163 7 GENERAL CONCLUSIONS AND DISCUSSION needed work adjustments, but not the diagnosis), and non-disclosure (not disclosing any information to the supervisor) (42). This is a limitation of the current thesis, as the type of disclosure might influence the disclosure outcomes. Previous research suggests that disclosure messages can influence the disclosure outcome, where it is advised to focus on information directly relevant to work performance, and to be reluctant to share the medical diagnosis (15). Future research into the association between disclosure and sustainable employment and well-being at work should thus consider the different forms of disclosure. Furthermore, another limitation of the current thesis is related to the limited generalizability of the findings. In all studies, an overrepresentation of older, higherranking, and higher-educated military personnel was found. The results might differ for different layers and branches of the military organization, and younger, lower-ranking military personnel may face different barriers to treatment-seeking and disclosure, compared to those with higher ranks. For example, previous research showed that more senior ranks were less likely to seek treatment compared to lower ranks (43, 44). Additionally, some trends that have occurred in the recent decade might not be properly represented in this study, as it included an older population. For example, a study that assessed population-based changes in the US mental health stigma over 22 years, found a decrease in stigma regarding depression (45). Additionally, the risk of self-selection bias is a limitation of the current study, as participants could freely sign up to participate in the qualitative studies. This means that the study population only included those with some previous interest in the topic of mental health stigma. It is likely that those with no previous interest in this topic, and possibly those who hold the most stigmatizing attitudes or had the most fear of stigmatizing attitudes and discrimination, were not included in this study. Moreover, a risk for studies on sensitive topics, as is the case for this thesis, is the risk that participants provide socially desirable answers. However, we believe that this was minimal for the current studies. First, several measures were taken during the focus group studies to ensure that participants would feel safe to share their answers. These measures included (1) the use of a diverse sample of military personnel from different armed forces to ensure participants were not familiar with each other, (2) participants were asked to participate in civilian clothes, in order not to emphasize the different ranks, and (3) focus group leaders could in no way influence the participants careers as they were not employed by the military. Second, for the quantitative studies, it was made clear to participants that they would be completely anonymous. Additionally, it was made clear that all analyses would be performed by researchers from Tilburg University and not the military. Given that there were participants who indicated that
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