161 7 GENERAL CONCLUSIONS AND DISCUSSION about enduring pain and being tough due to military training which focuses on skills and courage to face adversity as an emotionally ‘strong’ team member (34). Therefore, it is important that future research and interventions targeting the disclosure of MHI in the military, take this high preference for self-management into account. The importance of the supervisor The findings of the current thesis also showed the crucial role supervisors play in both treatment-seeking and disclosure decisions. One of the barriers to treatment-seeking found in the qualitative study was the fear of social rejection, including social rejection from a supervisor (chapter 2). Furthermore, the qualitative study on disclosure found that a lack of supervisor support formed a barrier to disclosure, while supervisor support was a facilitator for disclosure (chapter 4). Supervisor’s relationship quality was positively associated with both disclosure decisions and experiences (chapter 5). Finally, of those who reported a positive disclosure experience, 90.1% reported receiving support from their supervisor, which was significantly higher than the reported support (21.9%) of those with negative disclosure experiences (chapter 6). Previous research on treatment-seeking in the military also found that military personnel were concerned that treatment-seeking would result in less confidence in their ability from supervisors (35-38). The recent interdisciplinary review on the disclosure of MHI among civilians (32) also indicated that a supervisor’s attitude and personality influence the disclosure decision. The role of the supervisor is expected to be especially important in the military setting, due to the strong hierarchical structure in the military, making military personnel more dependent on their supervisors (39). Therefore, it is important that initiatives in the military that aim to support treatment-seeking and disclosure decisions, target the supervisor. These initiatives should aim to increase supervisors’ knowledge (mental health literacy) and attitudes, as a lack of knowledge (ignorance) and attitudes based on this lack of knowledge (prejudice) can lead to discrimination (40). Strengths and limitations The current thesis has several strengths and limitations, which are important to consider when interpreting the results. An important strength of this thesis is the novel research topic within the Dutch military, as it is the first to examine mental health stigma, MHI disclosure, and treatment-seeking. Additionally, research on MHI disclosure in the military is very scarce. Therefore, this thesis provides valuable insights, which can contribute to facilitating MHI disclosure and treatment-seeking and contribute to the sustainable employment and well-being of military personnel. Furthermore, this thesis examined the direct association between MHI disclosure and sustainable employment and well-being at work, which to the knowledge of the authors has not been examined before. Another strength of the current thesis is the use of mixed methods, as it included both qualitative
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