Disclosing Mental Illness Information to a Friend: Exploring How the Disclosure Decision-Making Model Informs Strategy Selection

Abstract

Within the context of mental illness disclosure between friends, this study tested the disclosure decision-making model (DD-MM; Greene, 2009) to comprehensively investigate factors that predict disclosure enactment strategies. The DD-MM describes how individuals determine whether they will reveal or conceal non-visible health information. Processes of revealing, called disclosures, take various forms including preparation and rehearsal, directness, third-party disclosure, incremental disclosures, entrapment, and indirect mediums (Afifi & Steuber, 2009). We explore the disclosure decision-making process to understand how college students select to disclose their mental illness information with a friend. Participants were 144 students at a Midwestern university who had disclosed their mental illness information to a friend. Structural equation modeling analyses revealed that college students choose strategies based on their evaluation of information assessment and closeness, and that for some strategies, efficacy mediates the relationship between information assessment and strategy. This manuscript discusses implications of findings and suggests direction for future research.

How Primary Care Physicians Elicit Sensitive Health Information From Patients: Describing Access to Psychosocial Information

“…The PCPs' (receiver) perspectives on disclosure are consistent with current health communication literature, which describes that disclosure is, at least in part, informed by the perceived closeness of the relationship between the sender and the receiver of personal health information (Venetis et al, 2018). Participants' assertion that the ability to build trust depends upon their ability to establish and nurture a relationship with patients is consistent with literature which describes that patients who indicate unsatisfactory relationships with health care practitioners leads to lack of trust, which can lead to disregard of recommendations for self-management (Gomersall et al, 2011).…”

“…Consequently, no existing explanatory model directly addresses patient disclosure in the context of health care delivery. Therefore, we situate the findings in the health communication literature with a particular emphasis on the circumstance in which individuals disclose sensitive health information (Venetis et al, 2018).…”

“…To establish shared goals and select treatment options (Burke et al, 2006;Linmans et al, 2015), patients must disclose sensitive, health-related psychosocial information to practitioners. This disclosure enables awareness and understanding of both facilitators and barriers to recommended self-management (Burke et al, 2006;Linmans et al, 2015;Venetis et al, 2018). Psychosocial information includes the individual (e.g., financial strain, health literacy) and environmental (e.g., social support, community resources, cultural traditions) information physicians use to help them understand patients' specific circumstances which may facilitate or present barriers to following recommended self-management behavior.…”

Disclosure and nondisclosure of suicidality to romantic partners: Understanding the decision-making process

“…The DD-MM has also been used to investigate other general nonvisible conditions, such as congenital and genetic illnesses (Choi et al, 2016), sexually transmitted infections, eating disorders, cancer, lupus (Greene et al, 2012), and HPV (Smith et al, 2014). More recently, the DD-MM has been applied to nonvisible mental health conditions, including anxiety, depression, attention deficit disorder (Venetis et al, 2018), and schizophrenia (Pahwa et al, 2017). Simply put, the DD-MM narrows the scope of health disclosure processes to describing assessments involving three components: information assessment, receiver assessment, and disclosure efficacy.…”

“…Since suicidality is often not well defined and does not have a singular diagnosis (Joiner et al, 2018), the disclosure process of this specific condition is further complicated. Previous studies have positioned mental health disclosures as contingent on a diagnosis (Choi et al, 2016;Venetis et al, 2018). Suicidal ideation or behaviors may not have prescribed exchanges with health professionals and thereby without pre-existing conversations or confirmation of a diagnosis.…”