50 3 CHAPTER 3 Setting In the Dutch military, healthcare is organised internally and is available relatively close to home. Personnel can seek treatment for both mental illness and substance abuse, and the costs are covered. There are sanctions for the use of soft and hard drugs (6). However, when substance (ab)use is reported to a mental health professional, there are confidentiality agreements (6). Statistics on the treatment gap within the Dutch military were not available. However, among the general Dutch working age population, twothirds of adults with mental illness have not received help in the past 12 months (13), making the treatment gap comparable to that of military personnel in the United States and the United Kingdom (5). Participant recruitment Active-duty military personnel were recruited for this study. A distinction was made between those with and without mental illness, during the survey. To ensure that personnel with and without mental illness would be represented in the sample, existing data from the questionnaire that personnel had received after deployment were used. Those who had been on deployment for 30 days or longer received this questionnaire 6 months after their deployment. It includes scores on depression, aggression, alcohol abuse, and PTSD. A stratified sample, based on gender, age, military division, and rank, of personnel was considered (N = 1000 with indication of mental illness and N = 1000 without). Data were collected between January and February of 2021. All personnel received invites simultaneously and were invited by e-mail and letter. Reminders were sent after three and five weeks. The main researcher sent invites. It was made clear that the research was in collaboration with Tilburg University and that responses to the questionnaire would be anonymous. Measures Demographics Gender, age, marital status, education level, type of work (operational or not), military department, rank, and years of service were assessed. Mental illness and substance abuse Current mental illness To assess current mental illness, the following measures were used: (a) the Hospital Anxiety and Depression Scale (14, 15), (b) ASSIST-LITE, to measure substance abuse (16), (c) AUDIT-C, to measure alcohol abuse (17), and (d) PTSD checklist for DSM-5 (15). For more details on the scales and cut-off scores used, see Appendix A.
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