Suicidality and mental health stigma and their impact on suicidal ideation disclosure: a narrative review

• Self-stigma and perceived/anticipated social stigma inhibit SI disclosure • Secrecy/concealment and feared reactions are recurrent stigma-linked mechanisms • Disclosure is selective and depends on recipient and relationship context • Confidentiality and loss-of-autonomy concerns hinder disclosure to clinicians • Longitudinal, multi-method, culturally diverse studies can test causal pathways : Suicidal ideation (SI) is a major global health concern, and prevention often depends on whether individuals disclose SI to clinicians or informal supports. Mental illness and suicide-related stigma may inhibit disclosure, thereby delaying help-seeking. This narrative review examines how self-stigma and perceived/anticipated social stigma shape disclosure of SI. : We conducted a structured search of six databases (PubMed, PsycINFO, EMBASE, CINAHL, Scopus, Google Scholar) for studies published from January 2014 to October 2024 examining stigma in relation to SI disclosure/non-disclosure. Primary empirical studies were screened for eligibility and methodological quality; 14 studies were included in the synthesis. Data extraction focused on study characteristics, disclosure operationalization, stigma-related findings, and disclosure recipients/settings. Quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesized using an inductive narrative thematic approach. : Across heterogeneous study designs and measures (predominantly cross-sectional and self-report), stigma-related processes were consistently linked to reduced likelihood of SI disclosure, often through anticipated negative social consequences (e.g., fear of judgment, overreaction, discrimination) and disclosure-adjacent processes such as secrecy/concealment. Individuals often disclosed selectively/gradually, balancing potential support against risks of discrimination. Cultural context shaped stigma perception and disclosure decisions. : Stigma remains a key barrier to disclosing suicidal thoughts and may impede timely access to support and care. Interventions should target modifiable mechanisms that influence disclosure decisions (e.g., anticipated stigma, confidentiality concerns, communication skills, supportive responses). Future research should prioritize longitudinal, multi-method, and culturally diverse designs and use clearer, context-sensitive measures to empirically test proposed pathways linking stigma to SI disclosure.