Disclosure and Double Standards: A Mixed Methods Study of Self-Disclosure of Mental Illness or Addiction Among Medical Learners

Abstract

PurposeDespite the proliferation of initiatives to address wellbeing and reduce burnout, mental illness and addiction stigma remains rooted within medical education and healthcare. One mechanism to address this stigma is self-disclosure. Given the paucity of literature on self-disclosure in medical learners, we sought to explore perceptions of self-disclosure in medical education.MethodIn a mixed method, convergent triangulation design, authors recruited medical learners from across Canada. Quantitative data included the Opening Minds Scale for Healthcare providers (OMS-HC), the Self Stigma of Mental Illness Scale (SSMIS), a wellbeing measure, and questions regarding substance use from Statistics Canada. Qualitative data included semi-structured interviews, which were collected and analyzed using a phenomenological approach. Data were collected simultaneously, analyzed separately, and then triangulated. Discrepancies were discussed until consensus was achieved.ResultsOverall, N= 125 medical learners (n= 67 medical students, n=58 resident physicians) responded to our survey, and N=13 participated in interviews (n = 10 medical students, n =3 resident physicians). OMS-HC scores showed resident physicians had more negative attitudes towards mental illness and disclosure (47.7 vs. 44.3,P= 0.02). Self-disclosure was modulated by the degree of intersectional vulnerability of the learner’s identity. When looking at self-disclosure, people who identified as men had more negative attitudes than people who identified as women (17.8 vs 16.1,P= 0.01). Racialized learners scored higher on self-stigma. Interview data suggested that disclosure was fraught with tensions, but perceived as having a positive outcome, including the perception that self-disclosure made learners better physicians and educators in the future.ConclusionThe individual process of disclosure is complex and appeared to become more challenging over time due to the internalization of negative attitudes about mental illness. Intersectional vulnerability in medical learners warrants further consideration. Fear of disclosure is an important factor shaped by the learning environment.