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PubMed2003

Relationship of psychological morbidity and quality of life to illness-related disclosure among HIV-infected persons.

OBJECTIVE: The aim of this study was to examine the relationship between HIV-related disclosure and quality of life, anxiety and depression among HIV-infected subjects in South India. METHODOLOGY: 68 subjects (35 men and 33 women) were assessed for quality of life and psychological morbidity using WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS). Details of disclosure were collected using a semistructured interview. RESULTS: Certain disclosure-related variables appear to relate significantly with quality of life among HIV-infected persons. A positive outcome related to disclosure and extent to which a subject felt the need to disclose were significantly associated with higher scores on the total quality of life measure and in the social and environmental domains of the WHOQOL-BREF. No relationship was found between disclosure-related variables and psychological morbidity or other domains of quality of life. The type of disclosure (voluntary/without consent) did not appear to influence quality of life in this sample. CONCLUSION: Disclosure-related variables may have an important influence on QOL in the context of HIV infection in India.

Adolescent↗

PubMed1997

On the threshold of disclosure. The effects of a mass media field experiment.

OBJECTIVE: To assess whether the number of disclosures of child abuse changed as a result of a prevention strategy on a national scale in a West-European country. The child abuse involved child sexual and physical abuse, both ongoing and past. METHODS: In order to assess possible intervention effects, changes in calling the Child Line were measured. For this, a 4 year longitudinal design, starting before the intervention and ending 2 and 1/2 years after it was used (N = 3,117 disclosures). In addition, data were collected from the Dutch Telecom and a newely developed Child Abuse Form (N = 1,227). Finally, two measures were introduced, the disclosure coefficient and the relative disclosure coefficient. RESULTS: Most calls were silent calls, a phenomenon that deserves more attention in disclosure research. Compared to pre-intervention data, the amount of disclosures almost tripled during the intervention and was even further enhanced in the post-intervention and follow-up. In nine out of 10 cases, ongoing abuse was disclosed. Marked differences between child physical abuse and child sexual abuse were observed. CONCLUSION: It is concluded that mass media communication, if well implemented, can positively influence the process of disclosure of ongoing child abuse.

Adolescent↗

PubMed1998

Cancer truth disclosure by Lebanese doctors.

Truthful disclosure of cancer diagnosis is still uncommon in some cultures. In Lebanon, legislation is permissive of non-disclosure. Physicians choose the recourse most agreeable to them. This study's goal was to determine the proportion of Lebanese physicians who choose truthful diagnosis disclosure to cancer patients and to identify factors affecting their choice. A survey of a random sample of Lebanese physicians was conducted to determine the proportion of those who prefer truthful diagnosis disclosure to cancer patients and to identify factors affecting that choice. The survey involved 268 participants representing 10% of all physicians practicing in specialties with potential contact with cancer cases in the Greater Beirut area. It was completed by 212 (79%), of whom 47% would usually tell the patient about cancer. Disclosure preference was not associated with gender, location of medical training, rate of patient contact or teaching activities. It was associated with longer clinical practice and with specialties outside primary care. Most participants were open to changing their policies and considered the patient's desire to know, compliance with treatment and the patient's profession as a physician as most influencing in their choice of disclosure. Exploring the Lebanese public predicament regarding disclosure seems necessary.

Adult↗

PubMed2006

Attitudes toward disease and prognosis disclosure and decision making for terminally ill patients in Japan, based on a nationwide random sampling survey of the general population and medical practitioners.

OBJECTIVE: Employing a nationwide cross-sectional survey, we investigated the Japanese general population's attitudes toward disease and prognosis disclosure and related factors. Furthermore, we investigated Japanese medical practitioners' attitudes toward disease and prognosis disclosure for patients and decision making. METHODS: A nationwide anonymous questionnaire survey was conducted. A total of 5000 individuals were randomly sampled from the general population and 3104 physicians and 6059 nurses were randomly sampled in Japan. RESULTS: Finally, 2422 people from the general population (response rate, 48%), 1577 physicians (51%), and 3361 nurses (56%) returned questionnaires. Among the general population, 73% of participants answered that they "want to know" about their disease and prognosis when in an incurable disease state. Ninety percent desired direct disclosure and 8% disclosure through their family. However, few medical practitioners answered "patient himself" (physician 3%, nurses 4%) as the person whom they would primarily notify about the disease and prognosis when in charge of a patient with an incurable disease. On the other hand, physicians answered "family" most frequently (59%), whereas nurses most commonly responded, "depends on patient's condition" (63%). SIGNIFICANCE OF RESEARCH: Several detailed analyses of factors associated with prognosis disclosure were conducted. Japanese physicians need to carefully communicate with the patients individually about whether direct disclosure or disclosure primarily to the family is preferred.

Adult↗

PubMed1976

Interpersonal attraction and rewarding aspects of disclosure content and level.

The relationship between self-disclosure and interpersonal attraction was viewed within the context of theories of social penetration and social exchange. The effects of similarity of disclosure level and similarity in content of disclosure on interpersonal attraction were assessed. Specifically, 24 high-self-disclosing subjects and 24 low-self-disclosing subjects were presented with four bogus inventories manipulated on the variables of agreement in content and amount of disclosure. The reward potential of various factors within the disclosure process were measured by the subject's attraction to these four hypothetical strangers. Results indicated that along with amount of disclosure, similarity in the content of the disclosed material and similarity between the subject's and another's level of disclosure had a positive influence on attraction.

Adolescent↗

PubMed1982

Loneliness and patterns of self-disclosure.

The first study in this paper examined the hypothesis that feeling lonely is related to a self-perceived lack of self-disclosure to significant others. Thirty-seven male and 38 female undergraduates rated themselves on the UCLA Loneliness Scale and the Jourard Self-Disclosure Questionnaire. Analyses showed that for males and females, loneliness was significantly and linearly related to a self-perceived lack of intimate disclosure to opposite-sex friends. For females, loneliness was also associated with a perceived lack of self-disclosure to same-sex friends. The second study investigated the relationship between loneliness and actual disclosure behavior. Twenty-four lonely subjects and 23 nonlonely subjects were paired with nonlonely partners in a structured acquaintanceship exercise. Both opposite-sex pairs and same-sex pairs were included in the design. Postexercise ratings by partners indicated that lonely subjects were less effective than nonlonely subjects in making themselves known. Analysis of the intimacy level in the conversations showed that lonely subjects had significantly different patterns of disclosure than nonlonely subjects. We suggest that the self-disclosure style of the lonely person impairs the normal development of social relationships.

Female↗

PubMed1997

Health effects of emotional disclosure in rheumatoid arthritis patients.

This study examined the effects of emotional disclosure of stressful events on the pain, physical and affective dysfunction, and joint condition of patients with rheumatoid arthritis (RA). Patients were randomly assigned to talk privately about stressful events (disclosure group, n = 36) or about trivial topics (control group, n = 36) for 4 consecutive days. Disclosure resulted in immediate increases in negative mood. At 2 weeks the 2 groups did not differ on any health measure, but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities. There was no main effect of disclosure on pain or joint condition, but among the disclosure patients, those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints. This study concludes that, among RA patients, verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning.

Activities of Daily Living↗

PubMed1995

Development of children's restrictive disclosure to friends.

Sixty preschool children, 60 peer friends, and 60 peer nonfriends (mean age = 4 years, ranging from 2 years 8 months to 6 years old) were engaged in conversations on topics varying in personal content. The findings indicate that restrictive disclosure to friends developed across the preschool period. Older preschool children (4 to 5 years old) displayed the restrictive disclosure to friend pattern; they provided more high-personal disclosures in conversations with friends than with nonfriends, while not differentially providing low-personal disclosures in conversations with the two types of peers. Younger preschool children (2 to 3 years old) displayed the opposite pattern; they provided more low-personal disclosures in conversations with friends than with nonfriends, while not differentially providing high-personal disclosures in conversations with the two types of peers. The potential causes and consequences of the development of restrictive disclosure to friends during the preschool period are discussed.

Child↗

PubMed2004

Intricacies and inter-relationships between HIV disclosure and HAART: a qualitative study.

This study aimed to understand whether and how highly active antiretroviral treatment (HAART) affects views and patterns of disclosure and how disclosure interacts with treatment decisions. One hundred and fifty-two HIV-positive adults (52 MSM, 56 women and 44 IDU men) from four US cities participated in two to three-hour, semi-structured interviews in 1998-99. Results indicate that HAART interacts with and shapes HIV disclosure issues in several ways. Medications may 'out' people living with HIV. Thus, in different settings (e.g. work, prisons, drug rehabs and public situations), some try to hide medications or modify dosing schedules, which can contribute to non-adherence, and affect sexual behaviours. Disclosure of HIV and/or HAART may also result in antagonism from others who hold negative attitudes and beliefs about HAART, potentially impeding adherence. Observable side effects of medications can also 'out' individuals. Conversely, medications may improve appearance, delaying or impeding disclosure. Some wait until they are on HAART and look 'well' before disclosing; some who look healthy as a result of medication deny being HIV-positive. Alternatively, HIV disclosure can lead to support that facilitates initiation of, and adherence to, treatment. HIV disclosure and adherence can shape one another in critical ways. Yet these interactions have been under-studied and need to be further examined. Interventions and studies concerning each of these domains have generally been separate, but need to be integrated, and the importance of relationships between these two areas needs to be recognized.

Adult↗

PubMed2006

Impact of diagnostic disclosure in dementia on patients and carers: qualitative case series analysis.

Adequate diagnostic information can be considered a basic intervention in dementia care. However, clear diagnostic disclosure in dementia is not yet regular practice and the evidence regarding patients' preferences for or against disclosure is scarce. The aim of this study was to give an in-depth description of the impact of receiving the diagnosis of dementia, both on patients and the patients' proxies. The method used was the design of a grounded theory interview study. Analysis of the interviews revealed that disclosure had an impact on three key domains: awareness of dementia, partnership, and social relationships. Most patients and carers reported that they had experienced the disclosure of the diagnosis as a confirmation of their assumptions. A minority of patients and carers felt threatened and shocked by the diagnosis, because they did not expect it. The findings of this analysis challenge current opinions and practice about diagnostic disclosure like obstacles anticipated by clinicians such as inducing negative feelings and causing harm. Disclosure of the diagnosis of dementia can generally be carried out without introducing stress for the patient or carer and facilitates guidance. Therefore regular practice should include the careful planning and performance of diagnostic disclosure.

Adult↗

PubMed2002

Loneliness, self-disclosure, and ICQ ("I seek you") use.

This study investigated the relationships between self-disclosure in ICQ ("I seek you") chat, level of loneliness, and ICQ usage. The Revised UCLA Loneliness Scale and the Revised Self-Disclosure Scale (RSDS) were administered to a multistaged stratified random sample of 576 college students. The results indicate that loneliness is not related to level of ICQ use, but inversely related to valence, accuracy, and the amount dimensions of self-disclosure in ICQ chat, and that ICQ usage is significantly related to control of depth and intent of disclosure. Specifically, it was found that the lonelier the student, the more dishonest, more negative, and the less revealing was the quality of the self-disclosure in their ICQ interaction. Conversely, appropriate, honest, positive, and accurate self-disclosure might lead to decreased loneliness when one feels understood, accepted, and cared about on ICQ. More important, as intimate relationships are based on high degrees of depth and intent of self-disclosure, heavy users of ICQ are usually open, personal, and consciously aware of what they are disclosing.

Adolescent↗

PubMed1999

Disclosure of the diagnosis of HIV/AIDS to children born of HIV-infected mothers.

HIV disease in perinatally infected patients is now treated as a chronic illness of childhood. The effective use of highly active anti-retroviral therapy has contributed to the improvements in the prognosis of this illness. As this population matures, the issue of disclosure of diagnosis becomes more significant and part of their comprehensive medical care. The importance of disclosure relates directly to medication adherence, treatment compliance, sexual exploration, fears associated with premature death, and the child's developing autonomy. disclosure of HIV disease to an infected child poses complex issues, such as transmissibility, maternal guilt, more than one family member with the virus, and the potential for social stigma and isolation, among others. A change in perspectives is currently taking place regarding the process of disclosure, whereby it may be approached as a gradual discussion process over the life of the child. A method of gradual and partial disclosure to the child with consistent support by a multi-disciplinary team of providers has been a successful strategy for many children cared for at the New York Hospital-Cornell University Medical Center. Of 73 perinatally HIV-infected children who are 6 years of age or older, 41% have had complete disclosure and another 19% are partially disclosed. Continuous communication and negotiation among the members of the team, which includes the parents and caregivers, are vital to the gradual process leading to complete disclosure.

Child↗

PubMed2005

Health effects of written emotional disclosure in adolescents with asthma: a randomized, controlled trial.

OBJECTIVE: To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes. METHODS: We randomized 50 adolescents with asthma to write for 3 days at home about stressful events (disclosure) or control topics. At baseline and 2 months after writing, we assessed symptoms, affect, disability, internalizing behavior problems, and lung function; parents independently rated internalizing behavior and disability. RESULTS: Compared with control writing, disclosure writing led to improved positive affect and internalizing problems. Disclosure also decreased asthma symptoms and functional disability among adolescents with baseline elevations of these difficulties. Lung function was not changed. Disclosures with more negative emotion, insight, and causal words--and increased causal or insight words over days--predicted improved health. CONCLUSIONS: Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma, particularly those whose writings suggest emotional processing and cognitive restructuring.

Adolescent↗

PubMed2004

Disclosure model for pediatric patients living with HIV in Puerto Rico: design, implementation, and evaluation.

The American Academy of Pediatrics strongly encourages the disclosure of HIV status to school-age children and further recommends that adolescents know their HIV status. Limited information exists on the impact of disclosure. We designed and implemented a disclosure model hypothesized to be associated with healthy psychological adjustment and improved medication adherence. We report the model's design and implementation and results of a quasi-experimental study of the disclosure's effects on health care professionals (n = 16), caregivers (n = 39), and HIV-infected youth (n = 40) in Puerto Rico. Information was collected from youth, caregivers, and professionals by semistructured interviews and questionnaires. Most youth (70%) had feelings of normalcy 6 months post-disclosure, and most also improved their adherence to therapy after disclosure as reported by both patients (58%) and caregivers (59%). Eighty-five percent of youth and 97% of caregivers considered disclosure a positive event for themselves and their families. Fewer health care professionals reported feelings of fear, discomfort, and insecurity after protocol participation.

Adaptation, Psychological↗

PubMed1978

Friendship, proximity, and self-disclosure.

Patterns of self-disclosure were explored by means of a questionnaire administered to pairs of roommates and hallmates (non-roommates living on the same floor) in freshman dormitories. It was predicted and found that friendship was more highly related to self-disclosure in intimate than in non-intimate topic areas, whereas proximity was more highly related to disclosure in non-intimate than in intimate areas. It was also found that friendship and intimate disclosure were more highly related among women than among men. These findings emphasize the interplay of personal, role-related, and environmental factors which underlie patterns of friendship and self-disclosure. They also point to the importance of viewing self-disclosure in differentiated terms, rather than as single monolithic entity. Other findings of both substantive and methodological interest are reported. For example, there was a strong tendency for respondents to overemphasize the degree to which their patterns of giving and receiving personal information were symmetrical. There was also a tendency for respondents to report giving more disclosure than they received in non-intimate areas, but not in intimate areas.

Analysis of Variance↗

PubMedDate not supplied

Calculating the risks and benefits of disclosure in African American women who have HIV.

OBJECTIVE: To identify the processes involved in and the patterns of disclosure of their HIV diagnosis reported by African American women. DESIGN: Qualitative descriptive. SETTING: Southeastern United States; nurse visits in the homes of the participants. PARTICIPANTS: Forty-eight African American women who were HIV-positive and were primary caretakers of young children. MAIN OUTCOME MEASURE: Field notes were analyzed using content analysis. RESULTS: Once the women learned they had HIV, they were faced with the issue of determining "what is at stake" in telling others of their diagnosis. This dilemma was characterized by the threat of stigma, feelings of shame, and the concurrent need for support. The women determined a calculus of disclosure in determining to whom and when to reveal their HIV diagnosis. This calculus involved a careful evaluation of the risks and benefits involved in disclosing their illness. Risks of telling were fueled by societal and experienced stigma associated with HIV, whereas the benefits were primarily fueled by personal needs. The calculus of disclosure was a recursive process, with decisions made and remade over time. Disclosure patterns ranged from secretive to full disclosure. CONCLUSIONS: Issues related to stigma and therefore to disclosure of a diagnosis of HIV are highly relevant to HIV-positive African American women. Nurses have an important role in supporting women regarding their disclosure decisions.

Adult↗

PubMed2006

The effects of interviewer race and child race on sexual abuse disclosures in forensic interviews.

This study examined the impact of interviewer race and child race on disclosures by alleged child sexual abuse victims during forensic interviews. Despite findings that supportiveness of caretaker, gender of interviewer, gender of child, and age of child affect disclosure, previous studies have failed to examine race as a variable impacting disclosure in a real-world setting. The study examined 220 cases from an archive of reports generated from forensic interviews in an urban setting. The reports were reviewed and coded for degree of disclosure, focusing on African American and Caucasian children and interviewers. The results indicate that child race and the interaction of child race and interviewer race reliably distinguished between no disclosure, tentative disclosure, and disclosure with detailed account of activity, while interviewer race alone failed to serve as a significant predictor. The interaction between child race and interviewer race was not in the predicted direction, with cross-race dyads disclosing more than same-race dyads. Results are discussed in the context of real-world applications versus the previous analogue child sexual abuse literature.

Adolescent↗

PubMed2002

The specificity of maternal disclosure of HIV/AIDS in relation to children's adjustment.

Disclosure experience of 58 HIV-seropositive women was examined as a multi-faceted process comprising eight variables: level, seriousness, breadth, frequency, source, secrecy, age at first disclosure, and time since disclosure. The majority of children (57%) were told that their mothers had HIV/AIDS and were given additional information about mothers' health (64%) including prognosis of potential death (68%). Most were disclosed to by their mothers (75%) and were not asked to keep disclosures secret (66%). For most (68%) discussion regarding mother's health was infrequent. Children, on average, were first disclosed information at age 7 and had been aware of information for 3 years. Disclosure characteristics were related to demographics of mothers and children. Hierarchical multiple regression analyses showed that children asked to keep disclosures secret tended to display more behavior problems than children not asked to keep secrets. However, the specificity of disclosure did not otherwise predict children's adaptive functioning.

Adaptation, Psychological↗