159 7 GENERAL CONCLUSIONS AND DISCUSSION Disclosure of mental health issues and illnesses and sustainable employment and well-being at work Previous research suggests that MHI disclosure to a supervisor can have both positive (15, 17, 18) and negative effects (13, 19) on sustainable employment and well-being at work. As little research has been done on the direct association between MHI disclosure and sustainable employment and well-being at work, and previous research shows mixed findings, the third aim of this thesis was to gain insight into the association between disclosure decisions and disclosure experiences and sustainable employment and wellbeing at work in the Dutch military. For this purpose, a quantitative questionnaire study was conducted (chapter 6) among military personnel with MHI (N=323), using several measures of sustainable employment and well-being at work. In this study, no significant association was found between the disclosure decision and sustainable employment and well-being at work. It is possible that the positive and negative consequences co-occurred, causing there to be no clear association between disclosure decisions and sustainable employment and well-being at work, as positive and negative consequences of disclosure balanced each other out. It should be noted however that this was a cross-sectional study and that there was a bias in the sample, as only military personnel in active service were included. Those who might have suffered the loss of employment due to disclosure were thus not included. Therefore, conclusions about the association between disclosure and sustainable employment and well-being at work should be taken with caution. Although no association was found between disclosure decisions and sustainable employment and well-being at work, the current study did show the importance of positive (non-)disclosure experiences, as disclosure experiences (positive vs. negative) were significantly associated with almost all measures of sustainable employment and well-being at work. Those with a positive experience with disclosing, reported significantly more support from their supervisors, showing the crucial role the supervisor has in sustainable employment and well-being at work of military personnel. Moreover, those with negative experiences with disclosure reported significantly more stigma-related consequences of disclosure, indicating that mental health stigma played a key role in negative disclosure experiences, and thus in sustainable employment and well-being at work. Of the military personnel with negative experiences from disclosure, 59.4% reported social rejection, compared to 9.9% of those who reported positive experiences. The important role of social rejection in disclosure experiences and ultimately sustainable employment and well-being at work can be related to the self-determination theory. This theory proposes that autonomy, competence, and relatedness are preconditions for motivation, and thus well-being at work (20). If military personnel are socially rejected, this harms their relatedness. Together these findings show the importance of facilitating disclosure in a safe environment, to create positive disclosure experiences and consequently improving sustainable employment and well-being at work.
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