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PubMed1999

When asked, patients tell: disclosure of sensitive health-risk behaviors.

OBJECTIVES: National health care organizations recommend routinely screening patients for behavioral health risks, the effectiveness of which depends on patients' willingness to disclose risky behaviors. This study aimed to determine if primary care patients' disclosures of potentially stigmatizing behaviors would be affected by (1) their expectation about whether or not their physician would see their disclosures and (2) the assessment method. METHODS: One thousand nine hundred fifty-two primary care patients completed a questionnaire assessing human immunodeficiency virus (HIV), alcohol, drug, domestic violence, tobacco, oral health, and seat belt risks; half were told their responses would be seen by the researcher and their physician and half were told that their responses would be seen by the researcher only. Patients were randomly assigned to one of five assessment methods: written, face-to-face, audio-based, computer-based, or video-based. RESULTS: Across all risk areas, patients did not disclose differently whether or not they believed their physician would see their disclosures. Technologically advanced assessment methods (audio, computer, and video) produced greater risk disclosure (4%-8% greater) than traditional methods in three of seven risk areas. CONCLUSIONS: These findings suggest patients are not less willing to disclose health risks to a research assistant knowing that this information would be shared with their physician and that a number of assessment methods can effectively elicit patient disclosure. Potentially small increases in risk disclosure must be weighed against other factors, such as cost and convenience, in determining which method(s) to use in different health care settings.

Adult↗

PubMedDate not supplied

Disclosure of traumas and health among Holocaust survivors.

On the basis of a theory of inhibition and psychosomatics, it was predicted that the more individuals disclosed personally traumatic experiences, the better their long-term health following the disclosure. Thirty-three Holocaust survivors talked for 1-2 hours about their personal experiences during World War II while skin conductance level (SCL) and heart rate (HR) were continuously monitored. Each videotaped interview was rated by independent judges once every minute on the degree to which the survivor's experience was traumatic. For each subject, the trauma ratings were correlated with minute-by-minute SCL and HR readings. Based on previous research, negative trauma-SCL correlations are indicative of high personal disclosure, whereas positive trauma-SCL correlations suggest low disclosure, whereas positive trauma-SCL correlations suggest low disclosure. Approximately 14 months after the interview, self-reports of the subjects' health were collected. Controlling for pre-interview health problems, degree of disclosure during the interview was found to be positively correlated with long-term health after the interview. The possible health benefits of disclosure are discussed.

Aged↗

PubMed2001

HIV-positive men's sexual practices in the context of self-disclosure of HIV status.

OBJECTIVE: To examine whether disclosure of HIV-positive status to sex partners at risk for HIV infection is associated with safer sex practices and to examine the prevalence and correlates of specific disclosure/sexual behavior patterns. METHODS: Cross-sectional assessment of 206 HIV-positive men (41% homosexual, 35% bisexual, 24% heterosexual) sampled randomly at an outpatient HIV clinic in Los Angeles, who reported that their most recent sex partner was HIV-negative or of unknown serostatus. Unsafe sex was defined as unprotected anal or vaginal intercourse with that partner. RESULTS: Twenty-five percent of the men engaged in unsafe sex, and 48% of the total sample withheld disclosure from the partner. The prevalence of safer sex was not significantly higher among disclosers than among nondisclosers (unadjusted odds ratio = 1.29; 95% confidence interval: 0.69-2.45), and disclosure was not significantly associated with safer sex in any of 25 demographic or partner subgroups examined in the study. In the full sample, 40% of the men disclosed and engaged in safer sex (informed protection), 35% withheld disclosure and engaged in safer sex (uninformed protection), 12% informed their partner and engaged in unsafe sexual behavior (informed exposure), and 13% withheld disclosure and engaged in unsafe sex (uninformed exposure). Risky behavior patterns were associated with using alcohol/drugs before sex, having an HIV-unknown partner, being less emotionally involved with one's partner, and testing seropositive in the previous 3 years. CONCLUSIONS: Interventions for seropositive men that focus primarily on increasing disclosure of serostatus to sex partners may not reduce the prevalence of unsafe sex. Interventions are needed to address the social and psychologic processes that give rise to risky behavior patterns in HIV-infected men. Improved substance abuse counseling also may be needed.

Adult↗

PubMed2002

When the time comes to talk about HIV: factors associated with diagnostic disclosure and emotional distress in HIV-infected children.

OBJECTIVE: To determine factors related to the timing and probability of nondisclosure of HIV status to perinatally HIV-infected children, and to explore factors associated with emotional distress in HIV-infected children. METHODS: This is a cross-sectional study of 51 HIV-infected children based on medical records, parent interviews, and child assessments. RESULTS: 1) Probability of earlier age of disclosure is associated with higher child IQ (p =.04) and more family expressiveness (p =.01); 2) controlling for child age, disclosure status at time of study is associated with major life events, but not with medical status; and 3) factors associated with increased parent-rated anxiety in HIV-infected children in univariate analyses are: HIV disclosure (p =.04), other major life events (p =.001), higher medication dose frequency ( p=.01), and child age (p =.01). Increased depression is associated only with more medication doses (p =.02). CONCLUSION: These data indicate that higher child IQ and greater family expressiveness increase the probability of earlier diagnostic disclosure to HIV-infected children. Factors associated with emotional distress highlight important areas of clinical attention. These data suggest that diagnostic disclosure may not necessarily minimize emotional distress, indicating the need for further evaluation of the appropriate timing and type of disclosure for pediatric HIV.

Adolescent↗

PubMedDate not supplied

For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain.

OBJECTIVE: Although written emotional disclosure has potential as a stress management intervention for people with health problems, the main (group) effects of disclosure in medical populations are limited. This study sought to identify individual difference moderators of the effects of written disclosure among women with chronic pelvic pain. METHODS: In a prospective, randomized trial, 48 women with chronic pelvic pain completed 3 individual difference measures and then wrote for 3 days about stressful consequences of their pain (disclosure) or positive events (control). Health status was assessed at baseline and 2 months after writing. RESULTS: Main effect group comparisons indicated that disclosure writing resulted in significantly lower evaluative pain intensity ratings than control writing at follow-up, but there were no main effects on other outcome variables (sensory or affective pain, disability, affect). Three baseline individual difference measures, however, significantly moderated group effects. Compared with control writing, disclosure led to less disability among women with higher baseline ambivalence over emotional expression or higher catastrophizing, and to increased positive affect among women with higher baseline negative affect. Ambivalence, but not catastrophizing, was independent of negative affect in its moderation effect. CONCLUSION: Although the main effects of writing about the stress of pelvic pain are limited, women with higher baseline ambivalence about emotional expression or negative affect appear to respond more positively to this intervention.

Adaptation, Psychological↗

PubMed2006

Disclosure of HIV status and sexual orientation independently predicts increased absolute CD4 cell counts over time for psychiatric patients.

OBJECTIVE: The objective of this study was to replicate the relationship between disclosure of sexual orientation and immune functioning in HIV-positive persons and to extend those findings to a different type of disclosure (HIV status) and a different population (psychiatric outpatients in a publicly funded HIV/AIDS clinic). METHODS: A sample of psychiatric outpatients (N = 373) from a large, urban HIV clinic was assessed for level of sexual orientation and HIV status disclosure as well as absolute CD4 cell counts over time. Mixed-effects random regression analysis was used to build a predictor model that included biobehavioral covariates. RESULTS: Consistent disclosure of both sexual orientation and HIV status independently predicted increased CD4 cell counts over time controlling for important biobehavioral covariates. The only other significant effects in the model were baseline CD4 cell count and number of days between assessment of disclosure and assessment of CD4 cell count. CONCLUSIONS: Relieving potential psychological distress by disclosing sexual orientation and HIV status has a positive impact on CD4 cell counts over time even among outpatients stressed by psychiatric illness and economic disadvantage. Additional research is needed to understand whether and under what conditions disclosure should be part of HIV disease management.

Adult↗

PubMed2006

Disclosure of HIV/AIDS diagnosis to HIV-infected children in Thailand.

BACKGROUND: With the availability of highly active antiretroviral therapy, more HIV-infected children have lived longer. Many children are at the age that they should know the diagnosis. AIM: To identify the prevalence and patterns of disclosure of HIV/AIDS diagnosis to HIV-infected children. METHODS: A cross-sectional study was conducted among 103 main care givers of HIV-infected children aged > or =6 years who received highly active antiretroviral therapy at Chiang Mai University and Sanpatong district hospitals, northern Thailand. RESULTS: One-third (30.1%) of the children knew their HIV/AIDS status at an average age of 9.2 years. The care givers' understanding of 'knowing' did not always mean that the children were told the name of 'HIV' or 'AIDS'. Many of those care givers (84.3%) who reported that the child did not know their diagnosis had inaccurately explained to the child that he or she had some kind of disease such as allergy, lung, or liver disease. The most common reason for non-disclosure was the fear that disclosure might have negative psychological consequences to the child (53.4%). Almost all (88.7%) agreed that they should tell the children their diagnosis in the future but half needed health-care providers to help them at the event. CONCLUSION: There is a need for the development of disclosure guide-lines and models for health-care providers and care givers as there was a high rate of inaccurate disclosure and, in addition, care givers expressed their need for assistance from health-care providers for the future disclosure.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Conflict of Interest Disclosure Policies and Practices in Peer-reviewed Biomedical Journals.

OBJECTIVE: We undertook this investigation to characterize conflict of interest (COI) policies of biomedical journals with respect to authors, peer-reviewers, and editors, and to ascertain what information about COI disclosures is publicly available. METHODS: We performed a cross-sectional survey of a convenience sample of 135 editors of peer-reviewed biomedical journals that publish original research. We chose an international selection of general and specialty medical journals that publish in English. Selection was based on journal impact factor, and the recommendations of experts in the field. We developed and pilot tested a 3-part web-based survey. The survey included questions about the presence of specific policies for authors, peer-reviewers, and editors, specific restrictions on authors, peer-reviewers, and editors based on COI, and the public availability of these disclosures. Editors were contacted a minimum of 3 times. RESULTS: The response rate for the survey was 91 (67%) of 135, and 85 (93%) of 91 journals reported having an author COI policy. Ten (11%) journals reported that they restrict author submissions based on COI (e.g., drug company authors' papers on their products are not accepted). While 77% report collecting COI information on all author submissions, only 57% publish all author disclosures. A minority of journals report having a specific policy on peer-reviewer 46% (42/91) or editor COI 40% (36/91); among these, 25% and 31% of journals state that they require recusal of peer-reviewers and editors if they report a COI. Only 3% of respondents publish COI disclosures of peer-reviewers, and 12% publish editor COI disclosures, while 11% and 24%, respectively, reported that this information is available upon request. CONCLUSION: Many more journals have a policy regarding COI for authors than they do for peer-reviewers or editors. Even author COI policies are variable, depending on the type of manuscript submitted. The COI information that is collected by journals is often not published; the extent to which such "secret disclosure" may impact the integrity of the journal or the published work is not known.

Conflict of Interest↗

PubMed1995

Timing disclosure sessions: adding a narrative perspective to clinical work with adult survivors of childhood sexual abuse.

Though the literature on the diagnosis and treatment of survivors of childhood sexual abuse has burgeoned in the last 20 years, relatively little guidance is available in the popular or professional literature to assist clients or therapists about issues of disclosure of this abuse to family members. When authors explicitly focus on disclosure, the timing of such disclosure is usually framed within a psychological and/or interpersonal perspective. In this article, we suggest that attention to characteristics of the sexual abuse narrative itself offers an important additional resource to guide decision making with respect to disclosure. We also describe ways that a narrative approach to disclosure can produce empowering conversational practices. A detailed case example provides the clinical material to illustrate this narrative approach to disclosure.

Adaptation, Psychological↗

PubMed2005

Disclosure of medical errors: ethical considerations for the development of a facility policy and organizational culture change.

The Institute of Medicine report, To Err Is Human: Building a Safer Health System, has spurred public concern over hospitals' ability to deliver safe care. The health care industry continues to struggle to address these concerns. These efforts have driven the growing expectation that health care practitioners or systems disclose unanticipated outcomes to patients and family members. Although the tort system has been cited as an impediment to medical error disclosure, some organizations and systems have successfully implemented policies calling for full disclosure of errors and unanticipated outcomes. However, most organizations have yet to develop policies concerning error disclosure. This article provides an overview of error disclosure and a model framework for an error disclosure policy. The ethical principle of respect for patient autonomy is emphasized as the driving force in developing an institutional disclosure policy and changing the organizational culture to one that supports development and implementation of such a policy.

Ethics, Institutional↗

PubMed2006

How the structure of contribution disclosure statements affects validity of authorship: a randomized study in a general medical journal.

OBJECTIVE: Many biomedical journals have introduced disclosure of research contribution in journal articles as a way to limit irresponsible authorship. Over the years, journals have developed different contribution disclosure policies and procedures, but it is not known how these policies and procedures affect authorship. The aim of our study was to analyse possible causative relationships between the structure of the contribution disclosure form and the number of authors who do not meet authorship criteria in biomedicine set by the International Committee of Medical Journal Editors (ICMJE). RESEARCH DESIGN AND METHODS: In a single-blind randomized trial, 1462 authors of 332 manuscripts submitted to a general medical journal answered one of three different contribution disclosure forms: (1) open-ended -- asking the respondents to describe in their own words their contributions in the submitted work; (2) categorical -- with 11 possible contribution choices and (3) instructional -- guiding through the ICMJE definition and instructing how many contributions are needed to satisfy individual criteria. MAIN OUTCOME MEASURE: The number of authors not satisfying ICMJE authorship criteria. RESULTS: The group answering the instructional form had significantly fewer authors whose reported contributions did not satisfy ICMJE criteria (18.7%) than the groups answering the categorical (62.8%) or open-ended (54.7%) form (chi2(2 ) = 210.833, p < 0.001). The group receiving instructional forms also had the fewest articles with honorary authors (32.5%) compared with those who responded in a categorical (68.7%) or open-ended (83.0%) form (chi2(2 ) = 63.378, p < 0.001). All authors who answered the open-ended form, regardless of their compliance with authorship criteria, reported significantly fewer contributions (median 3 [95% confidence interval = 3-3]) than authors responding to either the categorical (4 [4-4]; z score = -7.1899, p < 0.001) or instructional form (4 [4-5]; z score = -13.9760, p < 0.001). Honorary authors answering the instructional form reported more contributions than those answering either the categorical or open-ended form (z score = 2.7637, p = 0.0057 and z score = -3.3773, p < 0.001, respectively). Most honorary authors (39.9%) lacked only the third ICMJE criterion (final approval of the submitted manuscript). CONCLUSIONS: The structure of the contribution disclosure form significantly influenced the number of contributions reported by authors of submitted manuscripts and their compliance with the ICMJE authorship criteria. Journal editors should be aware of the cognitive aspects of survey methodology when they construct for their authors self-reports about behaviour, such as contribution disclosure forms.

Authorship↗

PubMed2004

Ethical issues in therapy: therapist self-disclosure of sexual feelings.

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosure of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions.

Codes of Ethics↗

PubMed2005

Serostatus disclosure to sexual partners by HIV-infected women before and after the advent of HAART.

HIV-positive individuals have been encouraged by public health officials to disclose their HIV status to sexual partners. In deciding what to do, however, they must weigh what they see as the potential costs and benefits of disclosing or not disclosing. In the present report we examine the reasons women offer for disclosing or not disclosing their serostatus and the reactions to that disclosure among two matched samples of HIV-infected women. The first sample was interviewed in 1994-1996, before the widespread availability of HAART; while the second sample was interviewed from 2000-2003 after these medications were widely in use. The findings reveal striking similarities between the two time periods in women's reasons for sharing or not sharing their status with partners, and the reactions to disclosure they experienced. The reconceptualization of AIDS as a chronic illness, rather than an acute fatal one, did not appear to have diminished women's felt responsibility to share their diagnosis with potential sexual partners nor their fear that disclosure would be met with rejection. The data revealed that disclosure remains a highly stressful event for HIV-infected women and that they experience considerable emotional suffering as a result of the diminished sense of self-worth and physical attractiveness brought about by their diagnosis. These findings suggest that intervention efforts toward reducing the stigmatization of HIV/AIDS and for assisting women to manage the stress of disclosure and non-disclosure and address women's feelings of self-worth continue to be needed despite the advent of HAART.

Adult↗

PubMed1987

Alcohol and self-disclosure: analyses of interpersonal behavior in male and female social drinkers.

We examined the effects of alcohol and expectations about drinking on self-disclosure in male and female social drinkers. Consistent with cognitive social learning theory, these effects were shown to vary as a function of dose, expectations about alcohol consumption and gender-related social learning history. In men, alcohol increases self-disclosure, but only at a moderate blood alcohol level. Expectations emerged as a powerful influence on self-disclosure. Men who believed that they and their female partner were both intoxicated showed increased self-disclosure although no alcohol was consumed. Women who believed that they were intoxicated showed the opposite pattern of a decrease in self-disclosure. Another gender difference was that moderate alcohol had no effect on women's self-disclosure. The self-awareness model of alcohol use failed to receive support.

Alcohol Drinking↗

PubMed2006

[Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers].

The purpose of this study was to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/ AIDS and their parents and caregivers at AIDS reference services in São Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Sex without disclosure of positive HIV serostatus in a US probability sample of persons receiving medical care for HIV infection.

OBJECTIVES: We estimated the proportion of HIV-positive adults who have any sexual contact without disclosure and the proportion of their sexual partnerships that involve unprotected sex without disclosure. METHODS: We drew participants from the HIV Cost and Services Utilization Study (n = 1421). Interviews assessed disclosure and sexual activities with up to 5 recent partners. RESULTS: Overall, 42% of the gay or bisexual men, 19% of the heterosexual men, and 17% of all the women reported any sex without disclosure, predominately within nonexclusive partnerships (P <.001). Across all groups, 13% of serodiscordant partnerships involved unprotected anal or vaginal sex without disclosure, with no significant difference between groups. CONCLUSIONS: Risky sex without disclosure of serostatus is not uncommon among people with HIV.

Adult↗

PubMed1994

Getting to know you: how own age and other's age relate to self-disclosure.

In this study, we compared self-disclosures made in ten same-aged (young-young) and ten mixed-aged (young-old) conversational dyads. We developed a scoring scheme to code get-acquainted conversations on amount, type, valence, and intimacy of self-disclosure (S-Ds). Overall, young women produced more S-Ds with same-aged than with older partners. Young women devoted marginally fewer of their self-disclosures to statements about the past than did older women. Younger and older women's S-Ds about the present and the past were not significantly different in how negative, positive, or intimate they were. The intimacy and negativity of disclosures made by the dyad members were more closely correlated in young-young than in young-old dyads. Young participants' affective reports following the conversations did not differ as a function of partner age, but did correlate with aspects of their partners' self-disclosures. Findings offer a contrast to the stereotype that older adults dominate conversations with intimate, negative disclosures about the past.

Adult↗

PubMed2005

Self-disclosure in romantic relationships and friendships among American and Japanese college students.

The author examined whether the level of self-disclosure would differ across four types of relationships--passionate love relationships, companionate love relationships, same-sex friendships, and cross-sex friendships--and across cultures: American culture and Japanese culture. Participants were 145 college students (64 Americans and 81 Japanese). The results supported three hypotheses: (a) Japanese students scored lower in self-disclosure than American students, regardless of relationship types, (b) self-disclosure was higher in same-sex friendships than in cross-sex friendships both among American participants and among Japanese participants, and (c) self-disclosure was higher in romantic relationships than in friendships both among American students and among Japanese students. However, the correlation between self-disclosure and passionate love was not stronger than the correlation between self-disclosure and companionate love. The author discussed the present study's findings and contribution.

Adolescent↗