotected sex. Disavowal of individual responsibility for safer sex in deference to community norms may contribute to the recent spiraling of risk behavior and HIV incidence. Implications for prevention policy are discussed.

Adult↗

PubMed1994

A prospective study of donor insemination recipients: secrecy, privacy, and disclosure.

OBJECTIVES: To study prospectively the attitudes and behaviors of heterosexual couples undergoing donor insemination. DESIGN: Couples undergoing donor insemination completed psychological questionnaires before treatment regarding psychiatric symptoms, self-esteem, marital adjustment, and their attitudes about privacy or disclosure. PARTICIPANTS: Forty-one of 82 heterosexual couples participated. MEASURES: A donor insemination questionnaire, a self-esteem scale, the Brief Symptom Inventory, and the Dyadic Adjustment scale were used. RESULTS: Psychiatric symptoms, self-esteem, and marital adjustment were all in the normal range. The amount of time taken by the couple to decide to do donor insemination was not related to reported psychiatric symptoms, self-esteem, marital adjustment, or marital satisfaction. Ninety-five percent of the couples believed a psychological consultation should be a mandatory part of the donor insemination treatment. The greatest concern the couples had about the donor child was its genetic and medical background. Thirty-eight percent of the couples did tell or planned to tell others about using donor insemination to conceive, and only 27% of the couples planned to tell the child of his or her donor origin. CONCLUSIONS: The results of this study support those of others, which have indicated that the majority of donor recipients are psychologically well adjusted and have average marital adjustment. In addition, this prospective study replicated the findings of other retrospective studies, indicating that most donor insemination recipients do not plan to tell the child of his or her donor origin. Additional prospective studies are needed to determine if attitudes and behavior regarding disclosure change over time.

Adaptation, Psychological↗

PubMed2003

To a safer place? Victims of sexual abuse by females and their disclosures to professionals.

OBJECTIVE: To explore the experiences of victims of female sex offenders with regard to disclosing sexual abuse to a professional, and importantly, the impact of professional responses on victims. METHOD: The data were derived from one-to-one semi-structured interviews with 14 (7 males, 7 females) victims of child sexual abuse by female perpetrators. Victims ranged in age from 23 to 59 years and were recruited through professional referrals or through poster advertisements in counseling services. Participants responded to questions on their family background, experience(s) of sexual abuse, experience(s) disclosing the sexual abuse to a professional, and the impact of professional responses. RESULTS: The majority of victims reported sexual abuse by their mothers. The average age of onset of the sexual abuse was age 5, lasting, on average, 6 years. Five participants reported experiencing severe, moderate and mild sexual abuse, four reported experiencing both severe and mild sexual abuse and five reported experiencing moderate and mild sexual abuse. The findings underscore the significance of professional intervention in relation to victim disclosures of sexual abuse by females. Professional responses to disclosures, whether positive or negative, appeared to have a crucial impact on the well-being of victims. Supportive professional responses including the acknowledgment and validation of victims' experiences of sexual abuse appeared to mitigate the negative effects of the abuse. In contrast, unsupportive responses where professionals minimized, or disbelieved victims' allegations of sexual abuse appeared to exacerbate the negative effects of the sexual abuse, ultimately inciting secondary victimization. CONCLUSION: The study highlights the need for the development and implementation of professional training initiatives to sensitize professionals to the issue of female sex offending and the intervention needs of victims. Failure to do so could have negative consequences for victims sexually abused by females.

Adult↗

PubMed2006

Strong HIV and hepatitis disclosure norms and frequent risk behaviors among Hungarian drug injectors.

Ethnographic interviews and focus groups were conducted between May 2003 and January 2004 among injection drug users (IDUs; n=29) in Budapest, Hungary, to assess knowledge related to HIV, hepatitis B (HBV), and hepatitis C (HCV) and norms, attitudes, and behaviors. Participants perceived themselves at low risk for infection with HIV but at high risk for hepatitis through injection but not sexual exposure. They reported strong disclosure norms for HIV and hepatitis infections, while sexual and injection risk behaviors were influenced by trust about partners' self-report of infection status. Injection networks were small, with infrequent syringe sharing among a few close friends. Cookers and drug filters often were shared, and filters were reused as a backup drug supply. Most sexual relationships were monogamous, and condoms were used rarely. Although participant norms supported HIV/HBV/HCV testing, the lack of available behaviors with injection and sex partners who are close friends. Network interventions among IDUs in Hungary should build on disclosure norms and trust to reduce injection and sex risk. Testing services should be expanded and access increased so that IDUs can act on and reinforce their norms for testing.

Adult↗

PubMed1999

The ethics of information disclosure in HIV disease and cancer: a study of medical residents attitudes.

The study analyzes medical residents (MRs) attitudes on the ethics of information disclosure in two case scenarios--HIV disease and cancer. A purposeful sample of 120 MRs took part in a self-completion questionnaire administered. Responses were factor analyzed and three factors (17 statements) protecting rights of (1) spouse/family, (2) patient and (3) society, were retained for study. Analysis revealed that: (1) MRs perceived greater justification (P < 0.0001) in protecting family rights in HIV disease and patient rights (P < 0.0001) in cancer; (2) male MRs were significantly more inclined to protect spouse/family rights (P < 0.01) in HIV disease, when compared to female MRs; and (3) international MRs were significantly more inclined to protect spouse/family (P < 0.05) and societal rights (P < 0.01) in HIV disease, compared with United States MRs. Perception differences by MRs on ethics of information disclosure in HIV disease and cancer are based on MRs gender and their cultural background. It is important to document and address these attitudes during residency training.

Attitude of Health Personnel↗

PubMedDate not supplied

Self-disclosure. Reconciling psychoanalytic psychotherapy and alcoholics anonymous philosophy.

Therapists working in the addictions field and practicing from a psychoanalytic psychodynamic framework are often confronted with the patient's need to know, the demand for therapist self-disclosure. Consistent with Alcoholics Anonymous (AA) principles, many patients state that they cannot be helped unless the therapist is revealing of their personal background. This paper discusses the theoretical roots of therapist self-disclosure and the AA philosophy and offers suggestions for how the two might be reconciled.

Alcoholics Anonymous↗

PubMed2006

Self-disclosure, depression, anxiety, and suicidal behavior in adolescent psychiatric inpatients.

The objectives of this paper were to examine the personality variable of self-disclosure, or the tendency to share feelings with others, and its relationship to depression, anxiety, and suicidal behavior in adolescent psychiatric inpatients. Of the 87 adolescents who were assessed, 53 had made a suicide attempt and 34 had never shown any suicidal behavior during their lifetime. There was a significant relationship between suicidality and low levels of self-disclosure, which appears to be mediated by anxiety and depression. This sharing difficulty was most significantly marked between the adolescent and his/her family and seemed to be mediated by feelings of depression and anxiety.

Adolescent↗

PubMed1993

Anxiety and self-disclosure: toward a motivational model.

The self-disclosures of socially anxious and nonanxious Ss were compared within the framework of R. M. Arkin's (1981) motivational theory of social anxiety. Ss (N = 84 women) were paired with a confederate who disclosed at either a high or a low level of intimacy (i.e., the classic reciprocity paradigm). Consistent with R. M. Arkin's theory, anxious Ss were concerned with self-protection during the task and disclosed at a moderate level of intimacy regardless of their partner's behavior. In addition, anxious Ss did not reciprocate their partners' disclosures as well as did nonanxious Ss. The self-protective behaviors of the anxious Ss were associated with less liking and more discomfort on the part of their partners. This suggests that the adoption of self-protective strategies may elicit negative interpersonal reactions that maintain self-defeating interpersonal patterns in socially anxious people.

Adult↗

PubMed2001

Maternal disclosure of mothers' HIV serostatus to their young children.

Mothers' disclosure of their HIV serostatus to their noninfected young children and factors associated with disclosure were investigated among 135 families. Overall, 30% of the mothers had personally disclosed their serostatus to their children. Mothers who disclosed reported higher levels of social support in their lives than mothers who did not disclose. Children whose mothers had disclosed to them displayed lower levels of aggressiveness and negative self-esteem compared to children whose mother had not disclosed. These findings indicate that for this sample, no negative effects were observed among young children to whom mothers have personally disclosed their HIV serostatus.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Variables in delayed disclosure of childhood sexual abuse.

In a study of 41 adult survivors of childhood sexual abuse, the level of childhood traumatization was found to have contributed to delayed disclosure of the abuse. Other delaying variables included: belief in the importance of obedience to grownups, mistrust of people, fear of social rejection, and fear of the criminal justice system. Variables such as media attention to similar cases and experiences of personal achievement were inversely related to the age at disclosure. Recommendations for policy are discussed.

Adolescent↗

PubMed2006

Delayed disclosure of alleged child abuse victims in Israel.

This study identifies characteristics of alleged child abuse victims that are associated with delayed disclosure of abuse. The database includes all alleged victims investigated in Israel between 1998 and 2004. Analyses suggest that most children delay disclosure and that delay is associated with type of abuse, child's age and gender, relationship to suspect and characteristics of abusive event.

Adolescent↗

PubMed2002

The disclosure dilemma for gay men and lesbians: "coming out" at work.

This study examined disclosing sexual orientation at work for 220 gay men and 159 lesbians. Self-acceptance, the centrality of one's identity, how "out" one is to friends and family, employer policies, and perceived employer gay-supportiveness were associated with disclosure behaviors at work for gay/lesbian employees. Disclosing at work and working for an organization perceived to be more gay supportive was related to higher job satisfaction and lower job anxiety. Reactions of coworkers to gay or lesbian workers mediated the relationship between disclosure and gay/lesbian workers' job attitudes. Implications and solutions for management are discussed.

Adult↗

PubMed2004

Written emotional disclosure buffers the effects of social constraints on distress among cancer patients.

The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint (negative social responses to patients' expressions of emotion regarding their cancer) on distress. Cancer patients (N=104) were randomly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic. They completed questionnaires at baseline and 6 months postintervention. Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects. The present data reinforce the notion that interventions should be tailored to patients' needs.

Adaptation, Psychological↗

PubMed2006

Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use.

Affect↗

PubMed1990

Researching the effects of confidentiality law on patients' self-disclosures.

We hypothesized that conflicting research findings on the effects that confidentiality laws have on patients' self-disclosure reflect the fact that privacy is important only to some patients in some circumstances. Instead of asking whether privacy is always important, we posed the following question: What factors determine whether privacy is important? With 42 outpatients we found that self-disclosures about sensitive issues (e.g., child abuse, drug abuse) during intake were determined partly by how legally informed patients were and partly by how relevant and consequential the law was to their cases.

Confidentiality↗

PubMed2001

Disclosure of minor mental health problems: an exploratory theoretical study.

AIM: The aim of this study was to explore people's experiences, concerns and beliefs about disclosing minor mental health problems by focusing on the ways in which such disclosures are interpreted. BACKGROUND: Approximately half of people with mental health problems do not seek help. The decision to consult represents just one aspect of the process of revealing one's illness to others. People with mental health problems are known to be reluctant to reveal the existence of those problems through fear of how others might then view them. DESIGN: A qualitative approach was employed. In-depth interviews were carried out with 47 users and nonusers of community mental health services. Interviews were tape-recorded, transcribed and analysed. RESULTS: The data suggest that when people reveal minor mental health problems others interpret these in relation to a number of perceived contextual factors. These include perceptions of the severity and duration of any possible causes, the inner 'strength' of the person, the expected ability of the person to either solve or suppress the experience, and the form and context of the expression itself. The data presented included individuals who were seeking help for relatively 'minor' mental health problems (primarily depression and anxiety) and individuals who had no current mental health problems but routinely managed expressions of their own emotions. Throughout the data there appeared to be no distinct difference between these two groups other than one of the severity of psychological experience. CONCLUSION: The key elements involved in the interpretation of people's expressions of sadness were essentially the same as those involved in the interpretation of expressions of depression. An appreciation of these contextual factors influencing the interpretation and disclosure of minor mental health problems may aid the development of more person-centred mental health services and inform the content of health education in the mental health field.

Adaptation, Psychological↗