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PubMed1995

Disclosure of trauma and immune response to a hepatitis B vaccination program.

This study investigated whether emotional expression of traumatic experiences influenced the immune response to a hepatitis B vaccination program. Forty medical students who tested negative for hepatitis B antibodies were randomly assigned to write about personal traumatic events or control topics during 4 consecutive daily sessions. The day after completion of the writing, participants were given their first hepatitis B vaccination, with booster injections at 1 and 4 months after the writing. Blood was collected before each vaccination and at a 6-month follow-up. Compared with the control group, participants in the emotional expression group showed significantly higher antibody levels against hepatitis B at the 4 and 6-month follow-up periods. Other immune changes evident immediately after writing were significantly lower numbers of circulating T helper lymphocytes and basophils in the treatment group. The finding that a writing intervention influences immune response provides further support for a link between emotional disclosure and health.

Adaptation, Psychological↗

PubMed1975

An experimental study of crowding: effects of room size, intrusion, and goal blocking on nonverbal behavior, self-disclosure, and self-reported stress.

This study hypothesized that stress in high room density, or crowding, depends on interpersonal disturbances such as intrusion and goal blocking. High room density was expected to intensify individual reactions to these disturbances. In a 2 X 2 X 2 design, groups of six male college students containing three subjects and three confederates were placed in a large or small room. Subjects and confederates interacted in pairs; confederates introduced intrusion by leaning forward, touching subjects, and attempting 80% eye contact as confederates talked. Goal blocking involved inattention and interruptions as subjects talked. Interactions were videotaped through two-way mirrors to record nonverbal behaviors associated with affiliation and stress. Subjects also completed self-report measures of stress and self-disclosure. Intrusion led to initial discomfort that decreased with time, and lower levels of facial regard. Goal blocking produced self-reported irritation that increased with time, and lower levels of facial regard, gesturing, and positive head nodding. Contrary to predictions, stress responses to intrusion and goal blocking were not intensified by high room density. Lower levels of affiliative behavior were viewed as coping responses to interpersonal disturbances--subjects apparently coped successfully with intrusion, but not with goal blocking. Results are interpreted in terms of a sequential, interpersonal model of crowding.

Adolescent↗

PubMed1999

Expressive writing and the role of alexythimia as a dispositional deficit in self-disclosure and psychological health.

Psychology students were randomly assigned to a condition in which they had to write for 20 min on 3 days or for 3 min on 1 day a factual description of disclosed traumas, undisclosed traumas, or recent social events. In the case of undisclosed traumatic events, intensive writing about these events showed a beneficial effect on affect and on the affective impact of remembering the event and appraisal. Participants who wrote briefly about an undisclosed traumatic event showed a more negative appraisal. Participants who wrote intensively about a traumatic event and had a dispositional deficit in self-disclosure, measured by a Toronto Alexithymia Scale subscale, showed a positive effect on self-reported measures of affect. Difficulty in describing feelings, an alexythimia dimension, correlated with psychological health problems, emotional inhibition, and a less introspective content of written essays about the emotional events.

Adult↗

PubMed1995

Research on disclosure of HIV status: cultural evolution finds an ally in science.

This editorial responds to Mason et al.'s (1995) "Culturally Sanctioned Secrets: Latino Men's Nondisclosure of HIV Infection to Family, Friends, and Lovers." Culture is an evolving dynamic phenomenon shaped by society, psychology, and history. Historically, familism and simpatía have been Hispanic cultural assets. As times change, however, values and behaviors that served a culture for generations may become liabilities unless they evolve to fit the changing world of the culture. In the case of Hispanic gay men, the desire to protect family members is a barrier to disclosure of HIV status. Mason et al.'s study points to areas in which cultural development is needed. Science and culture thus become allies, with science pointing the way to needed directions for adaptive cultural evolution.

Acculturation↗

PubMed2004

Emotional expression in cyberspace: searching for moderators of the Pennebaker disclosure effect via e-mail.

Research has shown that writing about emotional topics can positively influence physical and mental health. The current study tested the efficacy of an e-mail-based writing treatment and shows how such an implementation can aid in the search for moderators. Participants (N = 546) were randomly assigned to either a long- or short-interval traumatic writing condition or to a nonemotional writing control condition. In contrast to previous disclosure research, participants received and submitted their writing responses via e-mail. Health outcomes were assessed weekly for 5 weeks after treatment and were reported at the conclusion of the study. Results supported the effectiveness of an e-mail-based writing treatment in producing positive health outcomes and successfully identified several moderators of the writing treatment effect. The moderators implicated varied depending on the nature of the health outcome assessment.

Adaptation, Psychological↗

PubMed2003

Sex variations in the disclosure to parents of same-sex attractions.

The decision whether to disclose same-sex attractions to parents was explored through in-depth interviews with 164 young women and men. Participants were more likely to disclose to mothers than fathers, usually around age 19 years and in a face-to-face encounter. Mothers were told before fathers, largely because mothers asked or because youth wanted to share their life with them; fathers were told by someone other than their child or by the youth because it was time. The reason participants did not disclose to mothers was because it was not the right developmental time; the reason they did not disclose to fathers was because they were not close to them. Sons, more than daughters, feared the negative reactions of parents, who generally reacted in the same manner--supportive or slightly negative. Relationships with parents since disclosure generally had not changed or had improved. Sex of parent mattered more than sex of child on most domains.

Adolescent↗

PubMed2000

Racial differences in self-disclosure of suicidal ideation and reasons for living: implications for training.

Racial differences in suicidal self-disclosure and reasons for living were investigated in 2 separate studies. In Study 1, a random sample of archival client and therapist intake data from a university counseling center for 1 year was examined, and results indicate that ethnic minority clients do not self-disclose suicidal ideation as readily as their nonethnic minority peers. In addition, a significantly higher number of ethnic minority clients were deemed "hidden ideators" because their suicidal ideation only became evident when a counselor performed a suicide risk assessment. Only 1 of the 36 ethnic minority clients with suicidal ideation in the sample voluntarily self-disclosed this ideation at intake without an assessment by the therapist. Study 2 used the Reasons for Living Inventory (RFL) and compared African American and European American college students from an introductory psychology course. The RFL is a useful instrument to compare potential race differences in reasons people report for choosing not to kill themselves, because it does not require respondents to self-disclose (or to have) current suicidal ideation. The results from Study 2 indicate European Americans report fewer reasons for choosing not to kill themselves than their African American peers and that African Americans scored significantly higher than European Americans on the moral objections and survival and coping beliefs subscales of the RFL. Implications for training counselors in suicide risk assessment, prevention, and treatment with ethnic minorities are discussed.

Adaptation, Psychological↗

PubMed1998

Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences.

Lesbian, gay, and bisexual youngsters, aged 14-21 and living at home, were studied for patterns of disclosure of sexual orientation to families. Three-quarters had told at least one parent, more often the mother than the father. Those who had disclosed were generally more open about their sexual orientation than those who had not, and few of the nondisclosed expected parental acceptance. Those who had disclosed reported verbal and physical abuse by family members, and acknowledged more suicidality than those who had not "come out" to their families.

Adolescent↗

PubMed2006

Dealing with disclosure.

Researchers' disclosures of competing financial interests are undergoing a dangerous transformation from instruments of transparency to evidence of wrongdoing.

Biomedical Research↗

PubMed2003

Parents' stories of sensitive and insensitive care by paediatricians in the time leading up to and including diagnostic disclosure of a life-limiting condition in their child.

UNLABELLED: This study explored parents' experiences of care by paediatricians in the time leading up to and including diagnostic disclosure of a life-limiting condition in their child. RESEARCH METHODS: Qualitative exploration using in depth interviews with a purposive sample of 30 families whose child was diagnosed with a life-limiting condition. RESULTS: Parents' stories centred upon their need to have their concerns and needs as parents validated by paediatricians. Demonstrable qualitative differences were shown to exist between the sensitive and insensitive clinical practices of paediatricians. Parents' stories identify the need for clinical practice to be based upon a humanistic approach to care. These also identify how sensitive paediatricians achieved this ideal through meeting the 'double obligation' of combining technical skills with an understanding of their needs as parents.

Adolescent↗

PubMed2003

Public disclosure of comparative clinical performance data: lessons from the Scottish experience.

There is growing international interest in making information available on the clinical quality and performance of health care providers. In the United States of America, where public reporting is most advanced, comparative performance information in the form of 'report cards', 'provider profiles' and 'consumer reports' has been published for over a decade. In Europe, Scotland has been at the forefront of releasing clinical performance data and has disseminated such information since 1994. This paper reviews the Scottish experience of public disclosure and distils the key lessons for other countries seeking to implement similar programmes. It is based on the findings of the first empirical evaluation of a national clinical reporting initiative outside the United States. The study examined the impact of publication of Scottish (CRAG) clinical outcome indicators on four key stakeholder groups: health care providers, regional government health care purchasers, general practitioners and consumer advocacy agencies. We conclude that those responsible for developing clinical reporting systems should not only pay close attention to developing technically valid and professionally credible data which are tailored to the information needs of different end users, but should also focus on developing a suitable incentive structure and organizational environment that fosters the constructive use of such information.

Breast Neoplasms↗

PubMed2002

Analysis of the vocal profiles of male seduction: from exhibition to self-disclosure.

The authors analyzed the suprasegmental (temporary) vocal profiles of 19 young men (not married) during their seductive interaction with 19 young women (not married) whom they had not known previously. The aim of the research was to verify the specificity, the sequential temporal stream, and the efficacy of the acoustical features of the seducer's voice during seductive interaction. In an ecological laboratory situation, the male participants were asked to meet their female partners. Participant-by-participant analysis showed that the male seductive voice is characterized by strong variations during the course of the seductive sequence. At the beginning of the sequence it had a higher pitch and an elevated intensity, as well as a faster rate of articulation than it did during normal speech (the exhibition voice). In the following phases it became gradually lower, weaker, and warmer (the self-disclosure voice). The modulation and variability of the vocal profiles during the seductive interaction were significantly stressed in the 9 successful seducers (those who succeeded in arranging a subsequent meeting with the partner), compared with the 10 unsuccessful seducers. The results have been interpreted as an ability to perform an effective local management of seductive communication.

Exhibitionism↗

PubMed2003

Serostatus disclosure, sexual communication and safer sex in HIV-positive men.

This study assessed HIV-positive men's sexual behaviours with partners at risk for infection, and examined the extent to which safer sex was associated with interpersonal communication variables, namely, (1). disclosure of one's seropositive status and (2). specific communication with partners about safer-sex practices. A total of 105 HIV-positive men (43% homosexual, 38% bisexual, 19% heterosexual), randomly sampled at an HIV outpatient clinic in Los Angeles, completed a behavioural questionnaire assessing events in their most recent sexual encounter with an HIV-negative or unknown serostatus partner. Results indicated that men who disclosed their seropositive status and explicitly discussed the topic of safer sex with their at-risk partners had a significantly higher prevalence of protected anal or vaginal intercourse than did men who disclosed only. The findings suggest that post-test counselling regarding the importance of disclosing one's seropositive status to sex partners should be augmented by behavioural interventions that enhance seropositive persons' skills in communicating explicitly with partners about safer sex to help reduce transmission of HIV.

Adult↗

PubMed2006

Circuit parties: sexual behaviors and HIV disclosure practices among men who have sex with men at the White Party, Palm Springs, California, 2003.

The syphilis epidemic among men who have sex with men (MSM) in major US cities and concomitant increases in high-risk sexual behavior, have raised concerns of increased HIV transmission in this population. Therefore, to provide information for health promotion and disease awareness efforts, we investigated sexual behaviors, partner selection preferences and HIV serostatus disclosure practices of MSM at the White Party in Palm Springs, California. Circuit party attendees reported engaging in unprotected anal sex, however, a high proportion reported disclosing their HIV status. These findings suggest that some gay men are serosorting as a risk reduction strategy or implementing sexual risk reduction strategies to protect themselves and their partners. In our study, HIV-negative men were nine times more likely to report a preference for a seroconcordant sexual partner. The self-protecting attitudes of HIV-negative men in our sample outweighed the partner-protecting attitudes of HIV-positive men. This suggests that prevention interventions focusing on HIV-positive persons are warranted.

Adult↗

PubMed1998

HIV serostatus disclosure among gay and bisexual men in four American cities: general patterns and relation to sexual practices.

The present study examined patterns of serostatus disclosure among previously untested HIV-seropositive and HIV-seronegative gay and bisexual men recruited from four American cities (n = 701). Six months after learning their HIV serostatus, 97% of study participants had disclosed their test results to at least one other individual. Consistent with earlier studies, test results were most frequently shared with friends and the respondent's primary partner. HIV serostatus was disclosed less frequently to family members, co-workers, and non-primary sex partners. Compared with HIV-seronegative men, HIV-seropositive men were more likely to have disclosed their status to a health care provider and less likely to have shared this information with family members. Of seropositive men, 11% did not disclose their serostatus to their primary partner and 66% did not disclose to a non-primary sex partner. Of HIV-seropositive men with one or more non-primary partners, 16% of those who did not disclose their serostatus reported inconsistent condom use during anal intercourse with these partners. No significant differences in self-reported sexual practices were observed for HIV-seropositive disclosers versus non-disclosers. Compared with HIV-seronegative men who did not disclose, seronegative men who shared information about their serostatus were more likely to have had receptive anal intercourse with their primary partner (p < 0.05) and to have engaged in mutual masturbation (p < 0.005), receptive oral sex (p < 0.005) and insertive anal intercourse (p < 0.05) with non-primary partners. No significant differences were observed between disclosers and non-disclosers with regard to condom use. Implications of the findings for future research and HIV prevention programmes are discussed.

Adolescent↗

PubMed2006

Depressive affect among health care seekers: how it is related to attachment style, emotional disclosure, and health complaints.

The present cross-sectional questionnaire survey investigated depressive affect among persons visiting their general practitioner (GP). It examined the impact of a number of factors likely to be associated with depressive affect, including demographic variables, severity of medical condition, and personal factors such as ease in disclosing personal information, and attachment style. Results showed that among the sample of patients (N = 198) visiting their GP, depressive affect was generally quite high. In particular, those reporting more depressive affect were the elderly, those with more severe health problems, more psychological problems, and a lower level of emotional disclosure frequency. As expected, attachment style was also related to lack of well-being among patients: those with a less avoidant but more anxious attachment style reported higher levels of depressive affect. In total, 38% of the variance of depressive affect was predicted by this model. Security of attachment was also related to reasons why patients consulted their GP, with avoidant attachment related to physical problems and anxious attachment to mental problems. Theoretical relevance of the findings and implications for medical help-seeking are discussed.

Adolescent↗

PubMed2001

When cultures clash: physician, patient, and family wishes in truth disclosure for dying patients.

We describe two cases involving male foreign nationals (a Chinese and a Georgian) treated in a U.S. hospital. Both patients had terminal illnesses, and both cases involved clashes between families and the treating physicians, which occurred because of differing cultural beliefs about truth disclosure. Based on the specific backgrounds of these two patients, we discuss ethical and cultural considerations and make suggestions for physicians who care for ethnically diverse patients.

Aged↗

PubMed2006

The disclosure model versus a developmental illness experience model for children and adolescents living with HIV/AIDS in São Paulo, Brazil.

Whether, how, and when children's HIV/AIDS diagnosis needs to be disclosed to them has received growing attention. This paper describes and conceptualizes how communication about HIV/AIDS influences disease knowledge and psychosocial development in a group of children and adolescents living with perinatally acquired HIV infection in an AIDS institution in São Paulo, Brazil. Data consist of the lived experience of 36 children ages 1 to 15 and was gathered through ethnographic research methodologies: participant observation and semistructured informal interviews. Results show that AIDS diagnosis is not disclosed to children, who experience a growing confusion about the interconnected meanings of sickness, medications, living at a house/institution, and having AIDS. Children younger than 6 learn to accept medication taking and to silence illness-related questions. Seven to 9-year olds perceive that the word AIDS and/or being sick are considered negative attributes, but are confused about how these relate to their lives. Preadolescents' growing awareness of the relationship between their lives and negative social values associated with AIDS produces shame and anger. Adolescents exhibit a poor understanding of the implications of HIV/AIDS for their lives and cynicism toward AIDS care, their future, and information about risks to their health. In conclusion, lack of communication about HIV/AIDS creates a context of confusion and mistrust, is detrimental to psychosocial development and coping, compromises disease knowledge, and increases vulnerability to risk behavior. Providing developmentally appropriate information about HIV/AIDS that matches children's illness experiences at all ages would eliminate the need for disclosure and reduce children's emotional distress.

Adolescent↗