Developing a Framework for Mental Health Disclosure Decision-Making Among Medical Students: A Qualitative Pilot Study

PurposeAmerican medical students exhibit higher rates of depression, anxiety, and psychological distress than age-matched members of the general population, yet the majority of students do not seek help for these conditions. A necessary precursor to help-seeking is disclosure, or the sharing of one's diagnosis or symptoms with others. This pilot study aims to explore mental health disclosure decision-making among medical students.DesignSemi-structured qualitative interviews.SettingStudents were interviewed virtually using Zoom.Participants20 students enrolled in nine American undergraduate medical education institutions (MD or DO).MethodInterviews were audio-recorded and transcribed. Using Constructivist Grounded Theory (CGT) and iterative cycles of analysis with focused and theoretical coding, a preliminary framework was developed to represent mental health disclosure decision-making among medical students.ResultsThe proposed framework presents three factors that impact students' disclosure decisions: Assessing Anticipated Outcomes, Evaluating Priorities, and Determining Appropriate Recipients. The framework also identifies two moderating variables-Disclosure Goals and Severity and Type of Symptoms-that affect students' perspectives on outcomes and recipients.ConclusionThis pilot study highlights the complexity of student disclosure decision-making. While limited by the small sample size, the results suggest the importance of considering student perspectives on disclosure recipients, communication surrounding disclosure outcomes, and the flexibility of student schedules when pursuing future projects related to medical student well-being and mental health disclosure.