157 7 GENERAL CONCLUSIONS AND DISCUSSION as treatment-seeking, is influenced by (1) individuals’ attitudes toward the behavior, (2) subjective norms, and (3) individuals’ perceived behavioral control (7). The current thesis showed that attitudes towards the behavior (treatment-seeking), such as the belief that treatment is effective, were associated with treatment-seeking intentions. Also, the current thesis showed that the subjective norm was not to seek treatment, as military personnel expected that treatment-seeking would lead to social rejection and discrimination. These concerns were also associated with treatment-seeking intentions. Furthermore, the current study found that not knowing where to find treatment and a lack of time for treatment were both a barrier to treatment-seeking, showing the importance of perceived behavioral control. The current thesis examined both treatment-seeking behavior among military personnel with MHI and treatment-seeking intentions among military personnel without MHI, assuming that behavioral intentions are associated with actual behavior. This is in line with the theory of planned behavior, which suggests that intentions lead to a certain behavior. Previous research has also shown that treatment-seeking intentions are indeed related to actual treatment-seeking behavior (8). Additionally, several meta-analyses have shown that behavioral intentions are related to actual behavior (9, 10). The fact that intentions are related to actual behavior, means that not only the findings among military personnel with MHI are valuable for future interventions, but also the findings among military personnel without MHI. The decision of whether or not to disclose mental health issues and illnesses to a supervisor A second way in which stigma can form a problem for sustainable employment and wellbeing at work is through the decision of whether or not to disclose MHI to a supervisor (figure 1). Therefore, the second aim of this thesis was to gain insight into the decision to disclose MHI to a supervisor in the Dutch military, and to what extent stigma plays a role in this decision. Again both a qualitative and a quantitative study were conducted, where the qualitative study was used to explore the topic and the quantitative study to confirm and expand the qualitative findings. The qualitative study (chapter 4), which included the perspectives of three stakeholder groups, i.e. military personnel with MHI, those without MHI, and mental health professionals, highlighted five main barriers to disclosure, and three facilitators. The barriers included fear of negative career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHI, and the strong worker culture. The facilitators included anticipated positive consequences of disclosure, such as recovery, leadership support, and when MHI was work-related. Again, the different perspectives included in this study were highly congruent.
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