158 7 CHAPTER 7 The quantitative study (chapter 5) showed that a quarter of personnel with MHI had not disclosed to their supervisor, and 15.7% of those without MHI indicated that they would not disclose a MHI if they would develop one in the future. These rates are comparable to previous research among Dutch workers (11, 12). It should be noted that those who had disclosed, appeared to do so after a considerable delay when they had no choice as they had to report sick or needed treatment during work hours. The majority (73.8%) of military personnel with MHI preferred to solve their own problems, instead of disclosing. Military personnel anticipated that disclosure would lead to being stigmatized. For example, of those with MHI, one-third feared that disclosure would lead to gossip, social rejection, and negative career consequences. Simultaneously, 95.7% of those with MHI indicated that disclosure is important in order to be one’s true authentic self, and 74.7% indicated that disclosure is important due to the responsibility associated with the nature of their work. Furthermore, a good relationship with the supervisor was positively associated both with disclosure decisions and intentions, and stigma-related concerns were negatively associated both with disclosure decisions and intentions. To consider disclosure, most respondents indicated they would need a supervisor who showed understanding for MHI. Finally, the vast majority expressed a need for advice about the best ways to disclose, such as to whom, when, and what the message should be. The findings of the current thesis showed that stigma indeed plays a role in the disclosure decision and can therefore form a barrier to the sustainable employment and well-being of military personnel with MHI. Previous research on disclosure in the military is limited to one qualitative study within the German military, which also showed stigma to be a barrier to disclosure (13). More research on the disclosure decision has been done in the civilian setting. For example, the employee decision-making about the disclosure of MHI at work model by Toth and Dewa (14) also proposes that the fear of stigmatization forms a barrier to disclosure. This model also proposes that a triggering incident is needed before a disclosure decision is made. The current thesis found that military personnel often delayed disclosure until they had no choice as they had to report sick or needed treatment during work hours, which can both be examples of triggering incidents. Although little research has been done on stigma and disclosure in the military, it should be noted that the effect mental health stigma has on disclosure, is expected to be stronger in the military setting, compared to civilian settings. This might be expected due to the military culture, where people are expected to be ‘strong’ and not show weakness (15). A study in Canada compared perceived stigma in military and civilian samples and found that military personnel was significantly more likely to perceive stigma, and that stigma had a greater impact on military personnel (16). This makes it even more important to target stigma in the military, to create a safe environment for the disclosure of MHI to a supervisor.
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