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PubMed2002

"I could tell you, but then I'd have to kill you": classified information in the psychiatric evaluation.

Psychiatrists and other mental health professionals are presented with special challenges when their patients are involved in covert operations or other matters of national security. The patients' involvement may, by legal necessity, limit disclosures during the evaluation. Such situations may be encountered with varying degrees of frequency by military psychiatrists or consultants to various federal or law enforcement agencies involved in classified or undercover activities. The need to assess relevant psychosocial stressors while avoiding prohibited disclosure, the legal requirements to report potentially adverse information, or the procedure to gain legal permission to discuss classified details may present novel challenges for therapists in such evaluations. In this article, we present a case report illustrating these challenges and review applicable regulations and public law governing the disclosure of classified information. We also discuss common pitfalls and strategies for handling such situations.

Access to Information↗
PubMed1994

Empowering women in a violent society. Role of the family physician.

Despite erosion of key societal institutions, family physicians have remained a focal point for many troubled individuals--particularly women. The prevalence and types of abuse women experience and the effects on women's lives are summarized. Disclosures of abuse can affect family physicians. Increased awareness of gender role socialization messages for women is also relevant to family practice.

Canada↗
PubMed2004

Disclosure of HIV-positive status to Latino gay men's social networks.

This study explored disclosure of serostatus in a sample of 155 HIV-positive Latino gay men from New York City and Washington, DC. We examined rates of disclosure to different members of the social network: mothers, fathers, close friends, and primary sexual partners. There were high rates of disclosure of HIV-positive serostatus to main partners and closest friends and lower rates to fathers and mothers. We examined the role of 3 contextual target-dependent factors (emotional closeness to target, anticipated reactions from target, and target's knowledge of sexual orientation), as well as acculturation and time since diagnosis. Three separate logistic regression models were performed to predict disclosure of HIV-positive status to 3 targets: mothers, fathers, and closest friends. We found that disclosure was not a generalized tendency, but rather different factors were influential depending on the target. Whether the target was aware of participant's sexual orientation was associated with disclosure in all 3 models. Greater emotional closeness also predicted disclosure to mother and father; greater U.S. acculturation was associated with disclosure to father and marginally to mother. A longer time since diagnosis was associated with disclosure to the closest friend. These findings highlight the importance of taking into account roles and relationships, and their effect on disclosure.

Adolescent↗
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↗
PubMed2006

Medical privacy and the public's right to vote: what presidential candidates should disclose.

We argue that while presidential candidates have the right to medical privacy, the public nature and importance of the presidency generates a moral requirement that candidates waive those rights in certain circumstances. Specifically, candidates are required to disclose information about medical conditions that are likely to seriously undermine their ability to fulfill what we call the "core functions" of the office of the presidency. This requirement exists because (1) people have the right to be governed only with their consent, (2) people's consent is meaningful only when they have access to information necessary for making informed voting decisions, (3) such information is necessary for making informed voting decisions, and (4) there are no countervailing reasons sufficiently strong to override this right. We also investigate alternative mechanisms for legally encouraging or requiring disclosure. Protecting the public's right to this information is of particular importance because of the documented history of deception and secrecy regarding the health of presidents and presidential candidates.

Confidentiality↗
PubMed1992

Illness stories and patient care in the family practice context.

The importance of stories has been receiving great attention in the family and family medicine literature. Less emphasized is the presence of multiple listeners to patients' illness stories in the clinical context. This paper affirms the importance of patients' sharing their illness stories with the various members of the health care system. Through clinical examples and discussion, the paper seeks to sensitize primary care residents and teachers to the community of listeners a patient encounters in an individual clinic visit. Factors influencing patients' selective disclosure of their illness stories are identified. Methods of enhancing greater communication among the recipients of patients' illness stories are proposed.

Communication↗
PubMed1997

Depression, developmental level and disclosure in sexually abused children.

OBJECTIVE: To investigate the relationship between sexual abuse disclosure, developmental level and psychopathology in children. DESIGN: A retrospective analysis of case records, using chi-square and t-tests for statistical significance. SETTING: Child and Adolescent Unit, Midlands Hospital, Pietermaritzburg. SUBJECTS: One hundred children consecutively admitted for all types of mental health problems. OUTCOME MEASURES: Diagnostic evaluations were made using the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised). RESULTS: Forty of the 100 children had been sexually abused, but 14 (35%) of the abused children did not disclose their abuse until after admission. The post-admission disclosure group had a significantly higher mean age (13.71 years) than the pre-admission disclosure group (10.96 years). Also, significantly more post-admission disclosure children received a diagnosis of major depressive disorder than their pre-admission disclosure counterparts. CONCLUSION: The study highlights the issue of sexual abuse disclosure and its relationship to depression and developmental level. Internal psychological and developmental mechanisms appear to influence the disclosure/non-disclosure of sexual abuse.

Adolescent↗
PubMed1992

Disclosure and anxiety: a test of the fever model.

According to the fever model of Disclosure, the relationship of Disclosure (utterances that reveal subjective information) to psychological distress is analogous to the relationship of fever to physical infection: Both are indicators of some underlying disturbance and part of a restorative process. High and moderate trait anxious university students (but not the low trait anxious students) used higher percentages of Disclosure when speaking about an anxiety-arousing topic than when speaking about a happy topic. With topic order counterbalanced, students tended to use more Disclosure during their 1st presentation than during their 2nd. These results support the fever model's suggestion that people tend to Disclose when they are distressed.

Adaptation, Psychological↗
PubMed2003

A cross-cultural investigation of the communication of suicidal intent in Swedish and Turkish adolescents.

A recent study found that Swedish adolescents were more disapproving of a suicidal disclosure by a fictional friend than their Turkish counterparts. Given this finding, the present study investigated whether or not more adolescents in Turkey than in Sweden disclose their own suicidal thoughts to someone, to whom adolescents disclose their suicidal thoughts, what reactions such disclosures produce, and reasons for not disclosing suicidal feelings among 966 Swedish and 956 Turkish high school students. A questionnaire was used to collect information about different aspects of suicidal disclosures. More Turkish than Swedish adolescent suicide ideators disclosed their thoughts. More Turkish than Swedish students believed also that young people thinking about and planning suicide tell others of their plans and thereby ask for help. An overwhelming majority of adolescents in both groups revealed their thoughts to peers. The social reactions to suicidal disclosures in both samples were mainly positive. The two most common reasons for not disclosing in both groups involved interpersonal hopelessness. Adolescents who disclosed their past suicidal thoughts to someone reported having lower current suicidal ideation than those who had not. In line with favorable social attitudes towards suicidal disclosures and lower suicidal mortality rates in Turkey compared with Sweden, more Turkish than Swedish adolescents reported having disclosed their own suicidal thoughts to someone in their social milieu.

Adolescent↗
PubMed1985

Wives' reactions to learning that their husbands are bisexual.

Interviews with 33 women, plus data from 70 more, explored wives' reactions to being informed by their husbands that their husbands were bisexual, the consequences of disclosure, and the factors determining those reactions and consequences. Findings suggest that wives struggled less with the homosexuality itself than with problems of isolation, stigma, loss, cognitive confusion and dissonance, and lack of knowledgeable, empathic support or help in problem solving. Moreover, faulty assumptions about "disclosure" seem to have led to serious misconceptions about the wives, on the part of husbands, researchers, and therapists alike. These misconceptions and the "realities" are discussed.

Adult↗
PubMed2003

[Disclosure of incest as an emancipatory act--once again: "The Feast" by Thomas Vinterberg].

The author examines the Danish film "The Feast" referring to the dynamics of a typical incest family. The disclosure of the incest is the central point of the scenario of the film. It is understood as an expression of emancipatory strivings of the victim, the need to separate from denying collaboration and from identification with the role of the victim (identification with the aggressor). Closely connected with this emancipatory process is the development of the siblings out of their mutual relationships and those to their parents towards a self defined life.

Adult↗
PubMed1997

Disclose or conceal? Strategies of information management in persons with epilepsy.

PURPOSE: When handling information about their disease in their social contacts, persons with epilepsy try to avoid or limit stigmatization. We report two basic strategies of information management: general concealment and preventive disclosure. To test whether persons with epilepsy apply a strategy of preventive disclosure, we hypothesized that they would disclose their epilepsy when anticipating that their disease would make them conspicuous in social contacts and when believing that they would be able to forestall stigmatizing attribution processes through disclosure. METHODS: One hundred nineteen outpatients at the Bethel Epilepsy Center, Bielefeld, Germany, aged 16-74 years responded to a questionnaire assessing willingness to disclose their epilepsy in various fictitious daily scenarios, the perceived risk that the interaction partner might find out about their epilepsy (risk of detection), as well as the anticipated positive and negative social consequences of disclosure in these social situations. RESULTS: Willingness to disclose varied across the different scenarios, and only a few respondents rejected disclosure categorically. Willingness to disclose depended on the subjectively perceived risk of detection and the anticipated consequences of disclosure: Respondents were more willing to disclose their epilepsy the more they feared that their interaction partner would detect their disease or find out about it in another way and the more they anticipated that disclosure would enable them to exert a favorable impact on their partner's social judgment formation. CONCLUSIONS: Many persons with epilepsy appear to apply a strategy of preventive disclosure with which they strive to influence social judgment formation in their environment by purposefully disclosing their disease to forestall possible stigmatization processes.

Adaptation, Psychological↗
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↗
PubMed1997

HIV-positive and AIDS-infected women: challenges and difficulties of mothering.

The impact of HIV/AIDS on the ability of 12 mothers to raise their children was explored. Three key themes emerged: disclosure, fear of infecting children through casual contact, and impact of grief. The implications of these findings for research and provision of services are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Struggling with going along when you do not believe.

The phenomenon central to this study is, "struggling with going along in a situation you do not believe in." It emerged as a predominant universal lived experience within the lives of outstanding nurses in the United States studied earlier by the author. The purpose of the research reported in this article was to generate a structure of the lived experience of "struggling with going along in a situation you do not believe in," using Parse's research methodology. Through the processes of the method: participant selection, dialogical engagement, extraction-synthesis and heuristic interpretation, a structure of the lived experience for persons over 65 years of age was generated. This structure is: struggling with going along in a situation you do not believe in is justifiable yielding, as opposing views intensify personal convictions and compel disclosure while suffering consequences. When linked with the major concepts of Parse's theory, the theoretical definition is: valuing the powering of revealing-concealing. Recommendations for further study are offered.

Aged↗
PubMed1996

Children's emotional and behavioral reactions following the disclosure of extrafamilial sexual abuse: initial effects.

Despite a dramatic increase of the empirical literature on child sexual abuse, very few investigations have examined the initial effects of extrafamilial sexual abuse (ESA). The present study evaluated the emotional and behavioral adjustment of 41 children (mean age 10 years, range 5.4 to 15.5 years) within the first 3 months following the disclosure of ESA. Children's functioning was compared to that of a nonclinical comparison group of 43 children, matched on child's age, gender, and family constellation. Child functioning was assessed using a combination of child-report, primary caregiver-report (i.e., parent), and teacher-report measures. Results revealed that sexually abused children, in comparison to nonabused children, suffered deleterious and clinically significant effects. Standard multiple regressions found that the children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symptomatology of depression, social efficacy, and general and abuse-related fears. As well, child's gender predicted the level of general fearfulness. None of the other demographic or abuse-related variables were related to children's functioning. These results underscore the need for multidimensional and multisource assessment of children who experience ESA, and point to the clinical importance of addressing the abuse-related attributions of these children.

Adolescent↗
PubMed2006

A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS.

The purpose of this study was to examine the relationships between age, HIV-related stigma, and patterns of disclosure. Previous literature has suggested that older age is associated with increased HIV stigma and less disclosure of HIV status. Eighty-eight individuals, 44 between the ages of 20-39 and 44 aged 50 and over were recruited for the study through an AIDS service organization in the Pacific Northwest. Subjects in each group were matched as closely as possible by gender, ethnicity, HIV exposure and diagnosis. In a comparison of sociodemographic characteristics, older adults (50+) were significantly more likely to live alone, and to be retired. Younger adults were significantly more likely to be never married/ partnered, unemployed and be recipients of Medicaid. Bivariate analysis revealed no significant differences in overall stigma scores between groups; however, younger adults were more likely to fear losing their job because of HIV. Older adults were less likely to disclose HIV to relatives, partners, mental health workers, neighbors, and church members than those 20-39 years of age. Pearson product moment correlations found disclosure to be significantly associated with time since diagnosis, heterosexual exposure, ethnicity, use of HIV services, and having a confidant. Stigma was associated with ethnicity, having a confidant, and instrumental social support. In a multiple regressions analysis, 48.4% of the variance in disclosure accounted for by time since first diagnosis, service use, and having a confidant. Service use was the only independent variable significantly associated with stigma, accounting for 21.6% of the variance.

Adult↗