Disclosure Decision-making Model Research Articles

Gender-Specific Non-Disclosure of Mental Distress

Research suggests that non-disclosure of mental distress is associated with poorer mental health. While men are more reluctant to communicate about personal issues with informal and professional social contacts, little is known about the reasons for and factors associated with non-disclosure among men and women. Based on the Disclosure Decision-Making Model and the Communication Privacy Management Theory, we conducted a cross-sectional online survey with a quota sample of 2,471 participants in Germany. In the study, we (a) examined gender differences regarding non-disclosure of distress, (b) aimed to identify individual and relational factors associated with non-disclosure for both genders, and (c) studied men’s and women’s reasoning for non-disclosure of mental distress. Findings demonstrate that (a) non-disclosure was not higher in the male subsample but men had less trusted contacts; (b) individual level factors, particularly the conformity to traditional gender norms, were associated with non-disclosure among both genders; (c) men stipulated the superficiality of the relationship as more relevant reasons, while women indicated privacy and feelings of shame/self-blame as more important. The study findings might inform gender-sensitive mental health campaigns in the sense that questioning traditional gender norms could contribute to disclosure of mental distress among both men and women.

Testing a Trust-Based Model of Sexual Self-Disclosure in Romantic Relationships

Being able to talk comfortably about sexual topics enhances romantic relationships; however, revealing private sexual information entails trusting a partner with the disclosure. Based on the disclosure decision-making model, this study tested a sexual disclosure model identifying mechanisms linking perceived disclosure trust with willingness and likelihood to disclose private sexual information to partners. Survey responses from 595 individuals indicated that when deciding to reveal private sexual information, people consider their level of trust disclosing to a partner, the outcomes that they anticipate will incur if they reveal the information to the partner, and their ability to manage such a revelation. The sexual disclosure model provides a useful framework for understanding decisions to reveal private sexual information to romantic partners.

Relationship between mental health literacy and professional psychological help-seeking attitudes in China: a chain mediation model

BackgroundMental health literacy is considered an important factor in promoting professional psychological help-seeking attitudes. However, it is important to clarify the emotional and behavioral factors that underlie this association. Drawing from the ABC model of attitudes and the Health Disclosure Decision-Making Model, this study aimed to examine the mediating role of psychological help-seeking stigma and distress disclosure in the relationship between mental health literacy and professional psychological help-seeking attitudes.MethodsWe collected data from 827 participants in seven regions of China (597 female; Mage = 26.019, SD = 5.592 years old) using self-report measures, including the Mental Health Literacy Scale, Questionnaire of Stigma for Seeking Professional Psychological Help, Distress Disclosure Index, and Attitudes Toward Seeking Professional Psychological Help-Short Form. A chain mediation model was built to examine the relationships among mental health literacy, psychological help-seeking stigma, distress disclosure, and professional psychological help-seeking attitudes.ResultsThe results of the analyses showed a positive association between mental health literacy and professional psychological help-seeking attitudes, with psychological help-seeking stigma and distress disclosure playing mediating roles in this relationship. Furthermore, even after controlling for participants’ age, gender, and education, the chain mediation effect of psychological help-seeking stigma and distress disclosure on the relationship between mental health literacy and professional psychological help-seeking attitudes was observed among the Chinese population.ConclusionsThese findings underscore the significance of mental health literacy in shaping professional psychological help-seeking attitudes, while emphasizing the need to account for psychological help-seeking stigma and distress disclosure when examining this association. Additionally, the model proposed in this study provides a valuable framework for promoting the utilization of professional mental health services.

Experiences of prognosis disclosure versus nondisclosure among family caregivers of persons with advanced cancer

Caregiving in the South Asian context is often assumed by family automatically for the person with cancer (PWC). In this paper, we applied the disclosure decision-making model (DD-MM) to understand the motives behind cancer prognosis disclosure (or not) by caregivers to the PWC. Fifty caregivers participated in semi-structured interviews; and data were analyzed using Framework Approach. For the disclosing caregivers, some of the themes that emerged were consistent with the DD-MM framework while others were not. In particular, the theme “recipient assessment” was part of the DD-MM framework, while others such as unmet communication needs, caregiver self-reflection, and family support were outside of the framework. In contrast, for the non-disclosing caregivers, the reasons for nondisclosure fit very concisely into the DD-MM framework, particularly with information assessment, recipient assessment, and (non) disclosure efficacy. This study has significant implications for development of communication skills trainings around holding family meetings in India.

Navigating the Decision to Disclose Mental Illness in the Workplace: The Role of Leader Motivating Language and Perceived Organizational Support

ABSTRACT Mental health disclosure in the workplace has drawn much attention as it comes with multiple benefits such as reducing financial burden, facilitating relationships, and counteracting related stress. Drawing on insights from the disclosure decision-making model, motivating language theory, and organizational support theory, the study presents a model that pictures the underlying mechanisms of the disclosure decision-making process. The findings from a survey of 416 participants suggested that the direction-giving and empathic language strategy can lead to employees’ perceived organizational support. Such perception can help them reduce anticipated negative outcomes when considering disclosure and increase their disclosure efficacy, which in turn increases their disclosure intention.

Using the Disclosure Decision-Making Model to Examine Patient Confusion Disclosure

ABSTRACT The disclosure decision-making model (DD-MM) has been heavily explored within its initially proposed scope. Fewer known studies have tested the DD-MM’s boundaries by assessing the model’s application beyond close personal relationships, and none have explored it in a context outside of long-term health conditions. The current study investigates the disclosure decision-making process of patients to their healthcare providers when they experience situational confusion. A primarily quantitative online survey analyzed data from 251 U.S. adults who felt confusion during a recent appointment with their healthcare provider. Findings indicate that, although stigma and perceived disclosure efficacy impacted patient confusion disclosure as anticipated, anticipated response and relational quality (i.e., receiver assessments) did not play a significant role in disclosure. Stigma, anticipated response, and perceived disclosure efficacy were all related to remaining patient confusion as expected. This study contributes to our understanding of the scope of disclosure decision-making model as well as the to-date overlooked nuances of situational patient confusion: what impacts confusion disclosure and its likelihood to remain beyond the appointment’s end. Limitations, implications, and future directions are discussed.

The Influence of Perceived Provider Empathic Communication on Disclosure Decision-Making

ABSTRACT Provider empathy is a crucial component in establishing therapeutic provider–patient relationships. The benefits of increased perceptions of empathy can support patient psychological adjustment to their cancer as well as patients’ comfort and confidence in disclosing to providers, ultimately promoting patient engagement. Guided by the disclosure decision-making model, this manuscript explores how perceptions of empathy influence patient psychological adjustment and how those variables influence patient disclosure efficacy. The model ultimately predicts patient sharing and withholding of information during the medical interaction. This study tested a mediation model to investigate how current (n = 111) and former (n = 174) breast cancer patients’ psychological adjustment mediates the relationship between patient perceptions of oncologist empathic communication and efficacy to disclose health information to their oncologist and their disclosure enactment in sharing and withholding. Overall, former patients compared to current patients had more positive perceptions of their oncologist’s empathic communication, had better psychological adjustment, felt more self-efficacy to disclose to their oncologist, and shared more and withheld less information from their oncologist (p < .05 in all cases). Structural equation modeling revealed good fit to the data for both current and former patients such that more perceived empathic communication was associated with more efficacy for disclosure, which was associated with more sharing and less withholding. Additionally, there was an indirect relationship from perceptions of empathic communication to disclosure efficacy through patients’ psychological adjustment to the diagnosis. Results reinforce the importance of providers’ empathic communication for cancer patients’ psychological adjustment because patient sharing and withholding of information remain crucially important to achieving holistic care across the cancer trajectory.

A-29 To report or not to report: A review of adolescent decision-making theories following sports-related concussion

Abstract Purpose Sports-related concussion (SRC) is a prevalent concern among adolescent athletes. If SRC is suspected, athletes are usually removed from play for assessment and symptom monitoring. Return-to-play decisions heavily rely on athlete self-report of SRC and associated symptoms. Social pressures and attitudes related to symptom reporting influence an athlete’s decision of whether to disclose symptoms; not reporting increases risk for subsequent injury and delayed recovery. Therefore, it is important to understand the adolescent decision-making process following SRC. In this review, prevailing theories that explain symptom reporting and decision-making following SRC will be evaluated from a clinical lens. Data Selection Literature was reviewed using Google Scholar, PubMed, and SCOPUS. Search terms included “concussion” AND “sport” AND “symptom reporting” OR “reporting” OR “self-report”. Other terms included “decision-making”, “disclosure”, “adolescent”, “high school”, and “college”. Articles from 2004-2023 were included. Data Synthesis Three prevailing theories have been proposed to explain symptom underreporting among adolescent athletes: the Theory of Reasoned Action and Planned Behavior, the Bandura Social Cognitive Theory, and the Disclosure Decision-Making Model. These theories will be critiqued and the lack of research on neurodevelopmental components of decision-making will be highlighted. Conclusions The decision-making process following SRC is complex, multi-factorial, and state-dependent. While these theories provide critical insights into symptom reporting following SRC, they do not consider important neurodevelopmental factors such as the imbalance between cognitive control and reward processing in adolescence. When educating parents and coaches about symptom reporting following SRC, it will be important for clinicians to consider socioemotional, cultural, environmental, and neurodevelopmental factors.

Let’s Talk About Death: Applying the Disclosure Decision-Making Model to Death Planning Disclosure

ABSTRACT The disclosure decision-making model (DD-MM) explains an individual’s decision-making process regarding whether they disclose personal health information to others and consists of three tenets (i.e., assessment of information, assessment of receiver, and disclosure efficacy). Whereas traditional DD-MM applications have focused on physiological disclosures (e.g., HIV diagnosis), this study investigates the non-visible, non-diagnosis context of disclosing desired death arrangement plans with others (i.e., how individuals wish their body to be memorialized following their death). Data from 467 individuals aged between 18 and 82 were collected through online surveys. Path analysis findings indicate that while perceptions of stigma, prognosis, and relevance to others (i.e., assessment of information) were significantly related to disclosure efficacy and anticipated response, only relevance to others was directly related to relational quality. Additionally, anticipated response and relational quality (i.e., assessment of receiver) as well as disclosure efficacy and anticipated response performed in accordance with the DD-MM. This study provides meaningful conclusions for agencies who aim to craft messages that will help resonate with, inform, and protect consumers from becoming susceptible to unethical practices in the death service industry. Limitations and future research avenues are discussed.

The Role of Shame, Stigma, and Family Communication Patterns in the Decision to Disclose STIs to Parents in Order to Seek Support.

Emerging adulthood is identified as a time of personal growth wherein emerging adults engage in sexual exploration and risky behaviors, potentially resulting in the contraction of a sexually transmitted infection (STI). Due to the continued reliance on parents for support during this developmental period, emerging adults (EAs) may need to disclose their STI status to their parents. This study applies the health disclosure decision-making model (DD-MM) to extend our understanding of EA disclosures of sensitive health information such as STIs to parents. Data were collected from 204 college students. The results of mediational analyses provided some support for the mediating effects of family communication patterns on the relationship between relational quality and illness assessment (i.e., stigma) and willingness to disclose in a given scenario. The theoretical and practical implications of this are discussed.

Predicting Menstruation-Related Topic Avoidance between Daughters and Mothers in Two Regions of Northern India

Young women in India report that avoidant talk within families hinders their ability to communicate about menstruation, further promoting stigma and limiting knowledge. Participants included 287 college-attending women from one of two colleges in different locations in northern India. Participants completed surveys that were guided by the disclosure decision-making model (DD-MM) and asked about menstruation-related topic avoidance with mothers. Results find that the stigma of being dramatic is a consistent predictor across the two locations but that predictors otherwise differ. Theoretical and practical implications are discussed.

Modeling the Factors Associated with Topic Avoidance about Mental Health: Depressive Symptoms, Information and Relationship Assessments, and Efficacy

ABSTRACT This study modeled associations between depressive symptoms, information and relationship assessments, and efficacy as predictors of topic avoidance about mental health. We proposed a model, drawing on previous research and the disclosure decision-making model (DD-MM). A sample of 304 individuals with a self-reported mental illness completed an online survey about their diagnosis and their intentions to share information about their mental health. Results of a structural equation model found: (a) depressive symptoms were positively associated with stigma and anticipated outcome, (b) anticipated response was negatively associated with disclosure efficacy, (c) disclosure efficacy was negatively associated with topic avoidance, and (d) stigma was positively associated with topic avoidance about mental health. Theoretical and practical implications are discussed.

Testing the disclosure decision-making model: disclosing birth control status among college women

ABSTRACT Reproductive health communication can greatly benefit college women by providing informational and emotional support for their reproductive sexual health. However, communication about birth control with friends and sexual partners can be difficult especially if there is stigma around the topic. Applying the Disclosure Decision-Making Model, this study employs a survey of 104 college women regarding their disclosure of birth control status to a peer (Model 1) and a sexual partner (Model 2) to understand the mechanisms of decision-making (i.e., stigma, relational quality, anticipated response, disclosure efficacy) on the depth of disclosing reproductive health information. Results suggest that for both models, relational quality and anticipated response were the predictors of disclosure depth. Although all the significant paths were equivalent in the two models, relational quality predicted anticipated response more strongly in partner model. Theoretical and practical implications of the findings are discussed.

Applying the Disclosure Decision-Making Model to suicide-related disclosure: A theory-informed multilevel social network analysis

Applying the Disclosure Decision-Making Model to suicide-related disclosure: A theory-informed multilevel social network analysis

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

The stigmatization of suicidal thoughts and behaviors often prevents disclosure to others, including romantic partners. Minimal research has examined the disclosure or withholding of this stigmatized identity, resulting in a lack of knowledge about the benefits or consequences of informing others. Participants ( n = 61) were recruited from Reddit and completed open-ended questions about their prior suicidal ideation and behaviors while in a romantic relationship. Responses were separated by disclosers ( n = 31) and non-disclosers ( n = 30) to romantic partners. After utilizing a thematic analysis, the Disclosure Decision-Making Model (DD-MM) was applied to the results to make sense of decision-making processes. The three primary themes (assessing information, assessing emotional capacity, and assessing the receiver) provide insight into the psychological and communicative progression as well as the differences that arise for each individual. Findings discuss theoretical adaptations, implications, and future directions.

Decision-Making Criteria When Contemplating Disclosure of Transgender Identity to Medical Providers

ABSTRACT As identified in HealthyPeople 2020, the transgender population faces various barriers in accessing quality health care. One barrier includes the fear of negative response or refusal of treatment after disclosing one’s transgender identity. In an effort to address this concern, it is essential to understand the criteria that transgender patients consider when determining if they will disclose their gender identity. The disclosure decision-making model (DD-MM) describes how individuals make decisions to share non-visible, health-relevant information with others. Applying the information assessment component of the DD-MM, the present study investigated the salient information assessment themes that contribute to transgender patients’ decisions to disclose or withhold their gender identity from medical providers. The sample (N = 26) included transgender individuals who participated in in-depth interviews and described instances and criteria of disclosure decisions. Results revealed that when gauging stigma, participants consider cultural attitudes, how providers may attribute health concerns to their transgender identity, and if providers will perceive them as “trans enough” to provide access to transition-related care. When transition-related care is not necessary, participants’ disclosure decision criteria include thoughts on how providers will perceive their gender expression and whether their transgender identity is salient to the medical interaction. Findings also highlighted opportunities for extending prior theoretical conceptualizations and practical implications for transgender care.

Men's and Women's Approaches to Disclosure About BRCA-Related Cancer Risks and Family Planning Decision-Making.

Little is known about how men and women who test positive for a BRCA gene mutation or have a strong family history of carrying a BRCA mutation manage disclosures about their BRCA-related cancer risks and family planning decision-making. By conducting interviews with 25 men and 20 women, this study investigated men's and women's approaches to disclosing their BRCA-related cancer risks and family planning decision-making. Guided by the Disclosure Decision-Making Model (DD-MM), this study demonstrates that men and women assess both information and the recipients of disclosures when making disclosure decisions. Theoretical implications for the DD-MM are discussed along with practical implications for hereditary cancer risk and family planning.

Using the Disclosure Decision-Making Model to Understand High School Football Players’ Disclosures of Concussion Symptoms

Despite advancements in concussion treatment and management, health and sports professionals largely depend on athletes’ self-reporting of symptoms to begin the process of diagnosis. With this in mind, recent scholarly attention has focused on understanding the barriers and processes of athletes’ self-disclosure of symptoms. The current study applied the disclosure decision-making model to understand high school football players’ disclosure decisions after experiencing symptoms of a concussion. Data obtained from 184 high school football players from across the United States demonstrated 2 significant paths by which players’ disclosures of concussion symptoms during a game can be understood. First, the perceived severity of these symptoms predicted athletes’ self-efficacy to disclose concussions, which subsequently predicted their intentions to disclose concussion symptoms during a game. Second, the felt stigma around disclosing concussion symptoms predicted athletes’ anticipated responses from coaches to such disclosures, which subsequently predicted their intentions to disclose concussion symptoms during a game. Furthermore, the effect of perceived stigma on the anticipated responses from coaches was moderated by the quality of athletes’ relationships with their coaches. These results highlight the importance of convincing athletes to take concussion symptoms seriously and the role of athlete–coach relationships in combatting stigma around concussion disclosures. These findings suggest that scholars and practitioners should acknowledge the social contexts surrounding disclosure of concussion symptom and shift educational efforts to focus on the dangers of concussions and the process by which athletes should report potential symptoms.

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

ABSTRACTWithin 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.

Mental illness disclosure decision making.

Disclosure related to mental illness has been linked to various positive outcomes, including better mental health. However, many individuals with serious mental illness (SMI) continue to practice non-disclosure. Even though disclosure inherently occurs within the context of one's social relationships, research has generally conceptualized mental illness disclosure as an individual level phenomenon and neglected to consider preferences concerning to whom an individual discloses and the factors that influence this decision. The current study uses the disclosure decision-making model (DD-MM) by Greene (2009) to better understand the processes of mental illness disclosure preference and selective disclosure for individuals with SMI (n = 60) using multivariate random intercept logistic regression with an emphasis on the constituent factors of disclosure preference at both individual and relational levels. The majority of participants were found to practice selective disclosure, with 68% of the participants identifying at least 1 network member to whom they could disclose. Family members and friends were central to the selective disclosure process, comprising the greatest proportion of network members who, both were and were not identified as preferred confidants. Women were found to show higher odds of preference for mental illness disclosure than men. Having lower perceived social support was associated with lower odds of disclosure preference. Among relational factors, greater relationship availability and lower dyadic tangible social support were associated with lower odds of disclosure preference. Practice and research implications of using social network analysis to get a deeper understanding of disclosure and disclosure preference are discussed, including implications for future interventions targeting stigma reduction. (PsycINFO Database Record