182 CHAPTER 1 8 DISCUSSION (CHAPTER 7) This thesis focused on mental health stigma in the military and the influence this has on health-related decision-making (treatment-seeking and disclosure) and ultimately on sustainable employment and well-being at work. The current thesis showed that both anticipated and experienced mental health stigma exists in the Dutch military. The decision of whether to seek treatment for mental health issues and illnesses In line with previous research, the current thesis showed that stigma indeed played an important role in the decision to seek treatment for MHI. For example, military personnel with MHI were afraid that seeking treatment would lead to social rejection (38%), discrimination (26.9%), and negative career consequences (36.4%). As stigma can form a barrier to treatment seeking, it can also form a barrier to sustainable employment and well-being of military personnel with MHI. The decision of whether to disclose mental health issues and illnesses to a supervisor The findings of the current thesis also showed that stigma indeed played a role in the disclosure decision, as stigma-related concerns were significantly associated with both disclosure decisions and intentions. It should be noted that the effect mental health stigma has on disclosure, is expected to be stronger in the military setting, compared to civilian settings. This might be expected due to the military culture, where people are expected to be ‘strong’ and not show weakness. This makes it even more important to target stigma in the military, to create a safe environment for the disclosure of MHI to a supervisor. Disclosure of mental health issues and illnesses and 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 of disclosure 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. Thus, those who might have suffered the loss of employment due to disclosure were 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
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