117 5 DISCLOSURE IN THE MILITARY - A QUANTITATIVE STUDY Strengths and limitations The strengths of this study included the large sample and inclusion of a group that is usually hard to study (participants who have not disclosed). Additionally, the study included both personnel with and without MHI, providing insights for interventions for personnel who may develop MHI in the future. Finally, the study examined disclosure in the military where little research has been done on this topic. As for limitations, the sample was not representative for the entire military, due to the sampling method. This method also caused the sample to include only personnel who have been on deployment. This group might have had more positive attitudes towards MHI and disclosure due to mental health training related to deployment (35). Second, despite stratification, the current study included a sample of older, higher educated, and higher-ranking personnel. Comparisons showed that lower ranking and lower educated personnel were less likely to have completed the questionnaire once started. Majority of dropouts occurred during the mental health questions. Possibly these questions were hard to answer, or there were anonymity concerns. Additionally, drop-out might have been higher due to the use of forced response. The current study used a complete case analysis, which carries the assumption that data are missing completely at random (MCAR) (43). As the data appeared not to be missing completely at random, as described before, the results should be interpreted with caution, as they might be different for lower ranking and lower educated personnel. Previous research has shown that younger and lower educated workers disclosed less (18), so disclosure rates in the current study might be an overestimation of the true rates. Future research should further examine this in a representative sample. Third, it should be noted that MHI in the current study includes substance use disorders. Previous research suggests that the stigma concerning substance use disorder is higher compared to general mental health stigma (44), but no comparisons could be made in the current study. Therefore, it is important that future research examines the decision to disclose a substance use disorder separately from other MHI. Also, due to the cross-sectional design of the study, no causality can be presumed. Additionally, it should be noted that the questionnaire assessing attitudes, beliefs and needs regarding disclosure, has not been validated. It was developed specifically for the current study.
RkJQdWJsaXNoZXIy MjY0ODMw