ORIGINAL RESEARCH

published: 26 March 2021

doi: 10.3389/fpsyt.2021.631032

Workers’ Decisions to Disclose a

Mental Health Issue to Managers and
the Consequences
Carolyn S. Dewa 1*, Jaap van Weeghel 2 , Margot C. W. Joosen 2 , Petra C. Gronholm 3 and
Evelien P. M. Brouwers 2
1
Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States, 2 Tranzo,
Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands, 3 Health Services and Population Research
Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom

Background: Stigma can be a barrier to accessing effective interventions and work

accommodations for mental illnesses. Fear of stigma’s concomitant prejudice and
discrimination can inhibit workers from asking for help. Thus, it may be important
to develop effective interventions addressing workplace stigma. To identify important
targets for these interventions, this study addresses three questions: (1) what proportion
of workers experiencing mental health issues disclosed their mental health issue to their
Edited by:
managers, (2) what factors did they identify as contributing to their disclosure decisions,
Hikaru Hori,
University of Occupational and and (3) what were the consequences of their decisions?
Environmental Health Japan, Japan
Methods: The dataset is comprised of responses from respondents who were randomly
Reviewed by:
Hilary Weingarden,
drawn from a nationally representative sample of working Dutch adults who completed
Massachusetts General Hospital and a web-based survey in February 2018. Respondents indicating they either had or have
Harvard Medical School, mental health issues were asked three sets of questions focusing on: (1) Did you disclose
United States
Claudia Buntrock, your mental health issue to you manager? (2) For what reasons did you disclose/not
University of Erlangen disclose the issue? (3) What were the consequences of your disclosure decision?
Nuremberg, Germany
Results: About 73% of respondents with lived experience with mental health issues told
*Correspondence:
Carolyn S. Dewa their managers about their mental health issue. The structure of the survey questions
[email protected] identified four groups of workers who either: (1) disclosed and had a positive experience
(64.2%), (2) disclosed and had a negative experience (9.0%), (3) did not disclose
Specialty section:
This article was submitted to and had a positive experience (22.6%), or (4) did not disclose and had a negative
Psychological Therapies, experience (4.2%).
a section of the journal
Frontiers in Psychiatry Conclusion: Our results reflect workers’ diverse preferences for disclosing their mental
Received: 19 November 2020 health issues to their managers. Understanding both the factors that contributed to the
Accepted: 22 February 2021 decision to disclose and the consequences of disclosure decisions could help to better
Published: 26 March 2021
target workplace educational programs and interventions to address workplace stigma.
Citation:
Dewa CS, van Weeghel J, Our findings suggest that addressing workplace stigma may not be as straightforward
Joosen MCW, Gronholm PC and as requiring all employees to receive anti-stigma education. Rather, education should
Brouwers EPM (2021) Workers’
Decisions to Disclose a Mental Health
support workers to make the appropriate disclosure decision based on their workplace
Issue to Managers and the contexts. Future research is needed to understand the optimal ways for workers
Consequences. struggling with mental health issues to ask and receive help if they need it.
Front. Psychiatry 12:631032.
doi: 10.3389/fpsyt.2021.631032 Keywords: stigma, mental health, managers, disclosure, workplaces, workers

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Dewa et al. Workers’s Decisions to Disclose

WORKERS’ DECISIONS TO DISCLOSE A prejudices associated with mental disorders to themselves (14,
MENTAL HEALTH ISSUE TO MANAGERS 21). Self-stigma leads people to devalue themselves (20). In turn,
this can reduce their likelihood of seeking help (14).
AND THE CONSEQUENCES
Few workplace studies have focused on experiences of
During a 30-day period, an estimated 11% of workers experience workplace stigma related to mental illness and disclosure (17).
a mental disorder (1). Their disorders often hinder their work Rather, studies generally focus on attitudes about disclosure.
functioning (1). This can lead to significant work productivity Fewer studies have examined the actual consequences of
losses (2). In addition, there is evidence that even when decisions about disclosing a mental illness to managers. If stigma
symptoms are in remission, work limitations may continue (3). is a significant barrier for workers to accessing help at work,
This suggests that both during and after an episode of a mental more information regarding disclosure is required to guide the
disorder, workers may need help at work. This need for help development of ways to tackle this barrier. Stigma reduction is
may be underscored by the fact that those with a history of one of the strategies to support workers at work and to help
work disability are significantly more likely to have a future one workers obtain effective accommodations when they return to
(4). Thus, there is a rationale for work-based interventions for work from a work disability leave.
mental disorders.
During the past decade, there has been an increase in Purpose
the development of work-based interventions to prevent and This study uses a subsample that was randomly drawn from
decrease mental disorder related work disability (5). These a representative sample of adults in the Dutch labor force to
interventions include models to increase access to treatments and examine the experiences of workers who had a mental health
work accommodations (6, 7). There is evidence that work-based issue, their decisions to disclose their struggles to their managers,
interventions can decrease the likelihood of sickness absences and the consequences of their decisions. Specifically, our study
(8). Studies have reported that workers with mental disorders addresses the following sets of questions. Among those who have
who receive treatment are more productive at work than workers experienced a mental health issue, (1) what proportion disclosed
who do not (9). Furthermore, workers who perceive that they their mental health issue to their managers, (2) what factors did
have managers who are supportive and open to working with they identify as contributing to their disclosure decisions, and
employees who have mental disorders are less likely to have work (3) what were the consequences of their decisions? Our results
absences (10). can be useful in understanding what contributes to disclosure
However, there is equivocal evidence that all workers who decisions and further our understanding about the consequences
could benefit from treatment and/or supports access them (11). of disclosure choices.
For example, Canadian studies found that almost half of workers
who could benefit from mental health services did not access
any (9, 11). A US study observed that compared to workers
METHODS
with physical disorders, those who experienced depression
were less likely to report receiving work accommodations (12). Study Population
A Dutch study found that a third of workers with mental The data are from the February 2018 Longitudinal Internet
disorders reported receiving work accommodations (8). At Studies for the Social Sciences (LISS) panel that is administered
the same time, compared to workers with chronic physical by CentERdata. The panel was developed through a cooperation
disorders such as asthma/Chronic Obstructive Pulmonary of CentERdata and Statistics Netherlands. The LISS panel sample
Disease (COPD), diabetes, and musculoskeletal disorders, those consists of 5,000 households and 7,357 panel members. LISS
Dutch workers with mental disorders were more likely to have panel members have given informed consent to participate in
work accommodations (8). monthly questionnaires such as the one for this study. From the
Stigma has been identified as a barrier to asking for help LISS panel, participants over the age of 18 years who identified
(13, 14). In the workplace, receipt of work accommodations relies their most important daily activity as paid employment were
on the worker’s willingness to ask managers and supervisors for selected as potential recipients for this study. From this pool,
help; this requires disclosing a mental disorder (15, 16). Stigma a random sample of 1,671 participants was selected to receive
related to mental illnesses can prevent workers from asking for the link to a web-based questionnaire. The response rate was
help and disclosing that they are struggling with their mental 73.5% (n = 1,228). There were 1,224 respondents who voluntarily
health because they fear public stigma (i.e., mental illness related completed the survey, indicated they were in the labor force
prejudice and discrimination from the environment) (15, 17). (i.e., were employed for pay or looking for employment) and
Disclosing a mental disorder potentially exposes a worker to were not in management positions. This study focuses on the
stigma-related negative behaviors from managers and co-workers disclosure experiences of the 332 workers who indicated they
that could include social rejection, prejudice, discrimination, and have experienced mental health issues either in the past or at the
harassment (14, 18, 19). time of the survey. This group comprised 27% of the total study
In addition to public stigma, workers with a mental disorder sample. The study dataset was de-identified by CentERdata prior
may also experience internalized or self-stigma (20). Self-stigma to its use for the analysis. The University of California, Davis’
is a result of a person believing and applying the external Institutional Review Board reviewed the study protocol.

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Dewa et al. Workers’s Decisions to Disclose

FIGURE 1 | Survey questions analyzed.

Outcome Variables through organizational policies or to prevent having to report

Decision to Disclose Mental Health Problem (Q1) sick (listed in Table 2).
The first question in the series of questions about workers’
experiences with disclosing began with inquiring whether a Reasons for a Negative Disclosure Decision (Q2b)
mental health issue was disclosed to their managers (Figure 1). If Q1 was answered in the negative (i.e., did not tell their
managers), respondents were queried about the reasons for their
Reasons for a Positive Disclosure Decision (Q2a) negative response (Q2b). Respondents could choose as many
Subsequent questions were based on responses to Q1. The reasons as applied.
response choices included in the questionnaire were adapted Again applying concepts from educational theory, responses
from studies conducted by Brohan et al. (17) and Dewa (22) that were aggregated into either: (1) intrinsic factors or (2) extrinsic
examined workers’ attitudes toward disclosing a mental disorder factors (listed in Table 2) (23). For Q2b, intrinsic factors included
to their managers (see Tables 2, 3 for list). the belief that it would not make a difference, a preference to
If there was an affirmative disclosure response to Q1, deal with it alone, discomfort or embarrassment from disclosing,
the respondent was asked the reason(s) for disclosing (Q2a). and failure to see a reason to disclose. For Q2b, extrinsic factors
Respondents could identify as many reasons as applied. Applying included fear of negative career effects, negative impacts on
concepts from educational theory, responses were aggregated relationships, and potential loss of friends.
into one of two categories: (1) intrinsic or (2) extrinsic
(23). Educational theory suggests that different educational Actual Disclosure Decision Consequences (Q3a and
approaches are needed to address the two different types of Q4a–d)
motivating factors. Intrinsic factors are those that are motivated Respondents were also asked about the consequences of
by the inherent satisfaction that they bring to the person doing disclosing—both positive and negative (Q3a). They were then
them. For Q2a, intrinsic factors included disclosure reasons asked for the factors that contributed to their positive or negative
motivated by a sense of responsibility and positive feelings experiences (Q4a–d).
toward managers (listed in Table 2). In contrast, extrinsic
factors represent activities done in response to either external Descriptive Variables
encouragement or discouragement (23). Extrinsic factors are From responses to demographic questions, descriptive variables
those that are motivated by anticipated reactions of others, were created. They included sex (male/female), age (≤34,
incentives offered by the organization or manager, or advice 35–44, 45–54, ≥55 years), marital status (single/never
from a trusted source. For Q2a, extrinsic factors included married, married/cohabiting, divorced/separated/widowed),
motivation based on the belief that the manager would and educational attainment (≤high school yes/no).
notice the problem, the positive example others who disclosed
and benefitted from disclosing, a recommendation from an Analyses
occupational health physician, the desire to obtain either work χ2 tests were used to examine the differences in the
accommodations, treatment during work hours, solutions offered characteristics of those who did and did not disclose their

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Dewa et al. Workers’s Decisions to Disclose

TABLE 1 | Demographic characteristics by disclosure to manager.

Total Disclosed to manager Did not disclose to Test of significant

manager differences between
characteristics of
workers who did and did
not disclose

% n % n % n
Total 100% 332 73.2% 243 26.8% 89

Sex
Male 31.3% 104 30.5% 74 33.7% 30 χ2(1) = 0.32, p = 0.57
Female 68.7% 228 69.6% 169 66.3% 59
Age
≤34 years 24.7% 82 21.0% 51 34.8% 31 χ2(3) = 8.0, p = 0.046
35–44 26.5% 88 28.4% 69 21.4% 19
45–54 26.2% 87 28.4% 69 20.2% 18
≥55 years 22.6% 85 22.2% 54 23.6% 21
Marital Status
Married/co-habiting 55.4% 184 54.7% 133 57.3% 51 χ2(2) = 9.5, p = 0.0088
Separated/divorced/cohabiting 13.6% 45 16.9% 41 4.5% 4
Single, never married 31.0% 103 28.4% 69 38.2% 34
Educational Attainment
High school degree or less 25.6% 85 22.6% 55 33.7% 30 χ2(1) = 4.19, p = 0.041
More than high school degree 74.4% 247 77.4% 188 66.3% 59

mental health issue to their manager. The 95% confidence Reasons for Disclosing
intervals were calculated for the prevalence rates for the When asked for the reasons for their decision, respondents who
responses to the questions that asked about (1) the reasons for disclosed their mental health issues to their managers were as
disclosing to a manager and (2) the consequences of disclosing likely to point to intrinsic factors as they were to extrinsic factors
(or not disclosing). Given small cell sizes, additional statistical [74.9% (n = 182), 95% CI: 69.0–80.2 vs. 76.1% (n = 185),
analyses were not performed. 95% CI: 70.3–81.3]. Among the primary intrinsic motivating
factors were a good relationship with their manager [43.6% (n =
106), 95% CI: 37.3–50.1] and feeling a responsibility to disclose
RESULTS [46.9% (n = 114), 95% CI: 40.5–53.4]. The primary extrinsic
influencing factor was the fact that when they reported sick, they
Table 1 indicates that there were significant differences between felt compelled to disclose [39.9% (n = 97), 95% CI: 33.7–46.4].
those who did and did not disclose with regard to age, marital
status and educational attainment. Compared with those who Reasons for Not Disclosing
disclosed, those who did not were significantly younger [χ2(3) = Among those who chose not to disclose, there were significantly
8.0, p = 0.05], more likely to be single/never married [χ2(2) = 9.5, more who were influenced by intrinsic factors than extrinsic
p = 0.02], and more likely to have more than a high school degree factors [69.7% (n = 62), 95% CI: 59.0–80.0 vs. 34.8% (n =
[χ2(1) = 4.2, p = 0.04]. 31), 95% CI: 25.0–45.7]. Significant intrinsic factors included
preferring to deal with the issues alone [44.9% (n = 40), 95% CI:
34.4–55.9] and believing their work would not be affected by their
Disclosure mental health issues [27.0% (n = 24), 95% CI: 18.1–37.4]. Fear for
Table 2 contains the reasons for the disclosure decision. A their careers [16.9% (n = 15), 95% CI: 9.8–26.3] was one of the
significantly larger proportion of respondents disclosed their primary extrinsic motivations for those who chose not to disclose.
mental health issues than who did not [73.2% (n = 243), 95% CI:
68.1–77.9 vs. 26.8% (n = 89), 95% CI: 22.1–31.9]. The structure of Consequences of Disclosing
the survey questions identifies four groups of workers who either: Among workers who disclosed their mental health issues, 87.7%
(1) disclosed and had a positive experience [64.2% (n = 213), (n = 213) (95% CI: 82.8–91.5) indicated that their disclosure led
95% CI: 58.7–69.3], (2) disclosed and had a negative experience to a positive experience (Table 3). The most frequently reported
[9.0% (n = 30), 95% CI: 6.2–12.6], (3) did not disclose and had positive experience was managerial support [69.5% (n = 148),
a positive experience [22.6% (n = 75), 95% CI: 18.2–27.5], or (4) 95% CI: 62.8–75.6]. In contrast, 12.4% (n = 30) (95% CI: 8.5–
did not disclose and had a negative experience [4.2% (n = 14), 17.2) indicated they had a negative experience from disclosing
95% CI: 2.3–7.0]. primarily as a result of not receiving managerial support [66.7%

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Dewa et al. Workers’s Decisions to Disclose

TABLE 2 | Disclosure decision and reasons by experience with mental health TABLE 3 | Disclosure decision experiences.
problems.
% n 95% CI
Reasons for decision
Chose to disclose to manager* 100% 243
% n 95% CI
Positive experience from disclosing 87.7% 213 82.8, 91.5

Disclosed to Manager 73.2% 243 68.1, 77.9 Supported by manager 69.5% 148 62.8, 75.6

Reasons for disclosing* Improved workplace relationships 22.5% 48 17.1, 28.7

Intrinsic Factors 74.9% 182 69.0, 80.2 Led to positive workplace changes 33.3% 71 27.0, 40.1

Good relationship with manager 43.6% 106 37.3, 50.1 Did not need to hide 36.2% 77 29.7, 43.0

Feel responsible 46.9% 114 40.5, 53.4 Could be a positive example 12.7% 27 8.5, 17.9

Consistent with open personality 33.7% 82 27.8, 40.1 Negative Experience from Disclosing 12.4% 30 8.5, 17.2

Did not want to hide 27.2% 66 21.7, 33.2 Not supported by manager 66.7% 20 47.2, 82.7

Extrinsic Factors 76.1% 185 70.3, 81.3 Unfavorable impact on workplace relationships 26.7% 8 12.3, 45.9

Seen how others benefited 3.3% 8 1.4, 6.4 Felt uncomfortable/embarrassed 30.0% 9 14.7, 49.4

Manager would be able to tell 19.8% 48 14.9, 25.3 Lost job as a result 46.7% 14 28.3, 65.7

Obtain work accommodations 21.4% 52 15.4, 27.1 Negative effects on career 23.3% 7 9.9, 42.3

Company doctor 7.8% 19 4.8, 11.9 Treated differently 23.3% 7 9.9, 42.3

Prevent having to report sickness 16.9% 41 12.4, 22.2 Had no choice to tell 6.7% 2 0.8, 22.1
absence Chose not to tell disclose to manager* 100% 89
No choice, reported sick 39.9% 97 33.7, 46.4 Positive experience from not disclosing 84.3% 75 75.0, 91.1
Get time off for treatment during 15.6% 38 11.3, 20.8 Prefer to deal with it alone 46.2% 36 36.3, 59.8
work Feel uncomfortable or embarrassed 20.0% 15 11.6, 30.8
Organizational policies – – – Not treated differently 24.0% 18 14.9, 35.3
Did not disclose to manager 26.8% 89 22.1, 31.9 Did not have a negative effect on career 24.0% 18 14.9, 35.3
Reasons for not Disclosing* Did not affect work performance 38.7% 29 27.6, 50.6
Intrinsic factors 69.7% 62 59.0, 80.0 Negative experience from not disclosing 15.7% 14 8.9, 25.0
Would not affect work 27.0% 24 18.1, 37.4 Needed to hide 7.1% 1 0.2, 33.9
Prefer to deal with it alone 44.9% 40 34.4, 55.9 Did not get accommodations 7.1% 1 0.2, 33.9
Feel uncomfortable or 13.5% 12 7.2, 22.4 Did not get support 50.0% 7 23.4, 77.0
embarrassed
Could not be a positive example 11.8% 2 1.5, 36.4
Problems not serious 14.6% 13 8.0, 23.7
Did not realize needed help 13.5% 12 7.2, 22.4 *Categories do not sum to 100% because respondents identified all factors that applied.

Did not see a reason 16.9% 15 9.8, 26.3

Extrinsic factors 34.8% 31 25.0, 45.7
DISCUSSION
Fear of negative effect on career 16.9% 15 9.8, 26.3
Fear of affecting relationship with 7.9% 7 3.2, 15.5 Our study sought to understand the experiences of workers
manager
who have had mental health issues and their decision about
Fear of losing friendships – – –
whether or not to disclose their struggle to their managers and
Seen others have negative 7.9% 7 3.2, 15.5 the consequences of that decision.
experience
Wouldn’t want to be treated – – –
differently Deciding to Disclose
Our results indicate that about three quarters of workers
*Categories do not sum to 100% because respondents identified all factors that applied.
disclosed their mental health issues to their managers. These
results fall within the range reported in the literature. For
(n = 20), 95% CI: 47.2–82.7] or losing their job as a consequence example, Jones’ (16) review of the literature found that reported
[46.7% (n = 14), 95% CI: 36.1–57.5]. disclosure rates ranged from 35 to 87%. In addition, a US study
reported about 77% of those with a disability disclosed their
disability to their manager (15). Furthermore, the proportion
Consequences of Not Disclosing who actually disclosed is very similar to the proportion of workers
The majority [84.3% (n = 75), 95% CI: 75.0–91.1] of workers who who had no experience with mental health issues but thought
chose not to disclose reported their non-disclosure experience they would disclose if they did (24).
was positive. The main reasons they found it a positive experience The reasons workers in our study sample attributed for
were that they preferred to deal with the issues alone [46.2% their decision to disclose were consistent with the literature
(n = 36), 95% CI: 36.3–59.8] and the belief that their work from other countries (10, 15, 22). It appears that feelings
performance was not affected [38.7% (n = 29), 95% CI: play an important role in decisions. Specifically, feelings about
27.6–50.6]. Those who had a negative experience attributed it to managers contribute to the decision to disclose. Positive feelings
not receiving support [50.0% (n = 7), 95% CI: 23.4–77.0]. encouraged disclosure. In addition, feelings of responsibility to

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Dewa et al. Workers’s Decisions to Disclose

their workplaces were another significant contributor. This may Positive Experience With Non-disclosure
also reflect a perceived alliance and shared values with managers. The majority of workers who did not disclose attributed their
positive experiences to intrinsic factors such as being able to
Positive Experience With Disclosure handle the issues alone. These responses may be the result of
The majority of those who disclosed found it a positive the fact that there are workers who are able to handle issues
experience. They represented the largest group in our sample. by themselves. For example, the literature suggests that there
This suggests that the majority of managers were able to work are occupations in which workers have the autonomy to make
effectively with employees who disclosed their mental health work adjustments (17). In their study of Dutch workers, Boot
issues. Indeed, the majority of respondents who reported having a et al. (8) found that less than a quarter of workers with mental
positive experience attributed it to the support they received from disorders required work adjustments. In those circumstances,
their managers. This may be a reflection of the incentives the workers would not necessarily need to disclose. Nevertheless,
Dutch system creates for employers to prevent work disability. they might benefit from education that helps them to effectively
Under the Dutch Gatekeeper Protocol legislation, employers are self-adjust their work when they are struggling. Future research
financially responsible to provide sickness absence benefits for could explore the types of occupations and job content to which
2 years regardless of the cause of the absence (25). As a result, this could apply.
Dutch employers may be proactive in disability prevention (25).
Future work could focus on dyads of workers and their managers Negative Experience With Not Disclosing
to understand the experience from the manager’s perspective. The smallest group in our sample were those who did not
What organizational contexts enable the positive interactions? disclose and had a consequent negative experience. The primary
One might argue that these results suggest that stigma is not a reason reported for the negative experience was that they did not
“real” problem in workplaces. We would respectfully submit that receive support. This experience could be a reflection of existing
there is still a proportion of workers who either do not disclose workplace stigma. These workers may not have disclosed because
or who do not have positive experiences with their disclosure they anticipated that there would be no workplace support. If
decisions. These workers may be affected by stigma. If this is the this were the case, anti-stigma education for both managers and
case, workplaces seeking social justice for all workers still have workers would be important.
work to do to address stigma. One of the ways stigma is addressed Also, part of building a positive environment could be
is through workplace interventions. addressing microaggressions. Microaggressions are indirect
negative behaviors that have been shown to have significant
Negative Experience With Disclosure negative impacts (14). An example would be negative general
We also found about 12% who disclosed and did not have a comments about people with mental disorders that are not
positive experience. This is consistent with findings reported directed at a specific person. Yanos (14) points out that while
by von Schrader et al. (15) who reported that about 10% these types of comments are not discriminatory, they can be
of their respondents who had a disability reported negative discouraging and suggest that it leads to anticipated rejection. In
disclosure experiences. turn, this can result in reduced likelihood of help seeking.
In our study, negative disclosure experiences were attributed Microaggressions are also closely linked to self-stigma. If
to extrinsic factors such as not having managerial support colleagues make derogatory comments about mental disorders
or losing their jobs. Experiences such as these indicate that and those who experience them, workers may internalize the
some workers were in workplaces without support. Indeed, van comments. Corrigan and Rao (20) suggest that self-stigma can
Sonsbeek and Gradus (26) reported that there appeared to be a be addressed by teaching the worker techniques to reduce
variation in the effects of the Dutch Gatekeeper Improvement Act self-stigma. If there are microaggressions in the workplace,
among business sectors and the company sizes. van Sonsbeek and in addition to general training, it may be important for
Gradus (26) and others suggest (27) the variation may be related occupational health physicians to address potential self-stigma as
to differences in the amount of resources the organizations invest part of treatment.
in observing the legislation. Kopnima and Haafkens (28) note
similar findings. They observed heterogeneity among and within
Dutch organizations in how disability policies are interpreted Strengths and Limitations
and implemented. They point out that the flexibility of Dutch This is one of the first Dutch studies to examine the experiences
legislation allows organizations to be responsive to the individual of workers with mental health struggles with workplace stigma.
needs of workers. At the same time, this can lead to inconsistently One of strengths of the study design is that it allowed participants
implemented policies. This may indicate a need for education to remain anonymous. As result, it decreased the risk of social
and continual guidance within organizations to ensure the desirability bias.
observance of national anti-discrimination legislation. Another strength of our study is its examination of the factors
that contribute to disclosure decisions. This information helps
Deciding Against Disclosure in the development of interventions to support worker decision
About a quarter of our sample decided against disclosing. making. For example, if an organization’s goal is to increase
Intrinsic factors played a relatively more significant role in the disclosure, extrinsic factors may not be the most effective ways of
decision than extrinsic factors. The most significant reason for encouragement. Rather, it may be the intrinsic factors that must
non-disclosure was the preference to deal with it alone. also be addressed. These include helping managers and workers

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Dewa et al. Workers’s Decisions to Disclose

build relationships that help satisfy a need for connection and worker-manager relationships. In turn, this suggests manager
address work satisfaction (23). training regarding stigma may be warranted.
At the same time, our results should be interpreted within Understanding both the factors that contribute to disclosure
the limitations of our data. The fact that the sample is from decisions and the consequences of decisions helps to better target
the Dutch context raises the question of the generalizability of workplace educational programs. One correct answer to tackle
the findings to jurisdictions in which employers are not directly this challenge does not exist. Rather, the correct answer depends
financially accountable for the disability of their workers such as on the workplace circumstances. Future research is needed to
in North America. understand the optimal ways for workers struggling with mental
Our data also did not include information about respondent health issues to ask and receive help if they need it.
characteristics such as respondents’ job sector or occupation
or race/ethnicity. These factors may have been associated with DATA AVAILABILITY STATEMENT
respondent work experiences and disclosure decisions.
Another limitation is that it is not possible to determine The data analyzed in this study is subject to the following
the severity of the mental health issues with which the workers licenses/restrictions: The data that support the findings of this
struggled. In future work, it would be important to understand study are available from CentERdata but restrictions apply to
how the severity of issues influences disclosure decisions and the availability of these data, which were used under license
consequences. For example, there is evidence that severity of for the current study, and so are not publicly available.
symptoms is associated with help seeking (9). This raises the Data are however available from CentERdata upon reasonable
question of whether this is also the case for disclosure. request. Requests to access these datasets should be directed
The data also did not contain information about past to [email protected].
disclosure experiences. These past experiences could have
contributed to reporting decisions. Furthermore, it is not ETHICS STATEMENT
possible to determine whether respondents are reporting about
experiences in a current or past workplace. In this respect, The studies involving human participants were reviewed
the data only reflect one experience and do not tease out and approved by University of California IRB. Written
why respondents identified specific factors contributing to informed consent for participation was not required for this
their decisions. study in accordance with the national legislation and the
Finally, respondents were not asked about either the nature institutional requirements.
or timing of the disclosure. For example, as McDonald-Wilson
et al. (29) note, there are levels of disclosure that include full AUTHOR CONTRIBUTIONS
disclosure, selected disclosure, and targeted disclosure. There are
also different timings of disclosure that include at employment EB obtained the funding to access the data and led the design
and waiting until help is needed. The level and timing may affect of the data collection instrument for the special module. CD
the disclosure experience (30). For example, two small studies led the analysis, data interpretation, and manuscript writing.
have found that managing and planning disclosure significantly JW and MJ contributed to the design of the data collection
affects work outcomes (31, 32). To further enhance educational instrument and contributed to the data interpretation and
content, future work might consider types of disclosure, their manuscript writing. PG contributed to the data interpretation
timing, and the outcomes associated with each. and manuscript writing. All authors have read and approved the
submitted version.
CONCLUSIONS
FUNDING
Our results reflect the complexity involved with developing
interventions to address stigma in the workplace. They suggest The Tilburg University funded the data collection for the special
that addressing stigma at work may not be as straightforward modules used in this research. PG is supported by the UK
as requiring all employees to receive one type of anti-stigma Medical Research Council in relation the Indigo Partnership
education. However, they do underscore the importance of (MR/R023697/1) award.

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19806 License (CC BY). The use, distribution or reproduction in other forums is permitted,
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Audenhove C, et al. Discrimination in the workplace, reported by people with original publication in this journal is cited, in accordance with accepted academic
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(2016) 6:e009961. doi: 10.1136/bmjopen-2015-009961 with these terms.

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