49 3 TREATMENT SEEKING IN THE MILITARY - A QUANTITATIVE STUDY INTRODUCTION Worldwide, there is a treatment gap for mental illness, including substance abuse, creating a mismatch between the proportion of people who could benefit from treatment and those who actually seek treatment (1). People working in high-risk occupations (e.g. military, police) have increased chances of developing mental illnesses (2) and, especially in these occupations, it is difficult to seek treatment (3, 4). Approximately 60% of military personnel who experience mental illness do not seek treatment (5), or wait until they reach a crisis point (6, 7). In a previous qualitative study, we showed that stigma-related concerns form a barrier to seeking treatment in the Dutch military (6). These included concerns about career consequences, social rejection, and discrimination. Furthermore, multiple systematic reviews on help-seeking confirmed stigma as a barrier (8-11). It is a missed opportunity to prevent worsened symptoms and dropout if personnel wait until a crisis-point to seek treatment, especially when high-quality care is available within the military. More insight is needed into the process of seeking treatment. Information from healthy personnel about factors that influence treatment-seeking intentions (prior to possible mental illness development) is important for selective and indicated prevention, as it can be used to develop interventions to facilitate early treatment seeking. Previous research has mainly focused on personnel with mental illnesses (8). Therefore, the current study examines military personnel with and without mental illness; those without mental illness are asked about their intentions to seek treatment for possible future mental illness. The results can be used to validate and extend earlier qualitative findings (6). The current study aims to answer the following questions: (1) What are the attitudes, beliefs, and needs of military personnel regarding seeking treatment for mental illness? (2) Do those who have sought treatment or intend to seek treatment differ from those who do not, and if yes, how do they differ? and (3) What factors are associated with the decision and intention of not seeking treatment? METHOD Design A cross-sectional observational design was used in this study. The online questionnaire examined military personnel with and without mental illness. Comparisons of demographics, attitudes, beliefs, and needs were made based on past treatment-seeking decisions for personnel with mental illness and based on treatment-seeking intention for those without. The STROBE checklist was used in this study (12).
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