167 7 GENERAL CONCLUSIONS AND DISCUSSION Furthermore, the current thesis did not include measures of individual differences such as personality traits. As personality traits could for example influence both disclosure decisions (60) and sustainable employment and well-being at work (61), it would be important that future research includes measurements of individual differences such as personality traits. It should also be noted that the current thesis focused on MHI, including substance use disorder. As the Dutch military has a zero-tolerance policy for substance use, it can be expected that the decision to seek treatment for and disclose substance use disorder is harder compared to making these decisions for other MHI. Additionally, previous research suggests that the stigma concerning substance use disorder is higher compared to general mental health stigma (62), and employers’ discrimination intentions may be higher for substance use disorders (21). Therefore, it is important that future research examines the decision to seek treatment for, and disclose, substance use disorder separately from other MHI, to be able to make comparisons. Whereas the current thesis assessed mental health stigma, other health-related stigmas may also comprise well-being and sustainable employment. For example, previous research in civilian samples has shown that people with concealable physical illnesses, such as HIV (63), diabetes (64), or cancer (65), also experience the decision of whether or not to disclose their health problems in the workplace as a dilemma. Therefore, more research is needed on stigma across different contexts and the long-term effects on sustainable employment and well-being at work (1, 66). Finally, the findings of the current thesis, and earlier research, suggest that the decision to seek treatment, the decision to disclose, and sustainable employment and well-being at work should be examined from multiple perspectives. As can be seen in figure 1, the negative attitudes of stakeholders in the workplace is one of the four problem areas through which stigma can affect sustainable employment and well-being at work. As the current thesis highlights the crucial importance of the supervisor’s attitudes, knowledge, and support in the disclosure decision, the perspective of the supervisor warrants to be studied in more detail. A qualitative study on disclosure in the German armed forces did include the perspective of supervisors (13). They found that supervisors were often late in realizing that MHI played a role in their employees and supervisors felt that they had sufficient knowledge of post-traumatic stress disorder, but not about other MHI. Including the supervisors’ perspective, can inform future interventions targeting the supervisor. Also, as previous research in civilian settings has shown that organizational policies influence the disclosure decision (32, 67), and this perspective was not included in the current thesis, future research should examine this topic from the perspective of the military organization itself.
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