Subtheme: Non-disclosure as a way to be in control: The protective mechanism.

Participants voiced their non-disclosure of depression as a way to feel in control of their interpersonal settings. They expressed a persistent desire or need for control that may have defended them against possible judgments from others, particularly in terms of the perception that they were unable to manage their lives because of depression. Control was a helpful tool participants used to help portray an image of themselves that they wanted others to see. Some were more explicit in stating that control meant having the power over who to share their depression with. Secrecy was a way for participants to create a sense of safety, security, and predictability.

"Yeah, it’s more about it’s, it’s pretty…it’s all about control, and I feel like there’s a big idea that that people with like mental health issues don’t have self-control." (P27, 20, Male)

"You don’t want to share anything because you even in turn realize these ideas that there will be negative effects if you do or people will view you in these ways if you do and…Yeah, yeah. You want to control how you portray yourself so that others can see you in a way that is not only your depression." (P27, 20, Male)

"…it feels like it gives me control over it or control, at least over…Like, I don’t want people to to look at me as someone who cannot have self-control or is the way they are because of the depression." (P27, 20, Male)

In addition to being mentioned in many participant interviews as a strategy to maintain control, non-disclosure was also described as a function to protect self-esteem from unfavorable views by others that were then internalized into the self. Participants described that talking can lead to more harm than good, leading them to feel worse about themselves.

"And and even if, even if someone is like me and doesn’t particularly want to share you that just because you have a a diagnosis doesn’t mean you then have to share it as well. You still have control over who you do and don’t share to…And you know, that can have a big impact on your self-esteem." (P27, 20, Male)

"Starting with self-esteem, I think that’s the easiest one to explain. I linked that to internalized stigma and public stigma…Like they cause sort of lack of… Um really affect self-esteem. And then you know, depending on how much self-esteem you have will probably affect your self-disclosure and how much you talk to others about, you know…Personal sort of things. And that sort of also relates to how, you know, secretive you’re going to be." (P13, 18, Female)

"And there’s there are other times when I think that the amount that you self-disclose to people would also kind of be dependent on your self-esteem, because if you are somebody who has a higher self-esteem, you might not find it an issue to self-disclose about your problems because it wouldn’t affect how other people perceive it." (P04, 24, Female)

Though secrecy had a protective function, it also had a detrimental impact on young people’s experiences. In fact, considering the broader context, the personal and interpersonal consequences of stigma were largely caused by the way it encouraged secrecy surrounding one’s depression.

Subtheme: Depression secrecy as preventing authentic engagement.

Many participants were reluctant to disclose their depression for varying recurring reasons, such as feelings of non-acceptance by others, unauthentic social engagement, and feelings of abnormality and indifference. This led to frequent social withdrawal, along with added secrecy and stigma. Feelings of non-acceptance as a result of earlier views of depression’s stigma were repeatedly expressed as a big reason why participants did not disclose their depression.

It was evident in their recounts that participants yearned for others’ acceptance. However, participants expressed concerns that if they were open about their depression, their true selves might not be accepted by others. Participants felt that by keeping their depression to themselves, they were able to gain more social acceptance (i.e., their social selves were more accepted by others). Secrecy, although not always chosen, was the more desirable approach. It was a useful tool to gain acceptance from others by hiding aspects of the self.

"Um, I think like public stigma is like a main, uh, bubble, which like connects to internalized stigma, secrecy, and social isolation. Because I think like public perceptions of things really does like affect how people view themselves, and it does like kind of form a big narrative on how things are like valued or perceived in society. So, I think it can cause like a lot of, um, secrecy, as people don’t want, um, disclose like any mental health problems. And um, which in turn can cause social isolation as people with those mental health problems might not feel like they could be understood or accepted for who they are, so therefore might withdraw themselves from society." (P09, 19, Female)

"I think that internalized stigma can sometimes lead to secrecy, where you don’t sort of tell people about your problems, as well as the mental health stigma and the public stigma. So, if you are constantly being told that you are abnormal, if you’re going through something like a mental illness, or if you’re suffering from it, then on the next occasion when you meet a fresh set of people, you might be tempted to keep that a secret just to be accepted." (P04, 24, Female)

Few participants further described their non-disclosure of depression in terms of filtering out information and altering narratives as a desire to be accepted by others. This validated participant experiences of added stigma being directly linked to depression’s stigma; for instance, others’ stereotypical attitudes and beliefs about taking antidepressants or being hospitalized.

"Because if you keep your mental health a secret, it can feel it can lay really heavy on your head, cause it’s obviously such a massive part of everyone’s lives that you know you are keeping a massive part of your secret from the people around you, and when you can just freely even mention it in a conversation…Like for example, if I talk to someone about my day, you know, and if I have a counseling appointment that day, you know, if I know they’re not going to be accepting, I’d have to leave that bit out…You don’t feel accepted by them. And you know, you might get asked sort of like questions, and you know, just people putting in their input when it’s not needed, I suppose." (P13, 18, Female)

In addition, some participants suggested that stigma’s secrecy relates to more superficial and ineffective relationships. In particular, participants recognized that by hiding their depression from those around them, they were withholding a large portion of their lives. This inevitably results in one not feeling ´completely known´ by others.

"I also think that I do understand, to some level, that I do need more shallow friendships in my life. And friendships, you know, where I see them on a night out or I just see them in a seminar, and I wouldn’t, you know, disclose all of this to them because I don’t think that’s the space that they hold in my life. So…and I don’t think I know enough about them that I know that I wouldn’t be judged." (P20, 21, Female)

Overall, a key conclusion of this research was that hiding parts of the true self ultimately results in the continuation of a vicious cycle. For example, secrecy led to ineffective and superficial relationships, which exacerbated feelings of loneliness, social isolation, and low self-esteem. This process played a detrimental role in individuals’ recovery (i.e., help-seeking and receiving support).

"…because if you feel like you can’t be your true self around someone…It does definitely close…It breaks down relationships, cause it feels like they don’t have the effort to truly like truly understand you. Cause it leads to secrecy in everything, and that’s just that’s not a good foundation for a relationship, which I guess can lead into loneliness. Yeah, more loneliness, but I also do think it leads to more social isolation too, cause if you’re doing behaviours that you don’t want someone to know about, I guess that feeds into social isolation." (P11, 21, Female)

Subtheme: Stigma’s secrecy creates a vicious cycle.

Participants described that as they experienced more stigma (either public or internalized), they kept more secrets about their depression. This resulted in a vicious cycle. For example, the more public stigma there is, the more it is internalized (i.e., participants saw internalized stigma as a direct outcome of public stigma), and the more feelings of loneliness and social isolation there are, the more secrecy there is.

"Social isolation can be caused by loneliness, because if people feel like if people feel lonely surrounded by a group of people and they can’t help that they feel lonely…they may be more of a tendency to draw themselves away from their social group. So that in turn is them distancing themselves from their group of friends…that in turn can cause secrecy because they´re keeping it to themselves. They´re keeping themselves to themselves. They may not want to socialize um with people for their own reasons, and yeah, this can make you feel very left out." (P02, 18, Female)

"Yeah, I think that hiding a lot about yourself…So it goes both ways, so hiding a lot about yourself has a massive impact on your self-esteem…not being able to talk about stuff. And it makes you kind of feel ashamed around that. And by not talking about it, you’re then perpetuating that belief that something is wrong with you, that you shouldn’t talk about, which will lower your self-esteem but also…So then also having low self-esteem around your depression or whatever makes it a lot harder to be able to talk about things, and therefore you’re much more likely to be secretive about um the problems you’re facing, and that can be very lonely at times." (P03, 20, Other)

“Yeah, I’ve definitely not spoken to people for a while. Just for no real well, they think no reason but…Yeah, I definitely think that as soon as I feel lonely, the social isolation and the secrecy and everything like that definitely comes into play for me." (P10, 19, Female)

"Mental health stigma…internalized stigma and public stigma um cause loneliness because, you know, you feel like you can’t talk to other people about um mental health and just in general talking to people, and then the internalized stigma that you’ve got from general mental health stigma you know, also causes you to just not talk to people about things. So you sort of do, in a way, cut yourself off from others, which will cause you to feel lonely." (P13, 18, Female)

Subtheme: Finding safety in disclosure: “The healing process”.

It was important for participants disclosing to feel comfortable and understood by others. Participants said they were more willing to share when they felt less initial stigma and judgement. Participants also found disclosing their depression helpful. For some, it led to feeling accepted and secure and receiving understanding and support from friends and family. In this way, disclosure acted as a source of healing. Healing occurred for reasons such as disclosure, which fosters freedom, reduces feelings of loneliness and social isolation, and increases empowerment as a way to break the stigma.

A few participants expressed feeling free after talking, despite others’ lack of understanding or support. Participants felt better after disclosing, describing a weight being lifted from their shoulders.

"It makes you open and feel free after talking." (P16, 23, Male)

"And it’s being comfortable to disclose around people who you know have an understanding. And once you’ve gained, whether someone has that stigma or doesn’t have that stigma it, then you can kind of tell whether it’s safe or not to disclose that information." (P03, 20, Other)

"I think cause I’ve started speaking about it more and I’ve got like more positive reactions, I think it’s reduced my need to wanna be secret like secret about like mental health, and it’s reduced that loneliness feeling. Because I´m like ´Ohh the people out there get it. They also understand. ´ Yeah." (P15, 21, Female)

That said, participants recognized that not everyone would always understand what they were going through, making it difficult and less likely for them to disclose their mental health problems. Still, some participants remained open to sharing if others demonstrated a willingness to learn or some sort of understanding.

"Yeah, I think I would sort of keep it a secret from somebody who doesn’t understand, like my parents, who would always see it as a reflection on them and something that they did wrong in raising me, whereas I would be more comfortable talking about it with, let’s say, like my boyfriend or my friends who have also at some point struggled with some kind of depressive episode or have been to therapy. And they understand that it’s a it’s normal. And everyone goes through it, so it can be part of the conversation." (P06, 22, Male)

"Because they listen, they’re willing to learn. I think that’s another thing they’re willing to learn. If they don’t understand something, they will ask ´What?´ or ´Why do you do this or?´…A huge factor, a huge factor if you are willing to learn, then you feel more open and comfortable to talk about it. I’m less likely to talk to someone if they don’t get it, it’s really difficult to explain, but if that they’re not open to learning, they’re not open to trying to understand why someone does something the way they do." (P11, 21, Female)

Furthermore, one of the key reasons given by participants for disclosing their depression was to combat the effects that the stigma had on them. Participants understood that removing any existing stigmas about oneself was the first step toward recovery (both public and internalized). As a result, participants felt empowered to overcome stigma, with the goal of alleviating feelings of loneliness and social isolation.

"The stigma makes you want to keep it secret. But the stigma also makes you want to self-disclose in order to break the stigma." (P11, 21, Female)

"…it’s like overcoming the stigma for yourself is like the most important part. So as soon as, like, there’s sometimes people that I haven’t wanted to tell and then once I have, it does feel a lot better. So, I think it is just kind of like a mental barrier sometimes you do have to, like get past. Yeah, I definitely think if you overcome like the internal stigma, it becomes easier cause once you talk about it, it kind of people around you learn, and then sometimes, like that person, would like the stigma that they have kind of decreases. And yeah, the talking would help you feel less lonely. So…I do think that overcoming the internal one can help." (P17, 21, Female)

"I think so because once you’re able to talk about it with someone, you’re much less likely to feel that loneliness and isolation because you don’t feel so alone with what you’re feeling." (P19, 21, Female)

Subtheme: Disclosure invites danger.

Participants were sensitive to others’ non-verbal communication, including their facial expressions, body language, and unspoken responses towards individuals disclosing their depression. Participants recognized others’ discomfort as unhelpful and humiliating (i.e., others’ discomfort increased participants’ feelings of loneliness, social isolation, shame, and guilt). Instead of the support and understanding desired, participants were given adverse reactions and unsympathetic responses. As a result, some participants viewed disclosure as more harmful than helpful, increasing stigma, which in turn increased feelings of loneliness and social isolation and lowered self-esteem.

"I think a lot of people when you. Um. Disclosure about any kind of mental health or depression. It makes people uncomfortable. And this can be… Um. It can be awkward and a bit embarrassing. Um. And therefore they, a lot of people won’t make the effort trying to understand better, in that can create more misunderstanding and make public stigma a lot worse." (P03, 20, Other)

"My depression made me lonely because doesn’t feel like people understood what I was going through. Even the people I talked to about it later on, after I became a bit better, it still felt like I was in my own world and I was alone the whole time. Nobody understood. Nobody knew or people…it always felt like people didn’t care." (P18, 20, Male)

For many, non-verbal cues were interpreted as a motivator to disclose their mental health or not. One participant said she had no trouble telling someone about her depression as long as she received a positive response in return.

"…You sort of have to pick and choose, I suppose, who you talk to about it, depending on how you think they’ll react and what they’ll say. You´re more likely to share if you think they’re going to be like accepting, and not judging, and being sort of willing to listen and learn. Um. If you think you´re sort of going to get a bad reaction off of them and they´ll think of you differently, or you see they are uncomfortable…Um, yeah you´re less likely." (P13, 18, Female)

"Yeah, but if they were fine with it, you know, and and I have no I have no problem sort of talking about it. It’s just if I know the push back, I’d get with talking about it then I’ll probably leave it out." (P13, 18, Female)

That being said, some participants described having mental health difficulties that were debilitating and therefore required disclosure, though it may not have been their choice. Participants adapted in those circumstances to safe disclosure by selecting disclosure as necessary.

"Yeah, I think that if you’re around the right people talking about it helps because I think that with things like depression or agoraphobia or just kind of those types of things where you like your functioning is quite impaired and you know it doesn´t make a difference if you tell people about it or not because, um, it´s already quite obvious. Um, you don´t really have a choice. And you know, having people around you that can kind of celebrate your small wins and not put you on the same standards as other people really helps.” (P20, 21, Female)

One participant described using others’ overall support and reactions as a cue for whether to maintain those relationships. She added that, even though it might not be her choice, she needed disclosure in order to live a life of any quality.

“I think the reason is because my mental health issues are quite debilitating in regards to like the probably depression slightly less so. But I also have OCD and agoraphobia and that kind of almost has to be disclosed for me to have any kind of quality of life. So, I feel like…Probably had they not been had have…if they weren’t as debilitating as they were, I may feel less of a need to disclose them and because of the stigma and what I think people might think. But I think also because I have dealt with mental health issues since I was a very small child, I kind of learned that I can’t really be happy in any capacity if I surround myself with people who, if they knew what I was experiencing, they wouldn’t accept me.” (P20, 21, Female)

“…So, I kind of find it easier to just kind of like rip the bandage off and let people know that you know `This is difficult for me. ´ So if it makes me feel worse about myself and they make me feel like a problem, I know to step away so. Yeah. So yeah, so I think that it it definitely does affect me, but I think I’m at a point where I kind of don’t surround myself in situations where it would affect me as much as it would.” (P20, 21, Female)

Subtheme: Know how much to disclose.

Some participants talked about their family and friends’ stigmatizing attitudes and perspectives, as well as their unhelpful or unsupported replies, when specifics regarding their depression were revealed. For example, they discussed judgmental reactions to their engaging in behaviours such as self-harm or hospitalizations that were associated with depression. They felt those carried an even greater stigma. Some found others’ reactions to lack responsiveness, understanding, or to be insensitive, which resulted in increased feelings of stigma and discrimination, discouragement, and lower self-esteem. Participants shared an understanding of what information to communicate about their diagnosis and how much to divulge after observing others’ reactions.

"If you talk it out, you can open your heart out, and you feel more at peace and at peace with yourself other than if you continue to bottle it all in. You um just have to know how much to say." (P01, 25, Male)

"I think the only thing is that there are different levels of and things that you can disclose that have different kind of levels of stigma. Um. For example, if I were to say to someone, ´Ohh from time to time I experienced depression, ´ I feel like that has less stigma than if I was to kind of fully self-disclose and be like, `I’ve had depression since I was young. I’ve been hospitalized, ´ that kind of thing. They have very different kind of levels of stigma in the way I approach that. It’s very different." (P03, 20, Other)

"…because I think if other people make you feel bad about yourself, then you don´t necessarily come and open up to other people about it." (P17, 21, Female)

"There’s definitely that fear of what other people are gonna think of you that fear of potentially losing people that might be close to you because they don’t you know, you feel like they might not want to help you or might think badly of you. I think that’s definitely one of the biggest things. If you think that or if you’ve already got a sort of opinion of mental health yourself, you might feel like telling people about what you’re feeling might make you feel quite ashamed, so you sort of pick and choose what to share." (P19, 21, Female)

Participants understood that, nevertheless, effective disclosure required a certain amount of openness. Some found that the best course of action was to disclose just enough information to secure the necessary support and care but not enough to risk further stigmatization of their depression.

"Because I think it’s quite dangerous if you don’t talk about it…And you like you need help at the end of the day, and it can spiral. If you don’t talk about it and you need sort of the external sort of context, whereas if you just if you don’t tell anybody about it, then you´re not sort of getting support." (P12, 25, Female)

"Yeah, definitely. I think it depends on the person you speak about it with, cause if someone you speak with like the by the person speaking with, they have suffered from mental illness or they understand what it’s like, then it’s very easy to speak to them and not feel like judged or anything like that. But I do think it’s helpful to speak about it instead of bottling it up and you know." (P15, 21, Female)

"Um and sharing that experience with someone. I think it’s definitely very helpful, and even for a lot of people, sort of talking therapies is a good way of understanding what you’re going through and help help to find ways to sort of move past that stigma." (P19, 21, Female)

Subtheme: Disclosure raises questions.

Many participants recognized that disclosing mental conditions to others raised questions and required further explanations.

"…because I just feel like once you start explaining that, then you have to explain multiple other things that I have no interest in talking about." (P22, 23, Female)

Some said they were open to discussing their depression, but they were reluctant to share more than the bare minimum (i.e., avoid sharing specific information that may lead to further stigmatizing attitudes and beliefs, such as being hospitalized or taking antidepressants) because they felt uncomfortable with the possibility of being questioned further. For example, participants expressed discomfort when asked to share the causes and reasons of their depression.

"The problem is like, once you become more open, people start to ask questions, and I really don’t wanna talk about it…Sharing it already is enough." (P22, 23, Female)

"… some of the things that have caused my depression are quite private…I think that’s the main reason for me. Um, and the reason why I keep it secret… would be the nature of why. Why I feel like that, and rather than this rather than the symptoms themselves, I don’t mind. Like, I don’t think I would mind sharing that… Like why I’m feeling this way and that way. But I think it was the reason, the cause of it, that would make me keep it a secret, and also because they’re of, sort of…um how it how it may be perceived in the sense that I don’t I wouldn’t want to… Like I wouldn´t feel safe disclosing it. Um. My feelings." (P12, 25, Female)