12 CHAPTER 1 1 Previous research has suggested that stigma forms a barrier to sustainable employment and well-being at work in four different ways, which can be seen in figure 2 (9). First, employers often hold negative (stigmatizing) attitudes towards workers with MHI, which can negatively affect supportive supervisor behavior (9, 28, 29). Second, both the disclosure and non-disclosure of MHI in the work environment can lead to job loss (9). Due to the fear of being stigmatized, many workers with MHI do not disclose this in their work environment (30). However, disclosure can be important for the prevention of adverse occupational outcomes, such as sick leave and job loss, as it can lead to work adjustment and supervisor support (31). Disclosure can thus prevent adverse occupational outcomes through work adjustments and supervisor support, but simultaneously disclosure can lead to stigma and discrimination. Third, self-stigma, and the ‘Why Try’ effect can lead to a lack of motivation and effort to keep employment (9). Fourth, stigma is a barrier to treatment-seeking, which can lead to untreated and worsened symptoms, which can negatively influence sustainable employment and wellbeing at work (9, 32). The focus of the current thesis will be on the second (disclosure) and fourth (treatment-seeking) problem areas. Figure 2. Four key problem areas of stigma for sustainable employment of people with mental health issues and illnesses (9). Mental health stigma in the military Military personnel operate in potentially hazardous, dangerous, and emotionally demanding situations (33). Being exposed to stressors at work can lead to an increased risk of developing MHI – including posttraumatic stress disorder, substance use
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