180 CHAPTER 1 8 sustainable employment focuses more on performance indicators, such as workability, and medical indicators such as sick leave. However, due to the emerging field of positive organizational psychology, there is now more focus on well-being at work. The current thesis included both the traditional perspective on sustainable employment, focusing on performance, and more novel indicators of sustainable employment, such as well-being at work. Aim of the thesis The aims of this thesis were to gain insight into (1) the decision of whether or not to seek treatment for MHI within the Dutch military, and to which extent stigma plays a role in this decision, (2) the decision of whether or not to disclose MHI to a supervisor in the Dutch military, and to which extent stigma plays a role in this decision and (3) the association between actual disclosure decisions and disclosure experiences, and subsequent sustainable employment and well-being at work in the Dutch military. RESULTS (CHAPTERS 2 – 6) In chapter 2 we examined barriers to and facilitators for treatment-seeking for MHI using a qualitative focus group study examining multiple perspectives, namely military personnel with (N=20) and without MHI (N=10) and mental health professionals (N=16). Five main barriers to treatment seeking were identified: (1) fear of negative career consequences, (2) fear of social rejection, (3) confidentiality concerns, (4) the ‘strong worker’ workplace culture, (4) and practical barriers. Most of these barriers were related to stigma. Additionally, three facilitators were identified: (1) social support, (2) accessibility and knowledge, and (3) health care within the military. The views of the different perspectives were highly congruent. Subsequently, in chapter 3 a quantitative cross-sectional questionnaire study on the decision to seek treatment was conducted to confirm and expand the earlier qualitative findings. Both military personnel with (N=324) and without MHI (N=554) were examined. Their attitudes, beliefs, and needs related to treatment seeking for MHI were examined. The majority of the personnel believed treatment was effective (91.6%); however, most preferred to solve their own problems (66.0%). For personnel with MHI, compared to those who sought treatment, those who did not had a higher preference for self-management and found advice from others less important. For those without MHI, those with no intention to seek treatment indicated a higher preference for self-management, stigma-related concerns, denial of symptoms, and lower belief in treatment effectiveness; they also found it less important to be an example, compared to those with treatment-seeking intentions. A clear indication of where to seek help
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