Examining the effects of subjective and objective neurocognition on recovery within serious mental illness: the role of diagnostic disclosure

ABSTRACT Background Although living openly with psychosis or other serious mental illness (SMI) can be important for recovery, people often conceal this identity. Social-cognitive models of diagnostic concealment/disclosure posit that perception of symptoms (e.g. perceived neurocognitive symptoms), rather than objective symptoms, evokes concern regarding disclosure. The study aims to: 1) highlight fear of diagnostic disclosure (DD) as a recovery barrier; 2) examine whether perceived symptoms or subjective neurocognitive complaints (SNCS) are associated with greater fear of DD; and 3) determine whether fear of DD is a mechanism (mediator) through which SNCS impact recovery. Methods Fifty people experiencing SMI completed measures of recovery, fear of DD, SNCS and objective neurocognition. Three participants were excluded due to incomplete testing. Results To address Aim 1, correlations revealed negative associations for recovery with SNCS and fear of DD. SNCS and fear of DD were positively correlated. Better objective neurocognition was positively associated with SNCS, but not recovery. Consistent with Aims 2 and 3, SNCS were negatively associated with recovery via association with fear of DD. Discussion Results suggest fear of DD is associated with perceived difficulties, independent of actual functioning. Treatments targeting disclosure may hold promise for facilitating recovery.