An ecological momentary assessment of OCD-relevant intrusions: Frequency, feared self, and concealment.

This study provides the first examination of the frequency, characteristics, and dynamics surrounding daily experiences of OCD-relevant intrusions among non-clinical participants (N = 54, Nobs = 2314) using ecological momentary assessment. It also examines the extent to which self-related constructs-participants' feared-self beliefs and their tendency to conceal aspects of self-relate to such intrusive phenomena. Participants completed a baseline questionnaire before reporting state depressed mood and intrusions up to five times per day (at semi-random intervals) for 14 days. Results suggest that questionnaire measures may result in underreporting of the frequency of intrusions, with most participants (80%) reporting at least one intrusion across the momentary observations, and 20% of observations indicating intrusive phenomena experienced since the previous momentary report. Baseline factors including OCD-related beliefs and feared self were related to the proportion of intrusions experienced, whereas self-concealment was not. Within the moment, state feared-self predicted intrusion-related distress, duration, perceived importance, the urge to act, and the need to control thoughts. The urge to conceal within the moment was significant but negatively related to perceived importance and the urge to act. Overall, this study provides evidence for the relevance of momentary measures of intrusions, and adds to evidence for self-beliefs in the dynamics of the disorder.

Diagnosis concealment behaviors and disclosure beliefs are associated with health and quality of life in people with multiple sclerosis.

BACKGROUND: People with multiple sclerosis (pwMS) struggle with whether, how, and how much to disclose their diagnosis. They often expend resources to conceal their diagnosis, and hold beliefs that it may negatively affect their personal relationships and/or professional opportunities. To better understand these effects, we developed a measure to quantify concealment behaviors and disclosure beliefs. Our main objective is to evaluate relationships of DISCO-MS responses to health and quality of life in a multinational cohort. METHODS: Survey responses were obtained for DISCO-MS and PROMIS-MS scales: global health, communication, social roles participation, anxiety, depression, emotional / behavioral dyscontrol, fatigue, lower extremity function, positive affect / well-being, social roles satisfaction, sleep, stigma, upper extremity function, cognitive function, bladder control, bowel control, visual function. Simple linear regression assessed associations. RESULTS: 263 pwMS were include. Higher concealment was associated with higher anxiety (beta= 0.15 [0.07, 0.23]), depression (beta = 0.13 [0.05, 0.21]), emotional dyscontrol (beta = 0.12 [0.04, 0.20]), lower affect / well-being (beta = -0.13 [-0.21, - 0.05]). Higher anticipation of negative consequences of disclosure was associated with lower self-reported physical (beta = -0.15) and mental health (beta = -0.14), lower positive affect / well-being, social roles satisfaction, higher anxiety, depression, emotional dyscontrol, sleep disturbance, and higher perceived stigma. DISCUSSION: These results reveal potential consequences of diagnosis concealment for physical and mental health and quality of life. Raising awareness and implementing interventions may mitigate negative repercussions of concealment.

Children's attitudes about transgender identity disclosure and concealment.

Supportive peers are crucial for transgender children's well-being. Transgender children who live in their affirmed gender face decisions surrounding concealment and disclosure of their transgender identity. We sought to understand how cisgender (N = 115) and gender-diverse children (N = 127), and siblings of gender-diverse children (N = 63) think about transition disclosure and concealment. All groups viewed transition disclosure and concealment positively. However, gender-diverse children showed greater acceptance of transition concealment and had stronger liking of transition concealers (relative to non-transition concealers). Additionally, children generally expected transgender peers to be selective about who they disclose to, valuing trustworthiness and diverse friend groups in such decisions. Our findings suggest that regardless of gender identity, children are sensitive to the potential costs of disclosure and may support trans children however they choose to navigate these decisions.

A Conditional Process Analysis of Microaffirmations, Microaggressions, and Mental Health Among Thai Sexual Minorities.

Sexual orientation (SO) microaggressions contribute to mental health issues among sexual minorities. Microaffirmations may mitigate these effects, with internalized heterosexism and SO concealment proposed as mediators. A community sample of 307 Thai sexual minorities completed measures assessing SO microaggressions, microaffirmations, internalized heterosexism, SO concealment, and mental health concerns. Serial mediation analysis using Hayes' PROCESS macro model 6 tested indirect effects through proposed mediators. Conditional process analysis using PROCESS model 85 examined the moderating role of microaffirmations. These models tested hypothesized moderated serial mediation relationships among study variables. SO microaggressions had a total effect on mental health concerns, directly and indirectly through increased SO concealment. The internalized heterosexism → SO concealment sequence mediated this relationship. Microaffirmations moderated the direct microaggressions-mental health link, reducing this association at higher levels of microaffirmations. The full model accounted for 31.6% of the variance (R2 = 0.316) in mental health concerns. The Johnson-Neyman technique identified 0.613 as the microaffirmations value above which the effect of SO microaggressions on mental health was no longer significant. Findings elucidate mechanisms linking SO microaggressions to mental health issues and microaffirmations' protective role among Thai sexual minorities. These results could inform efforts to mitigate minority stress impacts.

Disclosing or concealing multiple sclerosis in the workplace: two sides of the same coin-insights from a Swedish population-based survey.

Background: People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks. However, concealing in the long-term may have health implications and prevent opportunities for support and work adjustments. Few studies have examined what drives PwMS to disclose or conceal MS at work and the consequences of these ways of managing MS. Objectives: To explore the reasons PwMS report for disclosing and/or concealing their MS diagnosis in the workplace, as well as the consequences they have experienced. Methods: A web-based survey of PwMS was conducted in 2021. All individuals aged 20-50 listed in the Swedish MS registry were invited to participate. The response rate was 52% and among these participants, 3,810 (86%) completed questions regarding workplace disclosure and/or concealment of MS. Free-text responses on these topics were analyzed using inductive content analysis. Results: It was common to disclose MS in the workplace (85%). Identified drivers for disclosure and concealment related to four categories: Work-related, Social, Personal and Circumstantial. Work-related drivers focused on employment or protecting one's career, and changing one's work situation versus maintaining it. Social drivers included the need for support, addressing or preventing stigma, and being considerate of others. Personal drivers were linked to moral values/personal beliefs and processing of the diagnosis. Circumstantial drivers related to involuntary or unforeseen events, timing factors, one's medical condition and external opinion/advice. Identified consequences for disclosure and concealment related to three categories: Work-life, Social, and Personal. Work-life consequences included work arrangements, and career opportunities. Social consequences were linked to MS awareness, stigma, interactions and social support, as well as dynamics of work relationships. Personal consequences involved levels of disease acceptance, and attitudes toward managing MS. Conclusion: PwMS often described the question of disclosure as challenging and navigated it with caution, as both disclosure and concealment can yield favorable and unfavorable outcomes.

Secrecy in Everyday Life.

Secrecy is common, yet we know little about how it plays out in daily life. Most existing research on secrecy is based on methods involving retrospection over long periods of time, failing to capture secrecy "in the wild." Filling this gap, we conducted two studies using intensive longitudinal designs to present the first picture of secrecy in everyday life. We investigated momentary contextual factors and individual differences as predictors of mind-wandering to and concealing secrets. Contextual factors more consistently predicted secrecy experiences than person-level factors. Feeling more negative about a secret predicted a greater likelihood of mind-wandering to the secret. Interacting with the secret target was linked with a greater likelihood of secret concealment. Individual differences were not consistently associated with mind-wandering to secrets. We conclude that daily experiences with secrets may be better predicted by momentary feelings rather than individual differences such as personality traits.

Why is concealment associated with health and wellbeing? An investigation of potential mechanisms.

RATIONALE: Many members of stigmatized groups face health and wellbeing deficits relative to their non-stigmatized peers. Ample evidence suggests that one method used by some members of stigmatized groups to manage the stigma they face-concealing their stigmatized identities-may contribute to these health and wellbeing disparities. However, precisely why concealment may contribute to these disparities is less clear. OBJECTIVE: The present work seeks to identify and distinguish between plausible explanations for why concealment may contribute to worse health and wellbeing. METHODS: In the present work, we explore a large number of plausible mechanisms that may explain why concealment is associated with worse health and wellbeing. In three studies (N = 2304) using cross-sectional (Studies 1 and 2) and longitudinal (Study 3) methods, participants were recruited from an online recruitment pool (Studies 1-3) and from an institutional recruitment pool (Study 2). Participants reported on their concealment, health and wellbeing, and constructs related to plausible explanations for the relationships between concealment and health and wellbeing. RESULTS: We find that concealment is associated with worse health and wellbeing, with generally small effect sizes. We further find that lower feelings of belonging, less social support, and lower self-esteem are the most plausible mechanisms for explaining why concealment is associated with worse health and wellbeing. When between- and within-subjects effects were distinguishable (i.e., Study 3), we observed only between-subjects relationships. CONCLUSION: Because people's choices to engage in self-protection through concealment should be respected, potential avenues for intervention to reduce minority health disparities may be more appropriately targeted at the mechanisms that account for why concealment may undermine health and wellbeing than at concealment itself. The present work makes strides towards identifying those mechanisms and thus towards addressing them.

The prevalence of feigning and concealment of Covid-19 infections in an international sample.

We asked 463 participants from 21 countries whether they had feigned and/or concealed having a coronavirus infection during the pandemic period. 384 respondents (83%) reported having experienced a coronavirus infection. They were, on average, younger and reported more chronic health issues than participants who said they had never been infected. 65 (14%) admitted to having feigned the infection. Prevalence doubled (28%) when asked if they knew anyone who had feigned a coronavirus infection. Main motives for feigning were to stay at home and to obtain sick leave. As to having concealed a coronavirus infection, 56 (12%) responded affirmatively, but when asked about others, the prevalence reached 51% (n = 210). The most common reasons for concealment were to avoid letting others know and to not miss an event. Thus, both feigning and concealing infections can occur on a nontrivial scale, directly affecting prevalence rates in studies that rely on self-reported data collected from social platforms.

When and Why People Conceal Infectious Disease.

People sick with infectious illnesses face negative social outcomes, like exclusion, and may take steps to conceal their illnesses from others. In 10 studies of past, current, and projected illness, we examined the prevalence and predictors of infection concealment in adult samples of U.S. university students, health-care employees, and online crowdsourced workers (total N = 4,110). About 75% reported concealing illness in interpersonal interactions, possibly placing others in harm's way. Concealment motives were largely social (e.g., wanting to attend events like parties) and achievement oriented (e.g., completing work objectives). Disease characteristics, including potential harm and illness immediacy, also influenced concealment decisions. People imagining harmful (vs. mild) infections concealed illness less frequently, whereas participants who were actually sick concealed frequently regardless of illness harm, suggesting state-specific biases underlying concealment decisions. Disease concealment appears to be a widely prevalent behavior by which concealers trade off risks to others in favor of their own goals, creating potentially important public-health consequences.

Identity Concealment May Discourage Health-Seeking Behaviors: Evidence From Sexual-Minority Men During the 2022 Global Mpox Outbreak.

People who conceal their stigmatized identities often experience worse physical health. One possibility for why is that concealment may render certain health-seeking behaviors more difficult. We tested this possibility during the 2022 global mpox outbreak, a public-health emergency that disproportionately affected sexual-minority men. We recruited adult sexual-minority men from Prolific at two time points near the outbreak's peak and attenuation (n = 864 and n = 685, respectively). We found that men who concealed their minority sexual orientations were less likely to (a) receive a vaccine to protect against mpox, (b) receive an mpox test, and (c) report having received an mpox vaccine. The relationship between concealment and vaccine receipt was serially mediated by reduced community connectedness and reduced knowledge of mpox resources. We call for thoughtful consideration of how to reach stigmatized groups with public-health resources, inclusive of those who conceal.

Development and Validation of the Korean Version of the Multidimensional Non-Suicidal Self-Injury Scar Scale.

OBJECTIVE: Non-Suicidal Self-Injury (NSSI) scars are common in individuals with NSSI experiences. However, little is known about NSSI scars because related tools are limited. This study aimed to develop and validate the Korean version of the multidimensional Non-Suicidal Self-Injury Scar Scale (K-NSSI-ScarS), consisting of three components: NSSI scar measurement, NSSI scar cognition, and NSSI scar concealment. METHODS: A total of 333 Korean adults with at least one NSSI scar and history of NSSI within the last 5 years (age: 18 to 39 years) completed the online survey. We conducted exploratory (n=133) and confirmatory (n=200) factor analyses of NSSI scar cognition. To measure the internal consistency of each subfactor of the scar cognition and scar concealment components, we used Cronbach's α. Kappa and intraclass correlation coefficients were used to measure the test-retest reliability of the entire scale. We also assessed the convergent and construct validity of the K-NSSI-ScarS. RESULTS: Factor analyses showed a 5-factor structure consisting of 23 items. Internal consistencies and test-retest reliability were excellent. The moderate correlation between the five subfactors of NSSI scar cognition and related concepts (e.g., acquired capability of suicide) confirmed the convergent validity. Lastly, moderate correlations were found between NSSI scar concealment, self-concealment, NSSI scar measurement information, and the five subfactors of NSSI scar cognition. CONCLUSION: The results verify the psychometric properties and support the necessity of a multidimensional NSSI scar scale.

Disclosing One's Non-Heterosexual Sexual Orientation at Work in 2020: A Survey of Quebec LGBQ Workers.

Concealing one's non-heterosexual orientation (NHO) remains a protection strategy against workplace discrimination used by many lesbian, gay, bisexual, and queer (LGBQ+) individuals. This article explores four sets of correlates (identity and individual trajectory, social support, professional position, and structural and cultural work context) relative to three levels of outness (total, partial, and null). Online cross-sectional data of 2,106 LGBQ+ participants from Quebec (Canada) showed that 27% reported total outness, while 64% reported partial outness, and 9%, null outness. Multinomial hierarchical regression analyses revealed that each set of correlates significantly contributed to levels of workplace NHO outness. The two sets of variables making the largest contributions to levels of outness were those pertaining to identity and individual trajectory (14% of the variance) and structural and cultural work context (9%). Compared to partial outness, null outness was associated with an unaccepting work climate, while total outness was more likely in contexts with organizational support (e.g., with the presence of an inclusivity policy). Without trivializing the influence of non-workplace factors on outness levels, the present findings support the need to develop an inclusive and accepting work climate for LGBQ+ individuals.

Self-concealment, secrecy, and guilt.

OBJECTIVE: Individuals with a tendency to conceal unflattering information about themselves are more likely to be preoccupied by their secrets and tend to report more negative affect. According to theory, this negative affect is due to self-concealers' conflicting motivation to be authentic in their relationship but fear the negative consequences should they reveal their secrets, which promotes ill-fated attempts to suppress. The purpose of the current study was to test a central component of this model. METHODS: Two studies of adults who were in a romantic relationship and keeping a secret from their partner (combined N = 635; 67.2% women; Mage  = 39.6, SD = 11.9) were surveyed on four biweekly occasions. Multilevel mediation analyses were conducted to test whether preoccupation and suppression mediated the link between self-concealing and negative affect and guilt. RESULTS: The data support the hypotheses. Self-concealers were more preoccupied with and prone to suppress their secret than those low on the trait, which, in turn, predicted greater negative affect and guilt. CONCLUSION: The findings suggest that self-concealers' insecurities and fear of the relational consequences of disclosure set the stage for the debilitating cycle of suppression and preoccupation that leaves them feeling anxious and guilty.

'Isn't it mad that we're all psychologists and we can't talk about our feelings?': A mixed-methods study exploring trainee clinical psychologists' experience of (non)disclosure of psychological distress during training.

OBJECTIVE: Literature on trainee clinical psychologists' mental health has highlighted elevated levels of mental health difficulties and/or psychological distress and low levels of disclosure within the workplace. The current study aimed to explore (1) trainee experiences of disclosure and/or concealment of psychological distress during their training, (2) beliefs, assumptions or predictions related to disclosure and (3) responses to disclosure. METHODS: A mixed-methods strategy was employed; 165 trainee or recently qualified clinical psychologists took part in an online survey. Thirteen of these were interviewed. Descriptive statistics and a reflexive thematic analysis were conducted to analyse the quantitative and qualitative data, respectively. RESULTS: The sample largely consisted of those who had disclosed distress. Beliefs related to negative judgement from others and feelings of anxiety and embarrassment were commonly endorsed responses within quantitative findings. Six main themes were constructed: (1) Diagnostic or psychological conceptualisations, (2) Worries about judgement complicate disclosure decisions, (3) Disclosure likelihood is determined by relationships, (4) Emotional support versus practical responses, (5) Desired changes that could increase disclosure and (6) Legacies of disclosure experiences. CONCLUSION: There is a need for training programme staff to prioritise emotional support, increase permission giving and enhance disclosure guidance. Further research including disclosure recipients is required.

The Invisible Minority: Stigma and Sexual and Gender Diversity in Health Care.

This analysis elucidates the concept of stigma in the sexual and gender diverse population, and how it impacts interactions with the health-care system. Significant research into social determinants of health has given rise to a greater understanding of their impact on health-care accessibility and utilization. The impact of stigma experienced by persons with diverse gender identities and sexual orientations has not been similarly studied. Utilizing Walker and Avant's method of concept analysis and the Minority Stress Model, this article explicates stigma in an inclusive manner that directly addresses health care. Records retrieved from PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsychINFO were screened for inclusion, supplemented by editorials and seminal earlier works. Review of the literature clarified the power imbalance perpetuating stigma, its defining attributes, antecedents, and consequences. Although the preponderance of consequences are negative outcomes, positive interactions with providers can empower sexual and gender diverse individuals to disclose their identity more willingly, navigate the health system effectively, and experience greater well-being. Nurses can combat stigma by acknowledging and respecting diverse identities; creating trusting, co-equal relationships; and advocating for sexual and gender diverse persons at both practice and policy levels.

Mediating effect of self-concealment between non-suicidal self-injury and internet addiction in college students: a cross-sectional study.

BACKGROUND: Internet addiction, defined as uncontrolled behaviour resulting from the use of the Internet without the influence of addictive substances, which can seriously impair academic, occupational and social functioning. Non-suicidal self-injury, defined as self-injurious behaviour without the intent to die, and its addictive characteristics are similar to those of Internet addiction. Currently, there is a lack of research on the relationship between non-suicidal self-injury and Internet addiction. The purpose of this study was to examine the relationship between non-suicidal self-injury and internet addiction among college students and the role of self-concealment in this relationship. METHODS: In this study, data were collected online between December 2022 and January 2023 from 600 university students in Chengdu, Sichuan Province, China, using purposive sampling. The questionnaires included the Non-Suicidal Self-Injury Inventory (NSSI), the Self-Concealment Scale (SCS) and the Internet Addiction Test (IAT). RESULTS: A total of 573 valid questionnaires were recovered, with a valid recovery rate of 95.50%. CONCLUTION: The results suggest that self-concealment plays a partial mediating role between non-suicidal self-injury and internet addiction among college students. The authors emphasized the importance of internet addiction. In order to reduce the occurrence of internet addiction, schools should provide targeted interventions to promote the psychological health of college students' internet addictive behaviours.

Reliability and Validity of Self-Concealment Scale in Chinese Older Adults.

Background: Individuals who initiate the concealment of their adverse or distressing thoughts from others can trigger off negative psychological experiences and social isolation, and lead to poorer health. Therefore, this study aimed to analyze the psychometric properties of the Self-Concealment Scale (SCS) in Chinese older adults. Methods: A questionnaire was administered to 1085 elderly people using convenience sampling and snowball sampling. Scales used included the SCS, Distress Disclosure Index (DDI), Revised Cheek and Buss Shyness Scale (RCBS), Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), UCLA Loneliness Scale (ULS-8), and Kessler Psychological Distress Scale (K10). Results: The SCS consisted of 10 items with a one-dimensional structure, explaining 55.66% of the variance. The factor loading values for each item ranged from 0.68 to 0.75, and the covariance ranged from 0.46 to 0.57. Confirmatory factor analysis showed good model fit (χ2/df=2.829, RMSEA=0.057, CFI=0.981, IFI=0.981, TLI=0.974, PNFI=0.712, PGFI=0.719). The criterion-related validity test found that the SCS was significantly and positively correlated with the RCBS, SIAS, SPS, ULS-8, K10, depression, and anxiety; and the SCS was significantly and negatively correlated with the DDI. The Cronbach's α coefficient value for the scale was 0.923; the split-half reliability coefficient value was 0.923. In addition, the SCS had cross-gender consistency. Conclusion: The SCS has good reliability and validity in older adults and can be used as a valid tool to assess self-concealment among older people.

Which Identities Are Concealable? Individual Differences in Concealability.

Concealment is a common and consequential identity management strategy. But which identities are concealable? In three studies (n = 468; obs = 4,068), we find substantial individual differences in which identities people experience as concealable. These individual differences in concealability manifest as Person × Identity interactions, such that people experience varying levels of concealability for each of their individual identities. In two additional studies (n = 465; obs = 3,784), we find that these individual differences predict the frequency and efficacy of concealment. We conclude that it is inaccurate to label entire categories of identities as either concealable or conspicuous and urge intergroup researchers to consider people's unique experiences of concealability. Pre-registrations for Studies 1 to 4 and open materials, code, and data for all studies are available on the Open Science Framework: https://osf.io/m95qu/.

Sexual Orientation Concealment, Hope, and Depressive Symptoms Among Sexual Minority Women: The Moderating Role of Sexual Orientation.

Sexual minority women (SMW) experience higher levels of depression compared to heterosexual women, and bisexual women show higher levels than lesbian women. Sexual orientation concealment is a risk factor for depressive symptoms among SMW. Hope is protective against depressive symptoms in diverse samples, but limited research in this area has centered on SMW. This study examined the role of hope and its components, agency and pathways, as moderators of the relation between sexual orientation concealment and depressive symptoms, and whether the moderating effects were conditional on sexual orientation. An international sample of 218 lesbian women aged 18 to 69 (M = 32.93 years, SD = 12.75) and 230 bisexual women aged 18 to 67 (M = 27.83 years, SD = 7.52) completed an online survey. Hope, agency, and pathways did not moderate the relation between sexual orientation concealment and depressive symptoms. The significant negative relations between hope and depressive symptoms, and between agency and depressive symptoms, were moderated by sexual orientation: the relations were stronger among lesbian women than bisexual women. Results suggest that increasing levels of hope and agency through clinical intervention may reduce depressive symptoms for both groups of women, with more pronounced effects among lesbian women.