116 5 CHAPTER 5 current study predominantly included males, which might also account for some of the differences (18). Future research into destigmatizing interventions is needed, as up to now only a few, especially in the military, rigorous destigmatizing intervention studies have been conducted (1). Trauma risk management (TRiM) is a promising destigmatizing program within (military) organizational settings, as it has shown to improve attitudes towards MHI (35). To facilitate disclosure, stigma should also be targeted at a policy level, to take away some of the fears personnel face (6). The preference for self-management also forms a barrier for (early-)disclosure. Although disclosure rates are comparable to earlier research among Dutch workers in general (17, 18), the reasons for non-disclosure differ. Of the non-disclosers, 87.3% reported a preference for self-management, compared to 44.9% of civilians. This is likely also caused by the military workplace culture, where people are expected to have a ‘cando’ problem fixing mentality (6). To target this preference for self-management, selfhelp apps or personal recovery programs could provide personnel the opportunity to manage their own MHI, possibly giving them more confidence in disclosing and a feeling of control, as they are already working on their MHI (36). This could also be done through easily accessible care from for example a social worker. Additionally, decision aids and programs could be implemented, as personnel indicated this as a need, and it can positively influence sustainable employability and coping with stigma (37-40). To facilitate (early-)disclosure, there is an important role for the supervisor. The results showed that lower employee-supervisor relationship quality was associated both with non-disclosure decision and intention. Having seen negative experiences of others with disclosure, was the second strongest predictor of non-disclosure intentions, indicating the importance of how others, including supervisors, respond to disclosure. It is also important that military personnel with positive experiences with disclosure, communicate openly about these experiences. The previous qualitative study in the Dutch military (6), and a study among Dutch workers in general (18), also showed the importance of supervisor relationships and support (6). Supervisor attitudes towards MHI and knowledge of MHI have also been found to be associated with whether employees disclose to the supervisor themselves, or that the supervisor finds out some other way (41). Finally, supervisor support was not only found to be important for disclosure, but also for treatment seeking for MHI, a decision which is also of influence on sustainable employability (10). To facilitate (early-)disclosure, training may be needed for supervisors to improve understanding and support of MHI needs (42). Additionally, supervisor relationship quality could be addressed, for example by adjusting the obligated job rotation every 3 years, giving personnel longer to build a relationship with their supervisor.
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