101 5 DISCLOSURE IN THE MILITARY - A QUANTITATIVE STUDY INTRODUCTION The decision for workers whether to disclose their mental health issues and illnesses (MHI), including substance use disorder, to their supervisors can have far-reaching consequences for their sustainable employment (1-4). Disclosure can lead to workplace support and accommodations, which can prevent worsened symptoms and sickleave, and non-disclosure can lead to missed opportunities for this support (2, 3, 5). However, disclosure can also lead to being stigmatized and discriminated against (6, 7). The disclosure dilemma is expected to be even more prominent for trauma-prone occupations, such as the military, where workers are expected to be ‘strong’ and disclosure may yield less positive outcomes (5, 8). Additionally, workers in these highrisk occupations are exposed to stressors at work, increasing their risk of developing MHI (9). Previous research in the military showed that there is a high preference for solving one’s own problems (10), there are stigma related concerns and military personnel tend to delay seeking help (6, 11, 12). Together this might cause a delay in disclosure to a supervisor. To facilitate (early-)disclosure, so that personnel can receive support which can prevent adverse occupational outcomes (2, 3, 5), more insight is needed into the (non-)disclosure decision. Although the (non-)disclosure decision is complex and has far-reaching consequences, research on this matter is scarce and mostly qualitative, especially in the military (3, 6, 11, 13). Research has shown that the supervisor plays an important role, where supervisor attitude and behavior can form both a barrier as well as be a facilitator for disclosure (6, 14, 15). Furthermore, “The model of employee decision-making about disclosure of a mental disorder at work” proposes that there is a default position of non-disclosure, caused by fear of stigma, wanting to maintain boundaries, and maintaining confidentiality (16). This model proposes that a triggering incident is needed before a disclosure decision is made (16). The aim of the current study was to gain insight into the (non-)disclosure decision to a supervisor in the military, and to confirm and expand earlier qualitative findings (6). This was done by examining beliefs, attitudes and needs related to disclosure to a supervisor. Based on earlier qualitative research on disclosure in the military (6, 11), studies on disclosure among Dutch workers (17, 18), and literature reviews on disclosure (2, 19), it was hypothesized that the following beliefs and attitudes pro non-disclosure would be important for, and associated with, the disclosure decision: stigma related concerns (e.g. social rejection), preference for self-management and privacy, negative attitudes of the supervisor towards MHI, and difficulty talking about MHI. Additionally, the following beliefs and attitudes pro disclosure were hypothesized to be important for the disclosure decision: wanting to be one’s true and authentic self, positive attitudes of the supervisor towards MHI, setting an example, organizational policies, a need for work accommodations, feelings of responsibility, whether MHI affects work functioning,
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