156 7 CHAPTER 7 The quantitative study (chapter 3) consisted of a questionnaire study among military personnel with MHI (N=324) and military personnel without MHI (N=554). The findings showed that of those with MHI, 90.7% had sought treatment, and of those without MHI, 83% indicated that they would seek treatment if they would develop a MHI in the future. Although these treatment-seeking rates and intentions might seem high, it should be noted that of those who sought treatment, almost 70% indicated that they had sought treatment because they had no choice as their symptoms were too severe. Additionally, the current thesis only examined active-duty military personnel, meaning that those who might have left the service due to worsened symptoms and not seeking treatment, were not included in this study. It is a missed opportunity for the prevention of worsened symptoms and dropout if military personnel wait until a crisis point to seek treatment. The results provide insight into several reasons that might have caused this delay in treatment seeking. Overall, most military personnel believed that treatment for MHI was effective, but they also preferred to solve their own problems. There were several stigma-related concerns, with one-third of military personnel with MHI believing that treatment-seeking would cause social rejection and negative career consequences, and a quarter fearing discrimination and blame. These stigma-related concerns were negatively associated with treatment-seeking intentions. When asked about their needs to facilitate treatment-seeking, military personnel primarily indicated to need a clear indication of where to go for help, the availability of mental health professionals with military experience, and a discrete location to seek treatment. In line with previous research (2, 3) the current thesis showed that stigma indeed plays an important role in the decision to seek treatment for MHI, and can therefore form a barrier to the sustainable employment and well-being of military personnel with MHI. It should be noted that in the current thesis, no negative association was found between stigma-related concerns and actual treatment-seeking decisions. A previous review (4) and a meta-analysis (5) also showed that even though stigma was reported as a barrier to treatment-seeking by military personnel, it may not always be negatively associated with actual treatment-seeking. The meta-analysis for example found that those who reported high levels of stigma still sought treatment (5). This could be explained by the finding of the current thesis, and previous research (6), that military personnel have the tendency to seek treatment in a late phase, when symptoms are severe. It is likely that when symptoms are very strong, the need for professional help is stronger than the concern about stigma. To further examine the relationship between mental health stigma and treatment seeking, there is a need for longitudinal research, which also continues to examine military personnel when they leave the military. The findings of the current thesis concerning the decision to seek treatment are in line with the theory of planned behavior. According to this theory, planned behavior, such
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