An exploration of self-disclosure after traumatic brain injury

Aims: To investigate the motivation for concealment and disclosure of issues related to acquired and traumatic brain injury, and the association of these motivations with a range of possible predictors and outcomes (specifically, self-esteem, social support, social avoidance, loneliness, life satisfaction and community integration). Method: Three studies were carried out. The first (N=18) was a qualitative exploration of the reasons why people with acquired brain injury and their family carers chose to disclose or conceal information about the brain injury. In the second (N=55) two questionnaires were developed from the first study (the Non-Disclosure and Self-Disclosure questionnaires). These focused on the motivations of the person with the brain injury, one addressing motivations to conceal and the other motivations to disclose. Assessments of the reliability and validity of these measures were carried out. The third study (N=65) investigated the relationships between these motivations to conceal/disclose and some possible predictors and outcomes of these motivations. Findings: In the first study, a range of motivations for disclosure (e.g. seeking social support) and for concealment (e.g. avoiding the negative reactions of others) emerged from the data. In the second study, the derived questionnaires showed good internal consistency (the Cronbach’s alpha levels are N-DQ = .92 and S-DQ = .92) and the test-retest reliability (ICC= ranged from .38 to .805). Predicted significant correlations with Brief Fear of Negative Evaluation and N-DQ1 (r=.418, n=55, p=.002) and with the Distress Disclosure Index and S-DQ2 (r=.595, n=54, p=.001) provided evidence of their concurrent validity. In the third study, as hypothesized, higher motivations to conceal (i.e. high N-DQ scores) were significantly correlated with lower self esteem (r = -.357, n = 65, p = .003 with the Rosenberg Self-Esteem Inventory); higher social avoidance (r = .345, n = 64, p = .005 with the SAD); and greater loneliness (r = .380, n = 65, p = .002 with the University of California Los Angeles loneliness scale). The results of a mediation analysis were consistent with the hypothesis that higher motivations to conceal had an impact on general life satisfaction (as measured by the LiSat-11) via the mediation of social avoidance (SAD) and loneliness scale (UCLA). However, the hypothesis related to social support was not supported. Conclusions and implications: Many people affected by a brain injury and their families are concerned about the negative and positive impact that disclosure of information about the brain injury may have. Concern about the negative impact may be associated with negative views of the self, and have a range of negative social consequences. However, disclosure in some circumstances does, in reality, have a negative impact. People with an acquired brain injury and their families may need support in learning to conceal and disclose information about their injury in a more effective way