Disclosing mental health in medical education: A global qualitative meta-synthesis.

Abstract

Mental health disorders among medical students represent a persistent global challenge. Disclosure, defined as the act of revealing a mental health disorder to peers, educators or institutions, is shaped by cultural norms, institutional structures and professional expectations. Despite growing awareness of well-being, disclosure remains complex and fraught with stigma, confidentiality concerns and fears of professional repercussions. This international qualitative meta-synthesis explores how medical students experience and navigate mental health disclosure, aiming to clarify the social, cultural and institutional forces that shape disclosure decisions. It further seeks to inform policies that create psychologically safe learning environments. A systematic search of nine databases (updated December 2025) identified peer-reviewed qualitative and mixed-methods studies published between 2013 and 2025. Data were synthesised using Thomas and Harden's thematic synthesis method within an interpretivist paradigm. Reporting followed the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodological quality was assessed using the critical appraisal skills programme (CASP) checklist. Confidence in the review findings was evaluated using confidence in the evidence from reviews of qualitative research (GRADE-CERQual). The review protocol was registered with the international prospective register of systematic reviews (PROSPERO; CRD42024521037). Eighteen studies from seven countries (n = 379 participants) met the inclusion criteria. Six overarching themes and 16 subthemes were identified. Key barriers to disclosure included stigma, professional anxiety, confidentiality concerns, institutional rigidity and uncertainty about support services. Peer influence emerged as the only consistent facilitator of disclosure. The findings illustrate how medical culture, systemic structures and social expectations intersect to sustain nondisclosure and limit access to support. Disclosure of mental health disorders in medical education is a negotiated, relational process embedded within socio-cultural and institutional power dynamics. This synthesis advances understanding by situating disclosure within disability and critical theory frameworks, highlighting how ableism and professional identity norms perpetuate silence. Addressing these structural forces through inclusive policies and psychologically safe learning cultures is essential to normalising openness and supporting the well-being of future doctors.