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PubMed1995

Parental distress and ability to cope following disclosure of extra-familial sexual abuse.

This study is concerned with the problems experienced by parents following disclosure of extra-familial sexual abuse where the perpetrator was known or related to the child or family. Thirty parents (including stepparents), took part and most completed a series of questionnaires, as well as participating in a semistructured interview. Data obtained related to depression, posttraumatic stress, marital satisfaction, and attitude to child victim. Other data relating to anger and loss of significant relationships was obtained from the semistructured interview. Parental distress and ability to cope is described in terms of three distinct types: Type I--Parents able to cope following initial period of distress; Type II--Parents able to cope following initial period of distress, but with significant problems; Type III--Parents unable to cope following initial period of distress.

Adaptation, Psychological↗

PubMed1996

Semistructured child sexual abuse interviews: interview and child characteristics related to credibility of disclosure.

This study provided the first empirical description of child and interviewer behaviors occurring within semistructured assessment interviews with children suspected of being victims of sexual abuse. Specifically, relationships between child and interviewer characteristics and interview credibility were examined. Using the Child Abuse Interview Interaction Coding System (CAIICS, Wood, 1990), 55 videotaped interviews of high-risk sex abuse cases seen at a multidisciplinary assessment center were behaviorally coded. Support was found for the interrater reliability and criterion related validity of the CAIICS was found. Results also revealed that children were initially rated as relaxed and displayed few emotional behaviors. Thus, the assumption that a credible disclosure of abuse must necessarily include the display of emotion by the child was not supported. Second, several behavioral differences between preschool and school-aged children were identified: however, no meaningful gender differences were found. Third, supporting evidence was found for both age and gender effects in judgments of interview credibility, with girls and school-aged children judged as more credible. Fourth, while the interviewer did engage in so called leading behaviors, these behaviors were not found to be related to rating of interview credibility. However, interviewer behaviors may have affected interview credibility through an intervening variable. Finally, implications, for further use of the CAIICS for examining interviewer-child interactions, evaluating standards of practice, and assisting with interviewer training are discussed.

Child↗

PubMed1996

Children's emotional and behavioral reactions following the disclosure of extrafamilial sexual abuse: initial effects.

Despite a dramatic increase of the empirical literature on child sexual abuse, very few investigations have examined the initial effects of extrafamilial sexual abuse (ESA). The present study evaluated the emotional and behavioral adjustment of 41 children (mean age 10 years, range 5.4 to 15.5 years) within the first 3 months following the disclosure of ESA. Children's functioning was compared to that of a nonclinical comparison group of 43 children, matched on child's age, gender, and family constellation. Child functioning was assessed using a combination of child-report, primary caregiver-report (i.e., parent), and teacher-report measures. Results revealed that sexually abused children, in comparison to nonabused children, suffered deleterious and clinically significant effects. Standard multiple regressions found that the children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symptomatology of depression, social efficacy, and general and abuse-related fears. As well, child's gender predicted the level of general fearfulness. None of the other demographic or abuse-related variables were related to children's functioning. These results underscore the need for multidimensional and multisource assessment of children who experience ESA, and point to the clinical importance of addressing the abuse-related attributions of these children.

Adolescent↗

PubMed1987

Psychophysiological reactivity and speech behavior during the Structured Type A Interview and a self-disclosure monologue.

Speech characteristics and the simultaneously recorded psychophysiological reactivity were compared between two tape-recorded speech tests, the Structured Type A Interview (SI) and a standardized 'self-disclosure' monologue (SD) as a non-social speech test. The SD started with a 5-min mental preparation interval followed by 3 subsequent self-reports each lasting 1.5 min. The 26 students used as subjects showed in all cardiovascular parameters (interbeat interval, pulse transit time to the earlobe, finger plethysmographic amplitudes and blood pressure) strong and similar reactivity to both tests. The individual rankings of physiological reactivity turned out to be remarkably constant over all experimental periods, but this reactivity was neither correlated with the Type A scores nor with sex. Modest correlations between the SI and SD test were obtained for word rate, expiratory sighs, and silent latent pauses. Thereby, some speech variables tended to be affected by the Type A behavior, and, to a somewhat stronger extent, by sex. The desirability of a non-social speech test for assessing Type A behavior is discussed.

Adult↗

PubMed2006

Patient views of adverse events: comparisons of self-reported healthcare staff attitudes with disclosure of accident information.

In the present paper, we report results of surveys in 2003 in Japan and Denmark about patients' views about adverse events, focusing on the actions of healthcare staff involved in a medical accident. Results show that patients were more likely to indicate negative expectations to a doctor's reactions after a medical accident when asked in general terms than when asked in relation to concrete case stories. When asked in general terms, 66% (47%) of Japanese (Danish) respondents expected that doctors sometimes hold back on providing information to patients about a medical accident, while 37% (7%) did so when asked about a concrete, mild-outcome case. We examine some possible reasons for the relatively high level of distrust of Japanese patients, and we discuss whether the seemingly lower level of disclosure in Japan than in Denmark and the negative stories in the Japanese press may have an impact. We also suggest some implications for introducing a patient-centred or customer-centred approach to risk management in healthcare and other domains.

Attitude of Health Personnel↗

PubMed2005

Complementary and alternative medicine (CAM) use patterns and disclosure to physicians in acute coronary syndromes patients.

This study assessed the frequency and types of CAM therapies used by patients hospitalized with acute coronary syndromes for general health purposes and cardiac reasons. We profiled CAM users including gender differences and degree of disclosure with treating physicians'. Data collection occurred via semi-structured interview and included demographics, past medical history, CAM use, physician visits, and patient-physician communications. Eight hundred and forty-six patients were screened for eligibility with 223 patients meeting eligibility criteria and completing data collection. Sixty-three percent of this sample used at least one CAM therapy for general health purposes in the year prior to the index hospitalization. Only 11.7% of patients reported using CAM for cardiac specific reasons. Women were more likely to use CAM relative to men and also tended to use a greater number of CAM therapies. More than one third (35.9%) of the patients that used CAM therapies did not inform their physician. Only a small fraction of CAM use was specific to cardiovascular health. These data suggest that a significant portion of patients do not report CAM use to their physicians and physicians seldom ask.

Aged↗

PubMed2005

Disclosure of competing financial interests and role of sponsors in phase III cancer trials.

Financial relationships between industry, researchers and academic institutions are becoming increasingly complex, raising concern about sponsors' involvement in the conduct of biomedical research. A review of published randomised trials (RCTs) in cancer research was performed to assess adherence to the 1997 disclosure requirements and to document the nature of the disclosed interests. Source(s) of study support, author-sponsor relationships and the role of the study sponsor were assessed for all RCTs published between 1999 and 2003 in 12 international journals. A total of 655 cancer RCTs were identified. Of these, 516 (78.8%) disclosed the source of sponsorship. The nature of the relationship between the authors and the study sponsor was included in 219 of the 227 industry-sponsored studies. The most commonly cited relationships were (131 studies had multiple relations): grants (93.6%); employment (39.2%); consultant/honorarium (12.7%) and stock ownership and participation in a speaker's bureau (12, 5.5% each). Only 41 (18%) of the 227 industry-sponsored RCTs reported the role of the sponsor. Of these, 20 explicitly stated that the sponsor had no role in the study. Twenty-one papers described the sponsor's role, the degree of sponsor involvement was variable and usually described vaguely. Among these papers, four stated that researchers had full access to all data, one that the researchers had no limits on publication and one that 'the decision to submit the paper for publication was determined by the study sponsor'. In conclusion, no researcher should be expected to produce 'findings' without full access to the data, freedom from interference in analysis and interpretation and liberty to publish all results, however disappointing to the stakeholder they may be. In the meantime, researchers do well to arm themselves with the rules for research partnerships and editors to take on the role of watchdog.

Clinical Trials, Phase III as Topic↗

PubMed2004

Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure.

OBJECTIVE: To compare the quality of family relationships and children's socioemotional adjustment in families created by donor insemination where parents tended either toward disclosure or nondisclosure. DESIGN: A study of 46 families with a child aged 4-8 years who was conceived through donor insemination. The study used standardized interview data from mothers and fathers, teachers, and the children themselves. SETTING: An assisted conception unit endorsing openness. PATIENT(S): Parents and their 4- to 8-year-old child conceived through donor insemination. INTERVENTION(S): Parents were interviewed, and children were administered psychological tests. MAIN OUTCOME MEASURE(S): Interviews and questionnaires assessing the quality of the marital relationship, parent-child relationships, and child psychological adjustment. RESULT(S): Mothers from disclosing families reported significantly less frequent and less severe arguments with their children and considered their children to show a lower level of conduct problems and to be less of a strain. The disclosing parents viewed themselves as more competent at parenting. CONCLUSION(S): The differences that were identified indicated more positive parent-child relationships in the disclosing than in the nondisclosing families. However, this did not represent dysfunctional relationships in the nondisclosing families but instead reflected particularly positive ratings in the disclosing group.

Adaptation, Psychological↗

PubMed2005

Disclosure of distress among anxiety-disordered youth: differences in treatment outcome.

The present study evaluated treatment outcome differences in anxiety-disordered youth who differed in their disclosure of internal distress as measured in a structured diagnostic interview. One hundred and seventy-one clinic-referred, anxiety-disordered children served as participants. Participants' primary diagnoses were one of three anxiety disorders: separation anxiety, generalized anxiety/overanxious, or social phobia/avoidance. At a pretreatment assessment, children and their parents were interviewed separately using the Anxiety Disorders Interview Schedule (ADIS) to determine the child's diagnosis. The child's status as a discloser of high distress or discloser of low distress was determined by the parents' endorsement of an anxiety disorder and the child's endorsement or lack of endorsement of an anxiety disorder, respectively. Parents, teachers, and children also completed measures assessing the child's psychopathology (e.g., Revised Children's Manifest Anxiety Scale, Child Behavior Checklist). In general, findings indicated that the level of distress reported by the children moderated treatment outcome. Although both groups benefited from treatment, the children disclosing high distress experienced greater treatment gains than the children disclosing low distress.

Adolescent↗

PubMed2006

Disclosure of medical errors.

The 1999 release of the Institute of Medicine's document To Err is Human was akin to removing the lid of Pandora's box. Not only were the magnitude and impact of medical errors now apparent to those working in the health care industry, but consumers or health care were alerted to the occurrence of medical events causing harm. One specific solution advocated was the disclosure to patients and their families of adverse events resulting from medical error. Knowledge of the historical perspective, ethical underpinnings, and medico-legal implications gives us a better appreciation of current recommendations for disclosing adverse events resulting from medical error to those affected.

Disclosure↗

PubMed2006

Physical violence by husbands: magnitude, disclosure and help-seeking behavior of women in Bangladesh.

This paper explores the magnitude of physical violence by husbands, the disclosure of it and the help-seeking behavior of abused women in urban and rural Bangladesh. The data come from a larger study on domestic violence against women conducted in Bangladesh during 2000-2004. All ever-married women covered by the population-based survey component (n=2702) conducted in 2001 were included in the current analysis. We also draw on in-depth interviews with 28 women who were physically abused by their husbands. Results show a high prevalence of lifetime physical spousal violence against women: 40% in urban and 42% in rural areas. Most of the abused women (66%) were silent about their experience. The main reasons behind this silence were high acceptance of violence, stigma and fear of greater harm. Sixty percent of urban and 51% of rural abused women never received any help from others. Only 2% ever sought help from institutional sources, from where support was not forthcoming. Women approached these sources only when they could not endure anymore or the violence became life threatening or children were at risk. The findings show that although providing appropriate services is absolutely necessary, it is also important to foster the use of such services and to help women overcome the barriers for accessing these services.

Adaptation, Psychological↗

PubMed2000

Mass media and disclosures of child abuse in the perspective of secondary prevention: putting ideas into practice.

OBJECTIVE: From a theoretical and practical point of view, it is worthwhile to utilize the full potential of prevention of child abuse. However, prevention strategies in the field of child abuse were generally limited to prevention by means of interpersonal communications. This paper seeks to address this lacuna. METHOD: A case-study is presented by describing and analyzing the organization and program development of a Dutch mass-media intervention aimed at the enhancement of disclosure of abuse of 8- to 15-year-old children, including physical, sexual, and emotional abuse. RESULTS: In the developmental process, several shortcomings are noticed, with respect to problem analysis, goal setting, and the assessment of unplanned effects. Critical comments are made on the intervention density, and the input and output of financial and human resources. Contrary to most preventive interventions, the described intervention could interrupt between the dependency of the abused child on the perpetrator and communicate with children directly. CONCLUSION: In a field which is in need of more effective prevention strategies, the program described may serve as an example of an ecological approach, which goes beyond the micro system, extending our potential in preventing ongoing abuse.

Adolescent↗

PubMedDate not supplied

The disclosure of information to cancer patients and its relationship to their mental state in a consultation-liaison psychiatry setting in Japan.

In Japan, as in some other countries, not all cancer patients are informed of their diagnosis and expected prognosis. However, we do not know enough about the relationship between the kind of information given to cancer patients and their mental state. The following is a study that examines this relationship. The subjects were 81 adult cancer inpatients referred to psychiatrists. Those with mental disorders before admission or with delirium were excluded. The subjects were classified into three groups according to the kind of information given to them: 28 were not informed of a diagnosis of cancer, 36 were informed of a diagnosis of cancer, and 17 were informed of both a diagnosis of cancer and a poor prognosis. The distributions of DSM-IV Axis I diagnoses were nearly equal among the three groups of patients. In each group, more than 90% of patients were diagnosed as having either major depressive disorder or adjustment disorders. In the results of HAM-D, HAM-A, and a question about irritability, the mean total HAM-A scores and mean scores for the factors of Suicide, Behavior at Interview, and Irritability, differed significantly among the three groups. They were highest in patients who were not informed of a diagnosis of cancer. The authors discuss the nature of relationship between the disclosure of information and the mental state in cancer patients.

Adaptation, Psychological↗

PubMed2003

Stigma revisited, disclosure of emotional problems in primary care consultations in Wales.

The nature and effects of stigma have been widely discussed in the context of mental illness, and references to stigma are commonly used to explain a wide array of social processes. For example, it is often claimed that stigmatisation affects aspects of personal identity, that it underpins unjust and discriminatory behaviour, and that it is responsible for a reluctance among members of the lay public to disclose the presence of treatable psychiatric symptoms and problems to health professionals. A widespread reluctance to disclose symptoms of 'emotional problems' to health professionals is in fact well documented. Yet the reasons for such patterns of behaviour are far from clear. However, in this paper, on the basis of qualitative data collected from primary care attendees in Wales (N=127), the authors suggest that appeals to stigma are inadequate to explain the phenomenon. More likely, it seems, is that members of the lay public have markedly different images from health professionals of what constitutes a mild to moderate psychiatric problem. Consequently, it is argued that the phenomenon of non-disclosure could be viewed more accurately as a problem of alternative taxonomic systems than of fear of stigma. The implications of the argument for health practice and theory are outlined.

Adolescent↗

PubMed2003

Truth and consequences: ethics, confidentiality, and disclosure in adolescent longitudinal prevention research.

PURPOSE: To examine data from a natural experiment resulting from a change made in the confidentiality agreement midway through a randomized, longitudinal, controlled trial to prevent or delay adolescent alcohol use. The investigators explored the impact of the change on adolescents' rates of participation and affirmative responses to a question on suicidal thoughts. METHODS: Adolescents 12-17 years old were administered a question on suicidal thoughts as part of a confidential exit interview after a general health examination with their primary care provider. After administration to 263 adolescents, the exit interview was made conditionally confidential with the remaining 181 adolescents. The revised consent form and protocol stipulated that researchers would reveal to appropriate professionals and parents any adolescent indicating suicidal thoughts. Prevalence estimates for the suicidal thoughts question and study participation rates were computed for conditions both before and after the change. RESULTS: Fewer adolescents responded affirmatively to the suicidal thoughts question when they were recruited using the revised (1%) than the original (8%) consent form and protocol (p=.001). The revised confidentiality agreement did not affect participation rates. CONCLUSIONS: Adolescents who assent to participate in research studies may be less likely to disclose personal information regarding suicidal thoughts if they know that their disclosure may result in a break in confidentiality. Specific guidelines are needed for conditional and unconditional confidentiality agreements to study mental health in adolescent longitudinal prevention research.

Adolescent↗

PubMed2001

Depression in primary care. 1: elderly patients' disclosure of depressive symptoms to their doctors.

BACKGROUND: This article examines some of the factors responsible for older patients' decision to report current depressive symptoms to their general medical practitioner. A companion article considers factors contributing to general practitioners' (GPs') recognition of major depressive episode when it was present. METHODS: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, to gauge the prevalence of depressive symptoms, the frequency with which patients had informed GPs of their symptoms, and GPs' recognition of major depressive episodes. Patients and informants were questioned using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. RESULTS: Logistic regression analysis showed that symptom disclosure was associated in descending order of importance with higher depressive scores, previous contact with a psychiatrist, and female gender. Even so, 48% of persons with ICD-10 moderate or severe depressive episode had not reported any current complaints to their doctor at the time of interview. CONCLUSION: Older patients often do not report depressive symptoms to their medical practitioner. Men and patients lacking "psychological mindedness" may be at special risk.

Aged↗

PubMed2002

Going quasi: the premature disclosure effect in a randomized clinical trial.

This paper describes a randomized clinical trial investigating a stress management program for women with breast cancer, which inadvertently turned quasi-experimental. Due to logistical considerations, group assignment was disclosed to participants (n = 63) prior to baseline assessment. Analyses of baseline measures unexpectedly revealed statistically significant differences between groups on psychological functioning. We suggest that what appears to be failed randomization may in fact point toward an important phenomenon which we have termed premature disclosure effect (PDE). A hierarchical regression model, developed to help explain the PDE, accounted for 47% of the variance. The findings indicate the importance of considering participant belief, preferences, and attributes when designing research protocols and interventions. Potential implications of PDE for clinical research in behavioral medicine are discussed and specific statistical methodologies suggested.

Attitude to Health↗

PubMed2004

Use of the internet for information and support: disclosure among persons with breast and prostate cancer.

The present study examined the feasibility of evaluating online communication of cancer patients using an automated content analysis program modified for application to cancer-related communication. Public messages posted to the Breast Cancer Discussion List and the Prostate Problems Mailing List were content analyzed uasing an augmented version of Linguistic Inquiry and Word Count to evaluate communication styles within these two cancer types. Breast cancer patients were more likely to submit multiple messages to the list and made greater use of words related to emotional disclosure and cognitive processing compared with prostate cancer patients. Prostate cancer patients were less likely to seek emotional support or repeated interaction with other patients, and more of their communication focused on cancer-related information. Use of cancer-specific word libraries significantly increased word identification within these samples. Content analysis of online communication appears to be a promising method for detecting communication differences among subgroups of cancer patients.

Adult↗