102 5 CHAPTER 5 advice from others, and not having a choice due to the visibility of symptoms, having to report sick or needing treatment during work. To inform future interventions, several needs related to disclosure were also assessed, based on earlier qualitative research (6). These needs were related to information on how to disclose and education for supervisors on how to support military personnel with MHI. As personnel with and without MHI have shown to have different views on treatment seeking (10, 12), the current study examined both actual disclosure decisions in personnel with MHI as well as future disclosure intentions for those without MHI. The research questions were: (1) ‘What are beliefs, attitudes, and needs of military personnel regarding disclosure to a supervisor?’, (2) ‘Do disclosers, differ from non-disclosers, and if so, how?’, and (3) ‘What factors are associated with non-disclosure to a supervisor?’. METHOD Design A cross-sectional observational design with an online questionnaire. Comparisons were made based on past disclosure decisions for personnel with MHI and on disclosure intentions for those without MHI. Data collection happened simultaneously with a study on treatment seeking for MHI (12). The strobe-checklist was used to report this study (20). Setting This study took place within the Dutch military, where healthcare is organized internally. There are sanctions for use of soft and hard drugs. However, when substance use disorder is reported to a mental health professional, there are confidentiality agreements (10). Patient and public involvement Different stakeholders from the Dutch military (psychologists, psychiatrists, policymakers, and military personnel) were involved in the development of the questionnaire. They provided advise on the language used in the questionnaire to ensure that it was military appropriate language. They also provided advise on the best way to recruit participants. Participant recruitment Active-duty military personnel who have been on deployment in the past 5 years were recruited. To ensure that both personnel with and without MHI would be present in the sample, existing data from a questionnaire personnel receive after deployment was used to select a sample. This questionnaire included scores of depression, aggression, alcohol use and PTSD. Clinical cut-off scores were used to identify personnel with and without an indication of MHI. Next, a stratified sample, based on gender, age, military
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