Why Reveal or Conceal Suicidal Thoughts? an Exploratory Study of Motivation for Disclosure and Non-Disclosure Among People with Serious Mental Illness

Background/Purpose: Although the disclosure of suicidal thoughts is integral to suicide risk management, such disclosure is poorly understood. A major deficit centers on disclosure motives, which are featured in theoretical models of disclosure for other concealable stigmatized statuses (e.g., HIV/AIDS) but have been neglected in suicide research. No known studies have explored reasons for disclosure and few studies have explored reasons for non-disclosure—none involving groups at particularly high risk for suicide. Informed by a functional disclosure model and multiple goal theory, the aims of this exploratory study were to (1) describe reasons for disclosing and not disclosing suicidal thoughts (2) determine the number of reasons for disclosing and not disclosing and (3) examine the association between the number of disclosure reasons, non-disclosure reasons, and the likelihood of NOT disclosing suicidal thoughts to anyone.

Methods: Data was collected from 45 young adults and adults with serious mental illness and a previous suicidal crisis in mental health treatment. Participants were presented with a list of 15 possible reasons for disclosure and non-disclosure drawn from prior research and were asked to rate each reason on a Likert scale from “not at all a reason” (coded 1) to “very likely a reason” (coded 5). Means and standard deviations were used to summarize them. Each reason was then dichotomized as an “unlikely reason” or “likely reason”, which were subsequently summed to create variables for the number of likely reasons for disclosure and non-disclosure. Bivariate analyses were used to evaluate associations between the number of disclosure reasons, non-disclosure reasons, and the likelihood of NOT disclosing suicidal thoughts; a standard exploratory study p-value threshold of less than .10 was considered meaningful. 

Results: Eleven out of 15 possible reasons were approximately rated as “likely a reason”. The highest rated reasons for disclosure were getting support [M(SD): 4.35(0.77)] and peer status [M(SD): 4.09(1.01)]. The lowest rated reasons were the obligation to tell others [M(SD): 1.91(0.91)] and testing others’ reactions [M(SD): 2.41(1.13)].  The highest rated reasons for non-disclosure were fear of rejection [M(SD): 4.63(0.75)] and shame [M(SD): 4.61(0.62)]. The lowest rated reasons were believing that suicidal thoughts aren’t serious [M(SD): 2.61(1.17)] and that one can cope without help [M(SD): 3.70(1.13)]. The number of reasons for disclosure and non-disclosure were positively associated (r=.27; p=.08) and a negative association was found between the number of reasons for disclosure and the likelihood of not disclosing to anyone (r= -.28; p=.07)—these represent moderate effect sizes.

Conclusions/Implications: Consistent with multiple goal theory, which assumes multiple goal pursuit, we found that many reasons for disclosure and non-disclosure were highly rated. Contrary to theory-based expectations that possessing multiple goals can have adverse effects (e.g. more stress), we found that a greater number of reasons for disclosure had favorable implications (i.e., less non-disclosure). These results provide clinical targets for promoting disclosure (e.g., building peer networks) and minimizing concealment (e.g., reducing shame). It also suggests that a simple assessment of the number of reasons for disclosure may help to determine if someone will share their suicidal thoughts.