Who Do Refugees Tell? a Multilevel Examination of Suicidal Disclosure Intent within Social Networks

Background and Purpose: Disclosure of suicidal thoughts is a critical step in accessing support and preventing suicide; however, little is known about how disclosure decisions are shaped by social relationships, particularly among refugee populations. Refugees often navigate complex social environments characterized by strong intra-community ties, stigma surrounding mental health, and structural barriers to care. Existing research has largely focused on individual-level predictors of help-seeking, overlooking the relational context in which disclosure occurs. This study aims to (1) examine the prevalence and patterns of suicidal disclosure within refugees’ social networks and (2) identify individual- and relational-level correlates of future disclosure intent. We hypothesize that relational factors will play a stronger role than individual characteristics in predicting disclosure intent.

Methods: This study uses egocentric social network data collected from refugees (N=150) resettled in the Southwestern United States. Participants identified members of their personal networks with whom they discussed important matters (N=376). The analytic sample consists of network members (alters) nested within participants (egos), enabling examination of both individual- and relational-level influences. Individual-level variables included age, sex, and psychological distress. Relational-level variables included relationship type (e.g., family, friends, service providers), emotional support, and prior disclosure. The outcome variable was future intent to disclose suicidal thoughts to each network member (binary). Two-level mixed-effects logistic regression models with random intercepts were used to account for clustering of network members within individuals. Intraclass correlation coefficients (ICC=0.584) indicated substantial within-person clustering, supporting the use of multilevel modeling.

Results: Findings indicate that relational factors are significantly associated with future disclosure intent. At the relational level, network members who provide emotional support were the strongest targets of future disclosure (OR = 44.79, 95% CI [11.36, 176.57]). Compared to friends, family members (OR = 9.61, 95% CI [2.37, 38.95]) and service providers (refugee organization staff, social workers, and doctors; OR = 29.60, 95% CI [1.77, 495.14]) were significantly more likely to be identified as disclosure targets. Prior disclosure was also a strong predictor, with both previously disclosed ties (OR = 10.24, 95% CI [1.39, 75.41]) and ties without prior disclosure due to no prior suicidal thoughts (OR = 10.00, 95% CI [1.55, 64.57]) associated with greater likelihood of future disclosure intent. At the individual level, higher psychological distress was associated with a lower likelihood of intending to disclose suicidal thoughts (OR = 0.93, 95% CI [0.88, 0.99]).

Conclusions and Implications: This study highlights disclosure of suicidal thoughts as a relational process embedded within social networks rather than solely an individual decision. The findings suggest that interventions should prioritize strengthening emotionally supportive relationships and identifying high-probability disclosure targets, such as family members and service providers. Training these individuals as gatekeepers may improve early identification and response to suicide risk. Additionally, leveraging prior disclosure relationships and addressing barriers within non-disclosed ties may enhance help-seeking pathways. These findings contribute to a growing body of research emphasizing network-based approaches to mental health and have important implications for culturally responsive suicide prevention efforts among refugee communities.