Disclosing Stigmatizing Health Information Across Illnesses: Learning How to Talk about Mental Illness by Examining HIV Disclosures

Aaron David Hunt

Advisor: Leah M Adams, PhD, Department of Psychology

Committee Members: Jerome Short, Lisa Lindley

Online Location, Join Zoom Meeting https://gmu.zoom.us/j/91203230526
July 18, 2023, 01:00 PM to 03:00 PM


Individuals with non-visible stigmatized health conditions face a difficult dilemma when seeking the social support that years of research indicates is vital to their care: they may experience prejudice and discrimination instead.  One such example is the sequelae of HIV disclosure, though extant literature on disclosure decisions has tended to focus on gay men disclosing to medical professionals and sexual partners.  Study 1 of this dissertation utilizes data from the Women’s Interagency HIV Study (N = 1105) to better elucidate the ways and correlates of how women living with HIV/AIDS (WLWHA) disclose their HIV status across eight types of relationships (e.g. family, neighbors).  Four distinct classes spanning minimal to very broad disclosure emerged from a latent class analysis and were characterized descriptively before being examined in two path models where disclosure class predicted symptoms of (1) anxiety and (2) depression, with social support and discrimination modeled as parallel mediators.  Despite initial analyses suggesting that low disclosers reported less endorsement of mental illness symptoms, results from the path analyses indicate that this relationship was subject to competing mediation by social support (anxiety model only) and HIV-related discrimination (both models).  These findings provide greater context for disclosure decisions by WLWHA, uncovering latent patterns of, and potential contributors to, anxiety and depression symptoms that may have been previously misattributed to greater disclosure.   

Study 2 shifts focus to mental illness, another stigmatized non-visible health condition.  Given that there are currently no disclosure decision-making models specific to mental illness, two potentially applicable health-related models, the Disclosure Decision-Making Model (DD-MM) and the Disclosure Processing Model (DPM), were examined and a systematic literature review of mental illness disclosure to close others was conducted.  As previous work has mostly considered a binary of whether people disclosed their mental illness, a focus on how people disclose was emphasized in this review.  Despite a comprehensive search and review of articles (N = 996), of the 23 total articles that met overall inclusion criteria, only eight specifically examined the how of mental illness disclosure.  All included articles assisted in identifying relevant themes about this process, including considerations of selecting an appropriate disclosure method, navigating outcomes of disclosures, the influence of culture and identity, and the potential of social media as a disclosure tool.  This review revealed several additional considerations for future research and intervention, including how mental illness is defined, the need for more diverse populations in these studies, the role of providers in preparing patients to make disclosures, the role of mental health advocates in social change, and the importance of viewing disclosure as a persistent, ongoing process that extends beyond one “coming out” conversation.