Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace

Background: Stigma and discrimination present an important barrier to finding and keeping work for individuals with a mental health problem. This paper reviews evidence on: 1) employment-related disclosure beliefs and behaviours of people with a mental health problem; 2) factors associated with the disclosure of a mental health problem in the employment setting; 3) whether employers are less likely to hire applicants who disclose a mental health problem; and 4) factors influencing employers' hiring beliefs and behaviours towards job applicants with a mental health problem. Methods: A systematic review was conducted for the period 1990-2010, using eight bibliographic databases. Meta-ethnography was used to provide a thematic understanding of the disclosure beliefs and behaviours of individuals with mental health problem. Results: The searches yielded 8,971 items which was systematically reduced to 48 included studies. Sixteen qualitative, one mixed methods and seven quantitative studies were located containing evidence on the disclosure beliefs and behaviours of people with a mental health problem, and the factors associated with these beliefs and behaviours. In the meta-ethnography four super-ordinate themes were generated: 1) expectations and experiences of discrimination; 2) other reasons for non-disclosure; 3) reasons for disclosure; and 4) disclosure dimensions. Two qualitative, one mixed methods and 22 quantitative studies provided data to address the remaining two questions on the employers perspective. Conclusions: By presenting evidence from the perspective of individuals on both sides of the employment interaction, this review provides integrated perspective on the impact of disclosure of a mental health problem on employment outcomes.