Table 2 Frequency of themes identified in the narrative synthesis of qualitative evidence

1. Expectation s and experiences of discrimination (n = 14 studies)

1.1. Wouldn't be hired (n = 8)

Study numbers = 1, 2, 3, 4, 7, 9, 14, 17

"I don't think you'd get a foot in through the door that way. You wouldn't get taken on in the first place if you told them you had a big mental history" [55]

1.2. Unfair treatment in workplace (n = 4)

Study numbers = 1, 2, 4, 5

"Because every time I go for a promotion interview, I'm always passed up. It's happened about 30 times by now... There's some kind of inherent risk involved. "We don't want to promote her-too much time off"..." [56]

1.3. Would lose credibility in eyes of others (n = 3)

Study numbers = 2, 4, 11

"I can probably lose my credibility, but they wouldn't perhaps...that's something that they would just store away in their mind and not discuss. Well certainly not in front of me, maybe with others. And they would just put on a front of not disclosing any hypocrisy, I suppose..." [57]

1.4. Legislation does not provide protection (n = 3)

Study numbers = 3, 4, 17

"[They] will find reasons apart from the disability for discriminating against potential employees if they know about the disability" "I would never, ever let on. I would make sure I had a good story for any time (such as gaps on a resume) that I might be asked about" [58]

1.5. Gossip (n = 4)

Study numbers = 3, 12, 13

"I felt that people [at work] were...getting together and saying...'you mustn't talk to her'...and I don't think that's me being paranoid I think that's the way it was..." [59]

1.6. Rejection (n = 4)

Study numbers = 6, 11, 14, 16

"I've had friends at work and... have told them because I thought they were friends...and it's like there's something scary about me, or, you know, I was diseased and it might be catching" [60]

2. Other reasons for non-disclosure (n = 8 studies)

2.1. Passing (n = 4)

Study numbers = 2, 6, 13, 15

"I don't go out and advertise myself as having a disability. I like being able to keep it hidden when I choose. I do run into problems, from time to time, when I then hear people talk about their true feelings about people with mental illness, and they don't know I've got one..." [56]

2.2. Illness as private (n = 4)

Study numbers = 1, 2, 5, 17

"There's the whole thing about disclosure...I have to say that I was very private...that's like, " it's none of their business...You've got to balance privacy with accommodation"" [61]

2.3. Job with natural adjustments (n = 4)

Study numbers = 1, 2, 4, 6

"Some jobs that I has really had the natural accommodations built into them. One was I was developing x-ray films and I was in a dark room and they 'd be sending these films to me and I'd be by myself most of the day, and I felt that was a great job because I didn't have that pressure..." [62]

2.4. Others don't want to know (n = 2)

Study numbers = 4, 6

"...other people were off with back injuries, stubbed their big toe, whatever, but when I came back for being on, well you know, I'd say it was depression or whatever, no one wanted to talk about it and I felt further alienated" [60]

3. Reasons for disclosure (n = 12 studies)

3.1. Role model for others (n = 2)

Study numbers = 4, 12

"I like to think I've changed people's attitudes...I'd just explain to them what it were like. I said "this is what it were like for me' I said 'everyone 's not the same'...I said 'I'm not dangerous or anything or...' the only things they hear about are the ones on the news" [59]

Themes identified

Example

3.2. To gain adjustment (n = 3)

Study numbers = 1, 4, 17

"Well I sort of feel like what's the point in disclosing, you have nothing to gain. (Laughs) I mean...I don't feel like I have anything to gain, especially during the job interview" [28]

3.3. Positive experience of disclosure (n = 5)

Study numbers = 4, 6, 9, 13, 14

"It came up in one of our meetings I don't know why it came up but it came up and I mentioned it and she said 'Oh thank you for disclosing that', you know, 'I appreciate that..." [63]

3.4. To obtain emotional support (n = 3)

Study numbers = 4,11,13

"A bit of understanding about how you might be feeling. A bit of... making allowances for the fact that today you don't feel good or today is a bad day for you or you have a good reason for not being happy today..." [57]

3.5. To be honest (n = 2)

Study numbers = 2,11

"Oh just to be able to be honest and... have people's understanding of what it is to have any form of mental illness... it comes back to how you're brought up, community attitudes and values, basic morals, and that part of your personality. I think it's more personal than a group thing" [57]

3.6. To explain behaviour (n = 7)

Study numbers = 3,6,9,11,13,14,16

3.7. Stress of concealing (n = 4)

Study numbers = 2,4,9,13

"I think to myself, you are ashamed of this, or you're worried about what people will think of you, because you have to invent this thing. Inventing it creates stress and it is using your mind to concoct all these things when it would be so much better to say, "you know what? I cannot do this because I have agoraphobia"..." [56]

4. Disclosure dimensions (n = 9 studies)

4.1. Selective disclosure (n = 2)

Study numbers = 1,3

"I think that what influences the decision is a pre-judgment on my part about the person, about their ability to hear me, so I'll like make a quick assessment if you will if there is anything about the person or the environment that is like could be oppressive or judgmental..." [62]

4.2. Partial disclosure (n = 5)

Study numbers = 1,3,6,7,14

"Believe it or not, I've been on the job for seven months, and they do not know I have schizophrenia. They do not know I have a mental illness. They do know I have diabetes..." [64]

4.3. Inadvertent disclosure (n = 4)

Study numbers = 2,3,4,14

"I'm a manic-depressive, so my manic state would go higher up and I'd be working constantly...it brought a lot of stress... when they fired me, they knew... they knew all along because I was hyper. They knew that they were going to let me go" [56]

4.4. Strategically timed disclosure (n = 3)

Study numbers = 3,5,10

"...I just want to be known as me, you know...and until I feel more secure or confident that my peers wouldn't treat me as a different person, then I won't share that information in the workplace" [57]