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Why People Conceal Mental Health Problems: Qualitative Analysis of TikTok Posts
Chloe Roske1, Kael Ragnini1, Qinchun Zhu1
1Department of Psychology, Harvard University, 33 Kirkland Ave, Cambridge, MA, 02138, United States, 1 6464775894.
Journal of Medical Internet Research
|May 19, 2026
Summary
Patients conceal psychiatric symptoms to avoid perceived punishment, manage impressions, or cope with distress. Understanding these motivations is key to improving mental health treatment and reducing suicide risk.
Area of Science:
- Mental Health Research
- Social Media Analysis
- Clinical Psychology
Background:
- Concealment of psychiatric symptoms hinders effective mental health treatment, especially for individuals with suicidal ideation.
- Traditional research methods like self-report and lab interviews may not reflect real-world disclosure decisions.
- Social media platforms, like TikTok, offer insights into patient motivations for concealment outside experimental settings.
Purpose of the Study:
- To investigate patient decision-making regarding the concealment and disclosure of psychiatric symptoms.
- To analyze social media content for real-world patient experiences with symptom concealment.
- To leverage TikTok's open-ended format for understanding diverse expressions of mental health experiences.
Main Methods:
- Utilized a new TikTok account to minimize algorithmic bias.
- Downloaded and analyzed the 25 most-viewed videos for four clinical concealment search terms.
- Applied reflexive thematic analysis to 98 videos, with four coders developing a consensus codebook.
- Recorded and summarized engagement metrics (views, likes, comments, shares, saves).
Main Results:
- Analysis of 98 videos (73M+ views) revealed four primary themes of concealment motivations.
- Theme 1: Disclosure perceived as punitive (34.4%), including avoiding hospitalization (18.8%).
- Theme 2: Managing others' feelings/impressions (31.1%), including maintaining wellness façade (7.7%).
- Theme 3: Negative emotions/inability to identify feelings (23.3%), including fear of vulnerability (6.6%).
- Theme 4: Negative opinions of psychiatric treatment (18.8%), including confidentiality concerns (3.3%).
- An exploratory theme identified ambivalence and guilt regarding nondisclosure.
Conclusions:
- Findings illuminate patient motivations for concealing suicidal thoughts and behaviors.
- Interventions should focus on improving therapeutic alliances and reducing stigma.
- Enhancing transparency around hospitalization and reducing barriers to honest reporting are crucial for suicide prevention.
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