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PubMed2003

A prospective study of memory for child sexual abuse: new findings relevant to the repressed-memory controversy.

Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.

Adolescent↗
PubMed2000

Stigma and mental disorder: conceptions of illness, public attitudes, personal disclosure, and social policy.

The end of the last millennium witnessed an unprecedented degree of public awareness regarding mental disorder as well as motivation for policy change. Like Sartorius, we contend that the continued stigmatization of mental illness may well be the central issue facing the field, as nearly all attendant issues (e.g., standards of care, funding for basic and applied research efforts) emanate from professional, societal, and personal attitudes towards persons with aberrant behavior. We discuss empirical and narrative evidence for stigmatization as well as historical trends regarding conceptualizations of mental illness, including the field's increasing focus on genetic and neurobiological causes and determinants of mental disorder. We next define stigma explicitly, noting both the multiple levels (community, societal, familial, individual) through which stigma operates to dehumanize and delegitimize individuals with mental disorders and the impact of stigma across development. Key developmental psychopathology principles are salient in this regard. We express concern over the recent oversimplification of mental illness as "brain disorder," supporting instead transactional models which account for the dynamic interplay of genes, neurobiology, environment, and self across development and which are consistent with both compassion and societal responsibility. Finally, we consider educational and policy-related initiatives regarding the destigmatization of mental disorder. We conclude that attitudes and policy regarding mental disorder reflect, in microcosmic form, two crucial issues for the next century and millennium: (a) tolerance for diversity (vs. pressure for conformity) and (b) intentional direction of our species' evolution, given fast-breaking genetic advances.

Attitude to Health↗
PubMed1989

Understanding hypertensive behaviour--I. Preference not to disclose.

Preference not to disclose information was investigated as a likely explanation for low rates of report of concerns in hypertensives. The research was designed to explore alternative explanations that have been provided by others. Two studies investigated the effect of situational contexts which provided low or high social pressure to reveal personal life concerns. Results showed that degree of disclosure by hypertensives was determined by a response style: disclosure was flexible and increased when situational pressure for accurate response increased. Thus, hypertensives prefer to withhold information. Normotensives had high levels of report whatever the situational context. The request to disclose was shown to have a potent dysregulatory effect on blood pressure for hypertensives only. Need for social approval was a possible underlying explanation for group differences. There are implications in these findings both for personality theory and therapy development.

Adult↗
PubMed2002

Emotional processes following disclosure of an extramarital affair.

In-depth interviews with individuals who had experienced marital infidelity revealed a three-stage process following disclosure of an affair. The process starts with an "emotional roller coaster" and moves through a "moratorium" before efforts at trust building are recognized. Implications for the literature on forgiveness and the process of change in couples therapy are discussed as well as implications for future research and for practice.

Adaptation, Psychological↗
PubMed2006

Sexual risk behavior of HIV-positive methamphetamine-using men who have sex with men: the role of partner serostatus and partner type.

This study examined the role of partner serostatus and partner type in relation to the sexual risk behaviors and disclosure practices of HIV-positive methamphetamine (meth)-using men who have sex with men (MSM). The sample consisted of 132 HIV-positive meth-using MSM who reported having both serodiscordant (i.e., HIV-negative and unknown serostatus) and seroconcordant (i.e., HIV-positive) partners. HIV-positive meth-using MSM engaged in significantly fewer acts of anal sex with serodiscordant partners as compared to seroconcordant partners. However, mean levels of unprotected anal and oral sex were high, and mean levels of protected sex were low for both seroconcordant and serodiscordant partners. Oral sex was practiced twice as often as anal sex; however, both types of sex were primarily unprotected. This pattern of risky sexual behavior was reported for steady, casual, and anonymous partners, regardless of partner serostatus. Despite high rates of unprotected sex, rates of HIV serostatus disclosure were consistently high for HIV-positive and HIV-negative steady, casual, and anonymous partners. However, rates of disclosure to unknown serostatus partners were low, particularly in relation to anonymous partners. Future research should address the reasons why HIV-positive meth-using MSM engage in risky sexual activity with serodiscordant partners, and HIV prevention programs for this population should emphasize the risks associated with unprotected sex with seroconcordant partners.

Adult↗
PubMed1998

Which patients talk about stressful life events and social problems to the general practitioner?

BACKGROUND: Life events and social problems are common in primary-care attenders and contribute to the high rate of emotional distress observed in this setting but are often not disclosed during the consultation. Physicians' characteristics associated with patients' disclosure of psychosocial problems are well documented, but less empirical evidence is available on the contribution of patients' variables. METHOD: Logistic regression analyses were performed on a set of clinical and psychosocial data from 319 primary-care attenders with stressful life events and/or social problems in the presence or absence of emotional distress, in order to identify the variables that predict disclosure of such problems during the consultation. RESULTS: Two-thirds of patients with stressful life events and social problems had mentioned them to their GP. In both sexes a positive attitude about confiding and emotional distress were the best predictors of confiding. In men they accounted for 76% of correct predictions and, in women, together with past confiding, long-lasting relationship with GP, and coexistence of life events and social problems, for 81%. A positive confiding attitude was related in males to age and severity of medical condition and in females to age and experience of past confiding. CONCLUSIONS: In view of the high prevalence of positive attitude towards confiding the efforts by GPs should focus on the reduction of disclosure thresholds. This would require increased abilities to elicit psychosocial information and show emphatic understanding of patients' life difficulties. By contrast there is a need to promote a positive attitude in confiding that concerns only a minority of primary-care patients. More data are needed for shaping more specific strategies for these patients.

Adult↗
PubMed2006

Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women.

HIV-related stigmatization remains a potent stressor for HIV-positive people. This study examined the relationships among stigma-related experiences and depression, medication adherence, serostatus disclosure, and sexual risk among 221 HIV-positive men and women. In bivariate analyses that controlled for background characteristics, stigma was associated with depressive symptoms, receiving recent psychiatric care, and greater HIV-related symptoms. Stigma was also associated with poorer adherence and more frequent serostatus disclosure to people other than sexual partners, but showed no association to sexual risk behavior. In a multivariate analysis that controlled for all correlates, depression, poor adherence, and serostatus disclosure remained as independent correlates of stigma-related experiences. Findings confirm that stigma is associated with psychological adjustment and adherence difficulties and is experienced more commonly among people who disclose their HIV status to a broad range of social contacts. Stigma should be addressed in stress management, health promotion, and medication adherence interventions for HIV-positive people.

Adult↗
PubMed2006

Silent voices and invisible walls: exploring end of life care with lesbians and gay men.

The needs and desires of lesbians and gay men with cancer at the end of their lives are not fundamentally different from any other dying individual's needs. There are, however, significant legal restrictions and societal attitudes that can negatively affect the dying experiences of lesbians and gay men. Lesbians and gay men face many challenges at the end of their lives, including issues of disclosure in the healthcare setting, discrimination, misconceptions, legal and financial barriers and the disenfranchised grief of surviving same-sex partners. Oncology social workers can play a prominent role in advocating for these individuals to allow for dignity and support in spite of these barriers and provide effective interventions to help in assisting lesbians and gaymen with healthcare decision-making and end-of-life care planning.

Advance Directives↗
PubMed1994

Adult survivors of childhood sexual abuse: survivor's disclosure and nurse therapist's response.

Recent literature pertinent to adult survivors suggests that childhood sexual abuse is a serious problem, and that disclosure is on the rise. The aftereffects of childhood sexual abuse can cause dysfunction in various aspects of the survivor's physical and mental health. Understanding the traumagenic dynamics of childhood sexual abuse and its aftereffects provides direction for the nurse therapist during both the client's disclosure and intervention planning. This knowledge assists the therapist in promoting mental health and healing, as well as providing comfort for the therapist. The nurse therapist's reactions to the client's disclosure can affect the way the client feels about disclosure and the therapeutic relationship. If a negative message is conveyed to the survivor at the time of disclosure, the feelings of betrayal, stigmatization, and powerlessness that the survivor experienced as a child will be replicated. This can damage the therapeutic relationship and delay the healing process. When disclosure is received and acted upon in a sensitive, therapeutic manner, the survivor is empowered and can enter with the nurse therapist into an effective therapeutic alliance. Nurse therapists should gain awareness of the types of emotional responses that can be engendered in the health professional during disclosure. Awareness of these emotional reactions can lead to the identification of coping strategies useful to both the therapist and the adult survivor. Coping strategies useful to the therapist include maintaining adequate boundaries, understanding oneself and one's responses to sexual-abuse issues, utilizing ongoing consultation or supervision, and preventing burnout.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed2001

Depression in primary care. 1: elderly patients' disclosure of depressive symptoms to their doctors.

BACKGROUND: This article examines some of the factors responsible for older patients' decision to report current depressive symptoms to their general medical practitioner. A companion article considers factors contributing to general practitioners' (GPs') recognition of major depressive episode when it was present. METHODS: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, to gauge the prevalence of depressive symptoms, the frequency with which patients had informed GPs of their symptoms, and GPs' recognition of major depressive episodes. Patients and informants were questioned using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. RESULTS: Logistic regression analysis showed that symptom disclosure was associated in descending order of importance with higher depressive scores, previous contact with a psychiatrist, and female gender. Even so, 48% of persons with ICD-10 moderate or severe depressive episode had not reported any current complaints to their doctor at the time of interview. CONCLUSION: Older patients often do not report depressive symptoms to their medical practitioner. Men and patients lacking "psychological mindedness" may be at special risk.

Aged↗
PubMedDate not supplied

The experience of African American women living with HIV: creating a prevention film for teens.

The personal and social costs of HIV are well documented. What remains unknown is the effect of public disclosure of HIV status on the individual who is doing the disclosing. This study describes the experience of four African American women living with HIV who participated in the development of an intergenerational education intervention for African American adolescent girls. These women suggested that they be filmed discussing the "dark side" of HIV in an effort to create an intergenerational education intervention that would alter the risk-taking behavior that they observed in young women in their community. After a rough cut of the film was completed, these women viewed the film and participated in a focus group during which they discussed what it was like to reveal and revisit their own painful experiences associated with becoming infected and then living with HIV. Findings from content analysis of transcribed dialogue included the following positive themes: (a) self-acceptance by telling one's own story and hearing the stories of the other women, (b) a sense of liberation by disclosing publicly one's image and message and letting go of others' judgments, (c) feeling supported by meeting other women who share the same experience, (d) value of using the film to impact or save young people from the pain one has experienced. A negative theme emerged related to personal pain in reliving the individual's history with HIV.

Adaptation, Psychological↗
PubMedDate not supplied

Human immunodeficiency virus (HIV) testing and false disclosures in heterosexual college students.

The authors assessed factors that motivate individuals to report negative human immunodeficiency virus (HIV) antibody test results, although they had never been tested. In particular, they investigated sexual intimacy motives associated with the needs for affiliation, sex, and dominance as contributing factors for faulty disclosures. Participants were 246 sexually active heterosexual students. Overall, 21% of the sample had been tested for HIV, and most individuals disclosed their results to intimate partners. Of the entire sample, 5% had previously told an intimate sexual partner they were HIV-negative, although they had not been tested. HIV testing and perceptions of partner deceptions with reference to primary prevention efforts and applications are explored.

AIDS Serodiagnosis↗
PubMed2006

Why do older women delay presentation with breast cancer symptoms?

Women who delay their presentation with breast cancer for three months or longer are more likely to be diagnosed with later stage disease and have poorer survival. Older women, who are at greater risk of developing breast cancer, are also more likely to delay their presentation. Factors associated with delayed presentation were assessed in 69 women (>65 years) with breast cancer. Previous factors identified for women of all ages were confirmed (having a non-lump symptom p=0.003) or strengthened (non-disclosure of symptom discovery to a relative or close friend p=0.001). Additional factors for delay in this older group included reservations about seeing their GP (p=0.02) and fear of the consequences of cancer (p=0.04). These factors should inform the design of interventions to reduce delays.

Aged↗
PubMed2002

The paradox of public HIV disclosure.

In order to examine the impact on HIV-positive people of publicly disclosing their status, in-depth interviews were conducted with 75 HIV-positive speakers from 20 countries in Africa and the Asia-Pacific region. Decreasing stigma and stopping new infections were equally strong motivators in becoming community AIDS educators. Although few respondents were trained, most had good support from peers and/or family. Public disclosure led to a diminution of discrimination. Speaking out was extremely rewarding. Disclosure led to a less stressful, more productive life and to improved wellbeing. Virtually all speakers from every setting had no regrets and saw only the benefits of public disclosure. The paradox of coming out openly as an HIV-positive person is that by facing AIDS-related stigma, one finds psychological release-liberation from the burden of secrecy and shame. Disclosure is beneficial to all concerned. It enriches the speakers' lives and it helps the community. HIV-positive speakers may be a fundamental component of successful AIDS education campaigns, but increasing the numbers of people who are 'out' is only possible in a conducive environment. Governments and AIDS organizations must provide adequate emotional and optimal organizational support to those who do so, including peer support, counselling and appropriate training.

Adolescent↗
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↗
PubMed2001

A study of practising nurses' perceptions and experiences of intimacy within the nurse-patient relationship.

AIM: This study investigated the perceptions and experiences of intimacy within the nurse-patient relationship. BACKGROUND: Intimacy is an increasingly recognized nursing concept, which is intrinsically related to the therapeutic potential of nursing. However, the nature of intimacy as practised in nursing remains largely unexplored. A qualitative design was used and a purposive sample of 10 nurses was involved. Data were collected by means of semistructured interviews and diaries. FINDINGS: Content analysis of the data yielded five categories relating to the nature of intimacy, involvement, resources, affinity for the patient and the rejection of intimacy. This paper focuses on the first of these categories. Intimacy emerged as a complex concept and included the subcategories of disclosure, levels of disclosure, sharing personal experiences, patient dependency and vulnerability, instrumental touch and intimacy and intimacy as an inappropriate term for the nurse-patient relationship. These findings are discussed in the light of existing theories and recommendations made for further research to expand and develop the issues highlighted. CONCLUSIONS: The paper concludes by highlighting the complexity of the concept and identifies some of the constraints to intimacy in practice such as insufficient resources, the health care system and role changes.

Attitude of Health Personnel↗
PubMed1989

"You're a what?": family member reactions to the disclosure of homosexuality.

The present review summarizes what is known about reactions of family members to disclosure of homosexual identity, both within the family of origin and in families where the disclosing member is a spouse or parent. It is suggested that the traumatic nature of family member reaction consists of two related processes: (a) the application of negative values about homosexuality to the disclosing member, and (b) a perception that homosexual identity negates or violates previous family roles. Future research in this complex and understudied area could reveal much about the nature of both homosexual identity and family relationships.

Adaptation, Psychological↗
PubMed2003

Predicting the willingness to disclose childhood sexual abuse from measures of repressive coping and dissociative tendencies.

Although it is generally agreed that the verbal disclosure of past childhood sexual abuse (CSA) experiences can be beneficial, CSA survivors are often reluctant to reveal such experiences. Bonanno et al. found that women with documented CSA histories who did not disclose abuse when provided an opportunity to do so were more likely to show nonverbal expressions of shame and polite smiling, relative to disclosing CSA survivors or nonabused controls. Disclosing CSA survivors, in contrast, showed greater facial expressions of disgust. The current study extended this paradigm by showing that among the same participants, CSA disclosure was associated with chronic dissociative experiences, whereas nondisclosure was associated with repressive coping. Further, repressive coping and dissociative experiences were inversely related and showed opposite patterns of facial expressions and adjustment. Repressors expressed greater negative and positive emotion and were relatively better adjusted, whereas dissociators expressed little emotion and had relatively poorer adjustment.

Adaptation, Psychological↗