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PubMed2000

Disclosure to the family of breast/ovarian cancer genetic test results: patient's willingness and associated factors.

Informed probands are key actors for disclosing genetic information to their relatives when a mutation has been identified in the family. The objectives were to study women's attitudes towards the family disclosure of positive breast cancer genetic testing results and to determine the predictive factors of the diffusion patterns observed. A national multi-center cross-sectional survey was carried out at five French cancer genetic clinics during a 1-year period. Self-administered questionnaires were completed after the consultation by 84.5% (398/471) of women attending breast cancer genetic clinics for the first time. Among the 383 respondents who had at least one living first-degree relative to inform, 8.6% would inform none, 33.2% would inform at least one of them, and 58.2% would inform all of them. The sibship would be the most frequently informed blood relatives, sisters in 86.9% and brothers in 79% compared with mother in 71.4%, children in 70.4%, and father in 64.9%. Women of the family would be more frequently informed than men (P < 0.05). After multivariate adjustment, age, the fact to be affected by cancer, the number of daughters, and the emotional disturbance due to cancer in a close relationship were the main determinants (P < 0.05) of the diffusion patterns observed. The first step of the relatives' attendance to genetic counseling and the proband's willingness to disclose breast cancer genetic tests results was high in this study and was clearly dependent on the women's personal and emotional characteristics.

Adult↗
PubMed2000

Parents' responses to disclosure of genetic test results of their children.

The psychological reactions of 22 parental couples and 3 single parents were investigated after disclosure of genetic test results of their children. The children were tested for the early-onset, monogenetic cancer disorder multiple endocrine neoplasia type 2. Participants came from 13 different families and were aged between 28 and 47 years. Parents who were informed that their child was a gene carrier reacted with resignation, showed moderate to high levels of test-related and general anxiety, but few psychological complaints. Daily activities were disturbed in 43% of the parents with carrier-children. There was little disruption of the parents' future perspective, apart from some socioeconomic disadvantages and increased parental concern for the carrier-children. Most parents with carrier-children showed restraint with respect to short-term prophylactic treatment. Parents with favorable test results showed significantly less anxiety and no disturbance in their daily activities. They did not, however, seem to be reassured by the DNA test result. These parents questioned the reliability of the DNA test, wanted confirmation of the test results, and were eager to continue screening of their noncarrier children. Parents, especially those with a lower level of education and/or a pessimistic view of the future, were distressed by unfavorable test results. Additional counseling is advised to prevent parents of carrier-children worrying unnecessarily, or parents with children in whom the disease gene was not found being not reassured. Am. J. Med. Genet. 94:316-323, 2000.

Adolescent↗
PubMed1977

Ratings of client self-disclosure and improvement as a function of sex of client and therapist.

This study examined the effects of client and therapist sex on client self-disclosure and improvement from individual psychotherapy. Based upon closing summary data collected at a college psychological counseling center, it was found that clients were more likely to be rated as low disclosers by female than by male therapists. Males viewed more clients as improved than did females (74% vs. 50%).

Attitude of Health Personnel↗
PubMed1980

Prediction of self-disclosure from objective personality assessment techniques.

Prior theory and research have suggested that self-disclosure may have a curvilinear relationship with psychological disturbance. The present study investigated the hypothesis using the CPI, MMPI, and Bipolar Psychological Inventory and employing Ss (N = 28) from a correctional institution. Analyses involved correlational, multiple regression and discriminant analysis techniques. The results offer partial support for the hypothesis and add substantially to the external validity of prior research.

Humans↗
PubMed1984

Self-disclosure patterns in clinical and nonclinical couples.

Examined differences in the self-disclosing patterns of 10 clinical and 10 nonclinical couples in a structured interview using the Self-Disclosure Coding System (SDCS), a behavioral content analysis system designed to assess the basic parameters of disclosing behavior. A discriminant function analysis revealed that two SDCS variables, (1) time spent talking; and (2) judged degree of congruence between verbal content and affective manner of presentation, could discriminate the two groups and would classify correctly 70% of the couples. These results suggest that it is not what clinical couples say, but how they say it that will distinguish them from nonclinical couples.

Adult↗
PubMed1984

Perceptions of therapist disclosure of previous experience as a client.

Investigated Ss' (N = 175) perceptions of a therapist and of the therapeutic relationship after the therapist's disclosure that he was once a client in therapy. The effect of information that indicated the reason he sought therapy also was examined. Additionally, the relationship of Ss' attitudes toward seeking professional help to their perceptions of the therapist was assessed. Results indicated that Ss evaluated the therapist primarily on the basis of his interactions with the client--the disclosing therapist consistently was seen as having more favorable personal and therapeutic abilities and as more facilitative of the therapeutic relationship than was the nondisclosing therapist.

Female↗
PubMed2006

Different differences: revelation and disclosure of social identity in the psychoanalytic situation.

The authors propose a taxonomy of social identities, suggesting that three different classifications of identities can be distinguished. These comprise those that are innate and visible, such as race or gender; those that are innate, but invisible, such as sexual orientation; and those that are acquired or achieved, such as marital status or political affiliation. The authors argue that each of these categories has different implications for the revelation or disclosure of aspects of the therapist's identity, as well as for transference-countertransference dynamics. These points are illustrated with brief clinical examples.

Ethnicity↗
PubMed2005

An experimental examination of emotional experience, expression, and disclosure in women reporting a history of childhood sexual abuse.

Researchers have suggested that childhood sexual abuse (CSA) is a distal risk factor for the development of emotion regulation difficulties in adulthood. The present study examined 20 females with and without a history of CSA on the dimensions of subjective emotional experience (positive and negative activation), facial expressivity, and disclosure (positive and negative emotion words) in response to positively and negatively valenced film stimuli. The CSA group reported experiencing reduced positive activation while no group differences were found for negative activation. The CSA group disclosed fewer negative emotion words to express their experience and exhibited a trend towards less facial expressivity. The results are interpreted within the context of CSA survivors' emotional responding difficulties, and their implications are discussed.

Adolescent↗
PubMed2006

Language use in imagined dialogue and narrative disclosures of trauma.

Support exists in many populations for the use of written disclosure to express thoughts and emotions about a traumatic experience. The present study examined language use in a variation of the writing task modified to include an imagined dialogue with another person. We hypothesized that this method would increase cognitive, affective, and present-tense word use, all of which are linked with beneficial outcomes from writing. We randomly assigned 169 college students to write in one of three conditions: trauma narrative, trauma dialogue, or control writing. Results suggested that writing about traumatic experiences in the form of a dialogue promotes greater present-oriented, affective experiencing and cognitive processing than does writing in the form of a narrative.

Adolescent↗
PubMed1998

The relationship between problem disclosure, coping strategies and placement outcome in foster adolescents.

Adolescence has been described as a period where normal developmental stresses are dealt with depending on past experiences and current demands. Foster care inherently brings with it many additional stresses which must be dealt with at a period where many young people find even normal developmental tasks overpowering. This study examines problem disclosure and coping strategies in 21 foster adolescents. Highly significant results indicate that teenagers who have experienced crisis foster placements were more likely to disclose concern over parent and authority control over their lives. Additionally, these young people seemed more likely to use non-productive coping strategies when dealing with everyday problems.

Adaptation, Psychological↗
PubMed1980

The effects of perceived physician competence on patients' symptom disclosure to male and female physicans.

One hundred and ninety-two subjects (128 male and 64 female) rated their willingness to disclose symptoms of a personal nature, general nature, and mental illness nature to a male or female physician who had been described as being either high or low in technical competence and either high or low in social competence or "beside manner." In addition, subjects were given a photograph of the physician which had been pretested for either high or low physical attractiveness. Increased willingness to disclose all types of symptoms was related to (a) perceived high technical competence, (b) high social competence, and (c)male patients. Neither the sex of the physician nor the physical attractiveness of the physician influenced symptom disclosure. Implications are drawn concerning physician-patient diagnostic effectiveness and the management of unfavorable first impressions through patient training.

Attitude↗
PubMed1983

Speaking without seeing, or the effect of interviewer absence on interviewee disclosure time.

The results of the present study confirmed earlier findings that the elimination of the usual face-to-face confrontation between interviewer and interviewee enhances disclosure time in relation to intimate questions. By unconfounding speaking time and pausing time, the present research demonstrated that the facilitating effect of an interviewer's absence is not simply an artifact of increased latencies and silent pauses within responses. The earlier findings were extended by manipulating the intimacy level of questions asked of subjects in the context of a gender-balanced design.

Female↗
PubMed2000

Reasons given for disclosure of maternal HIV status to children.

The purpose of this investigation was to ascertain the reasons given by mothers diagnosed with AIDS (acquired immunodeficiency syndrome) for disclosing or not disclosing their HIV (human immunodeficiency virus) status to their children, a dilemma faced by most HIV-infected parents and those who counsel them. We interviewed 29 mothers residing in one of two New York City facilities that provide housing and medical treatment for adults with AIDS. The majority of these mothers do not live with their children, but all had recent face-to-face contact with them. The two reasons most frequently considered important for disclosing to children were that disclosure was the "right thing to do" and the need to make arrangements for children's future in case of maternal death or incapacity. The reason most frequently considered important for not disclosing was maternal concern about discussing death and dying with children. These findings have significant implications for counseling of HIV-positive parents.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Women living with HIV: disclosure, violence, and social support.

This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a face-to-face interview. Women in the sample were 33 years old on average; 92% were African-American; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HIV-positive women.

Adolescent↗
PubMed2004

Cancer information disclosure in different cultural contexts.

The relationship between truth telling and culture has been the subject of increasing attention in the literature. The issue of whether, how and how much to tell cancer patients concerning diagnosis is still approached differently depending on country and culture. The majority of physicians tell the truth more often today than in the past, in both developed and developing countries, but most of them prefer to disclose the truth to the next of kin. Nurses in Anglo-Saxon countries are considered to be the most suitable health-care professionals for the patients to share their thoughts and feelings with. Nevertheless, in most other cultures the final decision on information disclosure lies with the treating physician. Regardless of cultural origin, the diagnosis of cancer affects both family structure and family dynamics. In most cases patients' families, in an effort to protect them from despair and a feeling of hopelessness, exclude the patient from the process of information exchange. The health-care team-patient relationship is a triangle consisting of the health-care professional, the patient and the family. Each part supports the other two and is affected by the cultural background of each of the others as well as the changes that occur within the triangle.

Attitude of Health Personnel↗
PubMed2006

Being silenced: the impact of negative social reactions on the disclosure of rape.

Rape survivors who speak out about their assault experiences are often punished for doing so when they are subjected to negative reactions from support providers. These negative reactions may thereby serve a silencing function, leading some rape survivors to stop talking about their experiences to anyone at all. The current study sought to examine this worst case scenario. Focusing on the qualitative narratives of eight rape survivors who initially disclosed the assault but then stopped disclosing for a significant period of time, this study sought to provide an in-depth description of how negative reactions silenced these survivors. Three routes to silence were identified: 1) negative reactions from professionals led survivors to question whether future disclosures would be effective; 2) negative reactions from friends and family reinforced feelings of self-blame; and 3) negative reactions from either source reinforced uncertainty about whether their experiences qualified as rape. Implications for future research and practice are discussed.

Adult↗
PubMed2005

Emotional responses to APO E genotype disclosure for Alzheimer disease.

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.

Affect↗