Focus on the blind spots of clinician-patient interactions: A critical narrative review of collusion in medical setting.

Collusions, interpersonal phenomena with an impact on patients, significant others, clinicians, and care, are mainly described in the psychotherapeutic literature but also occur in the medical setting. Comprehended as an unconscious bond between two or more persons from a psychotherapeutic perspective, definitions and collusive situations described in the medical setting vary. The question arises whether medical collusions, compared to collusions occurring in the psychiatric setting emerge in different clinical situations or are not identified as transference-countertransference experiences, since there is less sensitivity for the unconscious dimensions of care. We systematically reviewed the medical literature on collusions. Even though a read threat, avoidance of unpleasant feelings (mainly anxiety), runs through the described collusions, the unconscious dimensions and associated defensive maneuvers are rarely evoked. Given the expressed desire to act on collusions in medicine, involving third-party psychiatric liaison clinicians, who supervise clinicians, and hereby help to disentangle collusions, could be beneficial.

Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use.

Background: A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM. Aim: This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province. Setting: This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province. Methods: An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted. Results: Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes. Conclusion: Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded. Contribution: The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.

Strategic (Non)Disclosure: Activation and Avoidance of Social Ties among Women Seeking Abortion.

The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system.

Non-Disclosure and Suicidal Ideation in Adolescent Victims of Bullying: An Analysis from the Family and School Context / [El silencio y la ideación suicida en los adolescentes que son víctimas de acoso escolar: un análisis desde el contexto familiar y escolar]

In recent years, suicide rates among bullying victims have raised much concern among educators and health professionals. Suicide is the fourth leading cause of preventable death among adolescents, data that warn about the need to monitor the signs before victims’ suicidal behavior to prevent this fatal outcome. In the present study, the role of victims’ silence about their victimization situation was analysed, as well as the particular impact of family and school environments. More specifically, we examined the mediating role of the victim’s non-disclosure between the parental styles (observing the father’s and mother’s roles separately) and the school climate, concerning suicidal ideation in victims. The sample consisted of 2,977 adolescents (48.5% boys), aged 11-17 years (M = 14.1, SD = 1.42), of whom 635 (21.3%) reported having been victims of bullying in the past year. The results showed that parental styles of rejection and indifference were positively related to victims’ non-disclosure of bullying and suicidal ideation. Conversely, a positive school climate showed a negative relationship with victims’ disclosure of the bullying situation and suicidal ideation. The findings also indicated that non-disclosure mediates the relationship between the mother’s parental style and suicidal ideation. These findings expand knowledge about the role of bullying victims’ social context and the variable disclosure with regards to suicidal ideation in adolescents victimized by peers at school.(AU)

En los últimos años, el índice de suicidio entre las víctimas de acoso escolar ha generado mucha preocupación en los educadores y los profesionales de la salud. El suicidio es la cuarta causa de muerte prevenible entre los adolescentes, datos que alertan sobre la necesidad de vigilar los signos ante la conducta suicida de las víctimas para prevenir el fatal desenlace. En el presente estudio se analizó el papel del silencio de las víctimas en su victimización, así como el impacto particular del entorno familiar y escolar. Más concretamente, se analizó el papel mediador del silencio de la víctima entre los estilos parentales (considerando el rol del padre y de la madre por separado) y el clima escolar en la ideación suicida en las víctimas. La muestra constaba de 2,977 adolescentes (48.5% varones), en edades comprendidas entre 11 y 17 años (M = 14.1, DT = 1.42), de los cuales 635 (21.3%) indicaron haber sido víctimas de acoso escolar en el último año. Los resultados mostraron que los estilos parentales de rechazo e indiferencia se relacionaban positivamente con el silencio de las víctimas y la ideación suicida. Por el contrario, un clima escolar positivo mostraba una relación negativa con la revelación de la situación de acoso y la ideación suicida de los estudiantes victimizados. Los hallazgos también indican que el silencio de las víctimas media la relación entre el estilo parental de la madre y la ideación suicida. Estos resultados amplían el conocimiento del papel del contexto social de las víctimas de acoso y de la variable silencio con respecto a la ideación suicida en adolescentes victimizados en la escuela por compañeros.(AU)

Non-Disclosure and Suicidal Ideation in Adolescent Victims of Bullying: An Analysis from the Family and School Context.

In recent years, suicide rates among bullying victims have raised much concern among educators and health professionals. Suicide is the fourth leading cause of preventable death among adolescents, data that warn about the need to monitor the signs before victims' suicidal behavior to prevent this fatal outcome. In the present study, the role of victims' silence about their victimization situation was analysed, as well as the particular impact of family and school environments. More specifically, we examined the mediating role of the victim's non-disclosure between the parental styles (observing the father's and mother's roles separately) and the school climate, concerning suicidal ideation in victims. The sample consisted of 2,977 adolescents (48.5% boys), aged 11-17 years (M = 14.1, SD = 1.42), of whom 635 (21.3%) reported having been victims of bullying in the past year. The results showed that parental styles of rejection and indifference were positively related to victims' non-disclosure of bullying and suicidal ideation. Conversely, a positive school climate showed a negative relationship with victims' disclosure of the bullying situation and suicidal ideation. The findings also indicated that non-disclosure mediates the relationship between the mother's parental style and suicidal ideation. These findings expand knowledge about the role of bullying victims' social context and the variable disclosure with regards to suicidal ideation in adolescents victimized by peers at school.

En los últimos años, el índice de suicidio entre las víctimas de acoso escolar ha generado mucha preocupación en los educadores y los profesionales de la salud. El suicidio es la cuarta causa de muerte prevenible entre los adolescentes, datos que alertan sobre la necesidad de vigilar los signos ante la conducta suicida de las víctimas para prevenir el fatal desenlace. En el presente estudio se analizó el papel del silencio de las víctimas en su victimización, así como el impacto particular del entorno familiar y escolar. Más concretamente, se analizó el papel mediador del silencio de la víctima entre los estilos parentales (considerando el rol del padre y de la madre por separado) y el clima escolar en la ideación suicida en las víctimas. La muestra constaba de 2,977 adolescentes (48.5% varones), en edades comprendidas entre 11 y 17 años (M = 14.1, DT = 1.42), de los cuales 635 (21.3%) indicaron haber sido víctimas de acoso escolar en el último año. Los resultados mostraron que los estilos parentales de rechazo e indiferencia se relacionaban positivamente con el silencio de las víctimas y la ideación suicida. Por el contrario, un clima escolar positivo mostraba una relación negativa con la revelación de la situación de acoso y la ideación suicida de los estudiantes victimizados. Los hallazgos también indican que el silencio de las víctimas media la relación entre el estilo parental de la madre y la ideación suicida. Estos resultados amplían el conocimiento del papel del contexto social de las víctimas de acoso y de la variable silencio con respecto a la ideación suicida en adolescentes victimizados en la escuela por compañeros.

The right not to know: Non-disclosure of primary genetic test results and genetic counselors' response.

As part of clinical genetic counseling practice, patients may request that their primary genetic test results be disclosed to someone else, such as a relative or referring provider, or request that results be disclosed to no one (non-disclosure). In making these requests, patients employ the ethical principle of the "right not to know," which argues that autonomous individuals can choose not to know relevant health information. Although the right not to know has been well-studied in medicine in general, and in the return of genomic secondary findings, we are not aware of other studies that have explored the return of primary genetic test results when patients request non-disclosure or disclosure to another individual. This study aimed to describe common clinical scenarios in which these requests occur, how genetic counselors respond, and what ethical considerations they employ in their decision-making process. We recruited participants from the National Society of Genetic Counselors' (NSGC) "Student Research Surveys and Reminders" listserv and conducted semi-structured interviews with 11 genetic counselors in the United States who described genetic counseling cases where this occurred. Interviews were transcribed and coded inductively, and themes were identified. Case details varied, but in our study data the requests for non-disclosure were most commonly made by patients with poor, often oncologic, prognoses who requested their test results be disclosed to a family member instead of themselves. Genetic counselors considered similar factors in deciding how to respond to these requests: patient autonomy, medical actionability of results for the patient and family, the relationship between the patient and the person to whom results might be disclosed, and legal or practical concerns. Genetic counselors often made decisions on a case-by-case basis, depending on how relevant each of these factors were. This study adds to the growing body of literature regarding patients' "right not to know" and will hopefully provide guidance for genetic counselors who experience this situation in clinical practice.

Supervisor Cultural Humility and Supervisee Nondisclosure: The Supervisory Working Alliance Matters.

Given that half or more of supervisees (therapist trainees) never have their clinical work monitored or observed, supervisees who withhold salient information in clinical supervision compromise supervisors' ability to monitor client welfare and promote supervisees' professional development. Attempting to further understand the factors explaining supervisee nondisclosure, we tested the supervisory working alliance as a mediator of the hypothesized inverse relations of cultural humility and collaborative supervision with supervisee nondisclosure (supervision-related and clinically-related nondisclosure) among a diverse sample of 214 supervisees in applied psychology and allied mental health programs. Results supported the hypotheses that (1) descriptively, supervision-related nondisclosure was more prominent than clinically-related nondisclosure, (2) cultural humility substantially inversely predicted supervisee nondisclosure, and (3) the supervisory working alliance fully mediated the inverse relations of cultural humility and collaborative supervision with supervisee nondisclosure. Understanding the mechanisms underlying supervisee nondisclosure have broad implications for clinicians and researchers alike.

Factors Associated with HIV Positive Serostatus Disclosure to Sexual Partners Among Sexually Active Young People on Anti-Retroviral Therapy in Central Uganda.

Introduction: HIV serostatus disclosure is a fundamental HIV prevention and care strategy yet with a paucity of literature. This study comprehended the factors associated with HIV serostatus disclosure to sexual partners among young people aged 15-24 years on anti-retroviral therapy (ART). Methods: This explanatory sequential study utilized quantitative data from 238 young people who had been on ART for over 12 months and were sexually active for at least 6 months in seven districts of Central Uganda. Pearson's Chi-square and multinomial logistic regression analysis at α=0.05 was used to determine the factors associated with serostatus disclosure among study participants. Qualitative data from 18 young people were collected using an in-depth interview guide and analyzed thematically. Results: Non-disclosure was at 26.9%, one-way disclosure was at 24.4%, and two-way disclosure was at 48.7%. Participants who contracted HIV from their partners were three times more likely (RRR=2.752; 95% CI: 1.100-6.888) to have one-way disclosure than non-disclosure, compared to those who had a perinatal infection. Those who contracted HIV from their partners were twice more likely (RRR=2.357; 95% CI: 1.065-5.214) to have two-way disclosure than non-disclosure, compared to those who had a perinatal infection. Participants who stayed with their partners were four times more likely (RRR=3.869; 95% CI: 1.146-13.060) to have two-way disclosure than non-disclosure, compared to those who stayed with their parents. Young people disclosed because they were tired of secrecy and desired treatment adherence and did not disclose due to fear of stigma and losing their partners' support. Conclusion: Many sexually active young people on ART did not disclose their HIV-positive status to sexual partners mainly due to poverty, having multiple-sexual partners, and stigma. Interventions fighting stigma, multiple-sexual relationships, and poverty among sexually active young people on ART should be strengthened.

Non-Disclosure of HIV-Positive Serostatus: Unmatched Case-Control Study in People Living with HIV in Public Health Facilities of Gedeo Zone, Southern Ethiopia.

Background: Non-disclosure of HIV-positive status (NDHPSS) is the individual's experience of hiding their HIV status from other people or groups. People who fail to reveal their HIV-positive serostatus risk contracting the virus again, not receiving the best possible care, and even dying. Purpose: To assess predictors of NDHPSS in people living with HIV in public health facilities in Gedeo-Zone, Southern-Ethiopia. Methods: In Gedeo-Zone, Southern Ethiopia, a facility-based, unmatched, case-control study was carried out from the first of February to March 30, 2022GC. With a case-to-control ratio of 1:1, a total of 360 respondents (89 cases and 271 controls) were involved. The respondents were chosen using a sequential sampling technique. EpiData-V-3.1 was used to enter the data, and SPSS-V-25 was used to analyse it. To determine the factors that were connected to the result, a binary logistic regression analysis was performed. AOR at the 95% confidence interval and p-values under 0.05 were utilised to explain their statistical significance. Results: The study had 360 participants in total-271 controls and 89 cases-resulting in a response rate of 97.6%. The average age of the participants was 35.6 years (SD: 8.3). After adjusting the possible confounders, sex (AOR = 2.8, 95% CI: 1.04-7.56), residence (AORs = 3.52, 95% CI: 2.83-9.39), WHO clinical stage I (AORs = 4.68, 95% CI: 1.9-22.1), short duration of ART follow-up care (AOR = 4.21, 95% CI: 1.65-10.73), and number of lifetime sexual partners (AOR = 6.9, 95% CI: 1.86-26.3) were significantly associated factors with the outcome. Conclusion: According to this study, living in a rural area and being in WHO clinical stage one, in addition to being a woman and having multiple sexual partners during one's lifetime, were predictors of non-disclosure of an HIV-positive serostatus. As a result, encouraging people with HIV in WHO stage I and those who have had more than one sexual partner in their lifetime to disclose their status and expanding counselling services for rural residents and women have a substantial impact on reducing the HIV load.

Suppression and Memory for Childhood Traumatic Events: Trauma Symptoms and Non-Disclosure.

Self-reported lost memory of child sexual abuse (CSA) can be mistaken for "repressed memory." Based on our longitudinal studies of memory and disclosure in child maltreatment victims who are now adults, we discuss findings relevant to "repressed memory cases." We examined relations between self-report of temporarily lost memory of CSA (subjective forgetting) and memory accuracy for maltreatment-related experiences (objective memory). Across two studies involving separate samples, we find evidence for memory suppression rather than repression: (1) Most adults who claimed temporary lost memory of CSA reported memory suppression and clarified that they could have remembered the event if asked; (2) subjective forgetting was positively associated with accurate objective memory for maltreatment-related experiences. Subjective forgetting was also related to increased adult trauma symptoms and related to childhood non-disclosure of CSA. Moreover, trauma-related psychopathology mediated the relation between non-disclosure and subjective forgetting. Implications for psychological theory and repressed memory cases are discussed.

Non-disclosure of developmental neurotoxicity studies obstructs the safety assessment of pesticides in the European Union.

BACKGROUND: In the European Union (EU), the safety assessment of plant protection products relies to a large extent on toxicity studies commissioned by the companies producing them. By law, all performed studies must be included in the dossier submitted to authorities when applying for approval or renewal of the active substance. METHODS: For one type of toxicity, i.e. developmental neurotoxicity (DNT), we evaluated if studies submitted to the U.S. Environmental Protection Agency (EPA) had also been disclosed to EU authorities. RESULTS: We identified 35 DNT studies submitted to the U.S. EPA and with the corresponding EU dossiers available. Of these, 9 DNT studies (26%) were not disclosed by the pesticide company to EU authorities. For 7 of these studies, we have identified an actual or potential regulatory impact. CONCLUSIONS: We conclude that (1) non-disclosure of DNT studies to EU authorities, in spite of clear legal requirements, seems to be a recurring phenomenon, (2) the non-disclosure may introduce a bias in the regulatory risk assessment, and (3) without full access to all performed toxicity studies, there can be no reliable safety evaluation of pesticides by EU authorities. We suggest that EU authorities should cross-check their data sets with their counterparts in other jurisdictions. In addition, applications for pesticide approval should be cross-checked against lists of studies performed at test facilities operating under Good Laboratory Practice (GLP), to ensure that all studies have been submitted to authorities. Furthermore, rules should be amended so that future studies should be commissioned by authorities rather than companies. This ensures the authorities' knowledge of existing studies and prevents the economic interest of the company from influencing the design, performance, reporting and dissemination of studies. The rules or practices should also be revised to ensure that non-disclosure of toxicity studies carries a significant legal risk for pesticide companies.

Experiences of, and motivations for, disclosing HIV to social and familial networks: considering the social and relational domains of HIV disclosure.

For people living with HIV, decisions about when, how and who to tell about their HIV status can involve navigating complex social, legal and health domains. With a focus on disclosure to broader social and familial networks, we explored the experiences of, and motivations for, HIV (non-)disclosure among recently diagnosed people living with HIV in Australia. Semi-structured interviews were conducted with 35 people diagnosed with HIV from 2016 onwards, of whom 25 completed follow-up interviews. Participants commonly reported anticipating negative responses and rejection from others when considering whether to disclose their HIV status. Some participants also took on the role of ensuring others' wellbeing when disclosing (or not), even as they themselves needed emotional support. Finally, some participants felt it important to be open about their HIV status to raise awareness of HIV and challenge HIV-related stigma. Our findings highlight the complex relational and social contexts that shape HIV disclosure. In addition to supporting individual people living with HIV when disclosing, we argue that educational programmes that target the broader, HIV-negative population are needed to shift the social landscape in which people living with HIV disclose.

Truth-Telling to Terminal Stage Cancer Patients in India: A Study of the General Denial to Disclosure.

Telling the truth to the terminal-stage cancer patients differs socio-culturally based on the priorities assigned to patients' autonomy and the principles of beneficence and non-maleficence. After conducting in-depth interviews with 108 terminal-stage adult cancer patients, 306 family members, and 25 physicians, in private and public hospitals in both rural and urban areas, in the state of West Bengal, India it has been found that even though 85.60% of the patients prefer full disclosure, only 22.03% are actually informed. Though demographic characteristics, like age, gender, education etc., have marginal influences over the pattern of truth-telling, the main factor behind non-disclosure is the family members' preference for principles of beneficence and non-maleficence over patient autonomy. Hence, only 9.32% of those 118 patients' family members have agreed to full disclosure. Physicians comply with this culture of non-disclosure as family, in India, is the centre of decision-making and acts as the primary unit of care.

Who are the patients who deny suicidal intent? Exploring patients' characteristics associated with self-disclosure and denial of suicidal intent.

BACKGROUND: Patients' non-disclosure of suicidal ideation and intent concealment represent a major obstacle to the effective assessment of suicide risk and to the delivery of suicide prevention treatments. The present study aimed to investigate this phenomenon and to assess (1) if outpatient psychiatric patients are more or less likely to disclose intent to mental health clinicians in the context of psychiatric/psychological treatment than they are to in the context of research interviews with non-clinicians; and (2) if certain demographic, trait-like, and state-like characteristics may predict such disclosure differences. METHODS: A total of 780 psychiatric outpatient participants aged 18 to 84 and 193 clinician participants aged 25 to 54 were included in the study. The proportion of patients who disclosed to clinicians only, to research assistants (RAs) only, to both, and to none, was compared using a z-test. Univariate analyses were used to compare the participants' variables across disclosure groups, and significant individual predictors were included in multilevel regression analyses. RESULTS: Participants were more significantly more likely to disclose to RAs (10.4%) than to clinicians (5.6%), p < 0.001. Neuroticism and trait anxiety predicted disclosure to RAs vs no disclosure; low extraversion predicted disclosure to clinician versus no disclosure; and extraversion and trait anxiety predicted disclosure to RAs versus to clinicians. DISCUSSION: Patients' disclosure patterns, the personality variables predicting them, and their clinical implications were discussed in the context of the extant literature on patients' reasons for concealing suicidal ideation and intent.

Patterns of Reasons for Not Disclosing Personal Activities and Feelings to Mothers and Fathers among Ethnically Diverse Adolescents.

Adolescents' routine disclosure and self (non)disclosure to parents have been distinguished conceptually, but rarely empirically. Using latent profile analyses (LPA), these two types of (non)disclosure were operationalized and examined in terms of the patterns of reasons middle adolescents endorsed for not disclosing personal activities and personal feelings to mothers and fathers and their correlates. This was studied in a sample of 489 U.S. Chinese, Mexican, and European heritage middle adolescents (Mage = 16.37, SD = 0.77, 55% females). Three profiles emerged for both mothers and fathers: A majority profile for mothers consisting of adolescents who viewed personal activities and feelings as personal (i.e., private and not harmful), and much smaller sanction-driven and self-conscious profiles. With fathers, personal concerns were separated in the private profile, which also emphasized that fathers would not listen or understand, a harmless profile, and as with mothers, a sanction-driven profile. Overall, but varying in frequency for different profiles, middle adolescents emphasized personal concerns for not disclosing routine personal activities and psychological concerns for self nondisclosure. The profiles also differed by ethnicity/race, generational status, and trust in mothers and fathers. The father private profile and sanction-driven profiles with both parents were associated with more depressive symptoms and problem behavior relative to the other profiles. The results provide insight into why middle adolescents of diverse ethnicities do not disclose personal information to parents.

Non-Disclosure of abuse in children and young adults with disabilities: Reasons and mitigation strategies Northwest Region of Cameroon.

Background: Child abuse is a serious public health issue in low- and middle-income countries, and children with disabilities are at greater risk of abuse. Despite this heightened risk, the abuse of children with disabilities often goes undetected and under-reported, leading to the continuity of such abuse by their abusers. Objectives: This study was aimed at identifying the reasons for non-disclosure of abuse and possible mitigating strategies to curb this dilemma in children and young adults with disabilities (CWD). Methods: A population-based record-linkage qualitative study was conducted among CWD (both at home and in institutions) in the Northwest Region of Cameroon. Twelve key informant interviews and eight focus group discussions (FGDs) were conducted among key staff from child protection offices for child abuse, parents and teachers in schools. Fifty in-depth interviews were also conducted among children with disabilities. Reasons for nondisclosure and proposed mitigating approaches from audio tapes were transcribed verbatim, thematic analysis performed and findings reported. Results: A lack of knowledge on where to disclose, fear of stigma, long and expensive procedures, a lack of confidence in the justice system, threats from abusers, protection of family unity and friendship ties were linked with nondisclosures. The most common mitigating strategies postulated were sensitisation, capacity building on parenting and the creation of child protection committees. Conclusion: From this study, nondisclosure of abuse is common in CWD, and thus there is a need for urgent attention to curb the situation for safer and more child-friendly environments through sensitisation, parental support and putting in place strategic child protection committees. Contribution: This article is based on the experience of all authors with interest in the field of disability. This article contributes to the pull of knowledge by providing context specific reasons for non-disclosure of abuse as well as mitigation strategies.

Nondisclosure of Medical Related Information by Persons with Type 1 and Type 2 Diabetes Mellitus to Their Healthcare Providers: Do Different Patterns Exist?

Purpose: The doctor-patient relationship is often challenged by complex communication issues and nondisclosure of important related medical information, especially in diabetes management. Very little information is known about diabetic patient nondisclosure to their doctors. The present study evaluated the prevalence of nondisclosure of information by persons with type 1 and type 2 diabetes mellitus to healthcare providers and its associated factors among the Saudi population, as well as the differences between persons with type 1 and type 2 diabetes mellitus. Methods: A cross-sectional study targeting persons with type 1 and type 2 diabetes mellitus was conducted at King Saud University Medical City, Saudi Arabia, Riyadh. An online self-administered questionnaire was used to collect data. Results: A total of 285 participants were included in the study (155 [54.4%] and 130 [45.6%] type 1 and 2 diabetic patients, respectively). Having an unhealthy diet (25.3%, n = 72), not regularly exercising (23.5%, n = 67), hiding some glucose readings (23.2%, n = 65), and not following instructions for weight loss (22.8%, n = 44) were the most common types of nondisclosed information among diabetic patients. The nondisclosure of information was significantly higher among type 2 patients (29.2%) than type 1 diabetic patients (18.7%) in terms of not participating in regular exercise (p = 0.018). Similarly, the nondisclosure of information was significantly higher among persons with type 1 diabetes compared to persons with type 2 diabetes in terms of hiding some glucose readings (p < 0.001) and not disclosing hyperglycemia (p = 0.011). Conclusion: Nondisclosure of important related medical information among diabetic patients to their healthcare providers is prevalent among the Saudi population. Furthermore, the types and causes of nondisclosed information differ among persons with type 1 and type 2 diabetes mellitus.

Strategies and Reasons for Nondisclosure in Close Relationships During Adolescence.

Adolescents keep secrets from parents to assert independence or avoid punishment; however, there is little research on nondisclosure in other close relationships during adolescence. This article examines strategies and reasons for nondisclosure between adolescents (N = 244, 47.5% female, Mage = 12.71, SDage = 1.66) and multiple close relationships (parents, siblings, and best friends). The results show that adolescents tended to use nondisclosure strategies more for personal information (e.g., thoughts/feelings). Adolescents had more reasons to keep information from family as they got older, and girls reported keeping information from mothers more than boys because they would feel bad, embarrassed, or ashamed. These findings provide a greater understanding of patterns of nondisclosure during adolescence, which may in turn have implications for adolescent adjustment and relationship quality.

Stigma, discrimination and non-disclosure among young people living with HIV in Lagos, Nigeria.

Introduction: young people living with HIV (YPLH) constitute a significant population towards ending the AIDS epidemic. About half of YPLH are undiagnosed and one-third of new infections occurring among them. Stigma and discrimination remaina predominant enigma in the social response to HIV. Methods: this was a descriptive cross-sectional study among 124 YPLH aged 15-24 years selected by non-probability sampling from four antiretroviral centres targeted at young people across Lagos State. Ethical approval and informed consent were obtained. Data analysis was done using Epi info software version 7 and the level of significance was set at p<0.05. Results: the mean age of the participants was 19.4±3.2 years. Among the stigma variants, public stigma was the highest (48.4%), followed by anticipated stigma (20.2%), internalized stigma (14.5%), and enacted stigma (10.7%) while 7.3% of respondents experienced all forms. Thirty-seven percent of respondents had experienced one form of discrimination, with the most common form being 'treated with hostility by strangers´ (14.5%). The disclosure level was 56.5%. The most predominant reasons for non-disclosure were fear of rejection by other people (57.3%). Diagnosis at an earlier age and living with a single parent were associated with lower disclosure levels (p<0.001). Conclusion: overall stigma levels were found to be low, with differences in the individual stigma variants. The most common form of HIV-related discrimination reported in this study was being treated with hostility by strangers. Fear of rejection by other people was the main reason for non-disclosure among YPLH. The use of a multidisciplinary approach is needed to reduce the impact of stigma and discrimination among YPLH.

Non-response to questions about suicide ideation and attempts among veterans: Results from the National Health and Resilience in Veterans Study.

OBJECTIVES: Veterans who decline to provide information on their history of self-injurious thoughts and behaviors (SITBs) may be at elevated suicide risk. We examined associations between non-response to a question assessing lifetime SITBs and proxy variables of suicide risk. METHODS: In this population-based cross-sectional study of 4069 US veterans, responses to the Suicidal Behaviors Questionnaire-Revised were examined to group veterans into one of three categories: (1) denied lifetime SITBs, (2) reported lifetime SITBs, or (3) declined to respond. RESULTS: Overall, 69.5% of veterans denied a SITB history, 29.5% reported a SITB history, and 1.0% declined to provide information regarding SITBs. In adjusted analyses, veterans who declined to provide information on SITBs were significantly more likely than veterans who explicitly denied lifetime SITBs to screen positive for posttraumatic stress disorder; report lifetime non-suicidal self-injury; and report elevated levels of total trauma burden, externalizing behaviors, loneliness, received social support, and provided social support. Across these constructs, veterans who declined to provide SITB information were statistically indistinguishable from veterans who explicitly reported lifetime SITBs. CONCLUSIONS: Veterans who decline to provide information about suicidal thoughts and behaviors may represent a covert group at elevated risk for suicide.