Disclosure about Mental Illness: A Networks Perspective

Individuals living with a serious mental illness (SMI) are among the most stigmatized groups in society. The risk of being socially stigmatized for any given attribute, including mental illness, is conditional upon the attribute being recognizable or voluntarily disclosed.  Research has shown that while disclosure can elicit social support and reduce social isolation, sometimes disclosure can elicit discrimination and social rejection. Although any disclosure involves an individual making a decision to disclose and the selection of a confidant no known work has sought to simultaneously examine the relative influence of individual and relational factors on mental illness disclosure.  Furthermore, although some authors have discussed the role of the broader social network and cultural environment in disclosure. Keeping this in mind, the primary aim of this study was to identify and examine the association between various individual and relational factors and non- disclosure about serious mental illness.

Methods: Egocentric network and self-report survey data were collected from individuals with SMI receiving services in community-based mental health facilities (N=60). Information about the individuals’ networks, disclosure about their mental illness and associated psychosocial variables were collected using a social network interview and measures of symptomatology, psychosocial functioning, social support and internalized stigma. Multilevel Modeling (MLM) was conducted to determine the influence of individual and relational factors on intent to disclose.  MLM can account for clustering within individual-specific networks.  Of note, although the level-2 sample size corresponds to the number of participants in the study (n=60), the level 1 sample size corresponds to the number of people that constitute the participants’ social networks  (n=866). 

Results:

Bivariate analyses of individual-level factors indicate that males as well as those reporting less social support and more internalized stigma are less likely to disclose their mental illness. Among relational-level variables, closeness of the relationship whether an individual knew a network member before they started receiving mental health services were negatively associated with disclosure about mental illness. Results of the MLM demonstrated being male (OR=.094; p<.01), decreased perceived social support (OR=.78; p<.05) and low service intensity (.76; p<.05) were found to be associated with low likelihood of mental illness disclosure.

Conclusion of Implications:

Significant relationship of disclosure with social support and internalized stigma at both bivariate and MLM levels emphasize the importance of targeting interventions towards increasing social support and decreasing stigma levels. Additionally, gender differences in disclosure indicates a need of gender specific interventions to increase disclosure and increase service seeking.  Furthermore, finding relationship quality related to mental illness disclosure highlights the protective value of social network relationships in the experience of a mental illness and possible use of social network relationships.