Department of Psychology, University of Denver, Denver, USA.
Psychiatry and Behavioral Sciences Department, Vanderbilt University Medical Center, Nashville, USA.
Res Child Adolesc Psychopathol. 2022 May;50(5):669-681. doi: 10.1007/s10802-021-00878-x. Epub 2021 Oct 27.
Disclosure of self-injurious thoughts and behaviors (SITBs) is critical to current treatment and prevention programs. Limited research has examined patterns of and barriers to SITB disclosure in adolescents. This work is critical given the limits of confidentiality in this population. Over 1,000 adolescents aged 13-17 with a history of mental health treatment and SITBs were recruited online. Participants reported their history with disclosing SITBs across a range of relationships, honesty in and barriers to disclosure to health care providers, and their experiences with breaches of confidentiality to parents/guardians. We examined relationships among these experiences and a range of outcomes, including perceived likelihood of future disclosure. Participants reported most frequent disclosure of all SITBs to friends, and more frequent disclosure of nonsuicidal self-injury compared to suicide ideation or attempts. Adolescents were most likely to disclose SITBs when directly asked by health care providers, though many participants reported continued SITB concealment. The most commonly endorsed barrier to disclosure was fear that the provider would tell a parent/guardian. Experiences with confidentiality breaches involving a non-collaborative breach were negatively associated with future disclosure, mental health symptoms, and adolescent-parent relationships. SITB disclosure is a cornerstone to their treatment and prevention. Better understanding of to whom and when, barriers, and the impact of disclosure experiences is critical. Our research suggests that most adolescents do not want their parents to know about their SITBs, and that fear of parent involvement prevents disclosure. Results have several implications for SITB assessment across physical and mental healthcare settings.
披露自我伤害思想和行为（SITBs）对当前的治疗和预防计划至关重要。有限的研究调查了青少年中 SITB 披露的模式和障碍。鉴于该人群保密性的限制，这项工作至关重要。超过 1000 名 13-17 岁有心理健康治疗和 SITB 病史的青少年通过网络招募。参与者报告了他们在一系列关系中披露 SITB 的历史，以及向医疗保健提供者披露的诚实性和障碍，以及他们与父母/监护人的保密泄露的经历。我们研究了这些经历与一系列结果之间的关系，包括未来披露的可能性。参与者报告说，他们最常向朋友披露所有 SITB，并且比自杀意念或企图更频繁地披露非自杀性自我伤害。当医疗保健提供者直接询问时，青少年最有可能披露 SITB，尽管许多参与者报告说仍在隐瞒 SITB。披露的最常见障碍是担心提供者会告诉父母/监护人。涉及非合作性违约的保密性违约经历与未来的披露、心理健康症状和青少年与父母的关系呈负相关。SITB 披露是治疗和预防的基石。更好地了解向谁、何时、障碍以及披露经历的影响至关重要。我们的研究表明，大多数青少年不希望父母知道他们的 SITB，并且对父母参与的恐惧阻止了披露。结果对物理和心理健康医疗保健环境中的 SITB 评估有几个影响。
