The social consequences of stigma-related self-concealment after acquired brain injury

Social relationships often decline after brain injury. Although much of this is due to psychosocial impairments caused by the injury, the reactions to the injury of others in the person's wider social network, along with the response of the person with the injury to those reactions, also need to be considered. Anxiety about stigmatising reactions from others may lead some to conceal information about their brain injury. This study investigated some of the social consequences of such concealment. Sixty-five participants with acquired brain injury completed the Anticipated Stigma and Concealment Questionnaire, the Social Avoidance and Distress Scale, the UCLA Loneliness Scale, the Rosenberg Self-Esteem Scale, the Social Integration subscale of the Community Integration Questionnaire, and the Enacted Social Support Questionnaire. As hypothesised, concealment was associated with social anxiety, social avoidance, loneliness and lower self-esteem; and anxiety mediated the impact that concealment had on avoidance, loneliness and reduced community activity. However, contrary to expectation, concealment was not associated with reduced use of social support. Concealment may have negative consequences, but inappropriate disclosure can also be harmful. Services should support individuals to make optimal decisions about disclosing information about the brain injury and also help them address psychological barriers to disclosure.