title: Analysis of the barriers of mental distress disclosure in medical inpatients in Taiwan.
abstract: BACKGROUND
  Disclosure of mental distress to physicians is important for mental illness identification, early referrals and proper treatment to prevent suicide. Little is known about what affects mental health communication in the clinical settings in the Chinese societies.
  
  
  OBJECTIVE
  The study aimed to identify the demographic, psychosocial and medical factors related to people with non-disclosure of their mental distress.
  
  
  METHODS
  We interviewed a series of consecutive inpatients from two medical wards of a general hospital in northern Taiwan. We collected depressive symptoms (the Patient Health Questionnaire, PHQ-9), living arrangement, threatening life events, suicide risks (i.e. past self-harm history, lifetime suicide ideas and hopelessness) and recent experience of mental distress disclosure. Furthermore, we explored the reasons of non-disclosure.
  
  
  RESULTS
  A total of 230 medical inpatients agreed to participate (53.5% males). The results indicated that only 5.7% actually communicated their mental health concerns, and that 12.3% were willing to talk about their mental health problems. Among the 69 (30%) depressed participants (PHQ-9 score ≥ 10 points), the disclosure rate was low (8.7%) and the wish to talk about mental distress was also low (10.3%). After adjustment, living alone (OR = 7.58, 95% CI =  1.56-36.91) and having stressful life events (OR = 3.68, 95% CI = 1.09-12.46) remained significant in predicting disclosure of mental distress. The 109 participants attributed their refusal of communicating mental distress as medical-related attributes, subjective perceptions or sociocultural factors.
  
  
  CONCLUSIONS
  Communication of mental distress in medical settings was uncommon due to medical or psychosocial barriers in Taiwan. Skill training to facilitate disclosure in medical education and public campaigns to improve knowledge of depression and enhance help-seeking deserve more attention, particularly under the influence of stigma in the Chinese societies.
authors.affiliation: Center for General Education, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan.
authors.forename: Der-Yan
authors.initials: DY
authors.lastname: Han
authors.affiliation: Gerontology Institute, Georgia State University, Atlanta, GA, USA.
authors.forename: Yi-Yin
authors.initials: YY
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shih-Cheng
authors.initials: SC
authors.lastname: Liao
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ming-Been
authors.initials: MB
authors.lastname: Lee
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan jennycyw@ntu.edu.tw.
authors.forename: Chia-Yi
authors.initials: CY
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D030881:Disclosure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D000066505:Help-Seeking Behavior; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D057545:Social Stigma; D013315:Stress, Psychological / Q000175:diagnosis*; D013624:Taiwan; D000092864:Suicide Prevention
keywords: Barriers; Taiwan; mental distress disclosure; suicide prevention