69 3 TREATMENT SEEKING IN THE MILITARY - A QUANTITATIVE STUDY experiences seen were those of colleagues who were seen as outsiders. Perhaps, personnel did not want to be associated with them, and thus did not seek treatment. However, as this effect was surprising and the sample of those not seeking treatment was small, future research should further examine this. Strengths and limitations The first strength of this study is that it included personnel with mental illness who had not sought treatment; thus, providing insight into interventions. Second, it included both personnel with and without mental illness, thereby providing insights from personnel who may develop mental illness in the future. The sample was not representative of the entire military, as personnel were selected based on earlier mental illness scores. This also caused the sample to include only personnel who had been deployed. As they have had training on mental illness related to deployment, this group might have more positive attitudes toward seeking treatment compared to those who have not been deployed. In addition, despite stratification, the current study included a sample of older, highly educated, and higher-ranking personnel. Comparisons showed that lower ranking and less educated personnel were less likely to complete the questionnaire once started, and most abandoned the process during the mental health questions. Perhaps these questions were difficult to answer. There might also be a bias as those who have sought treatment may be more inclined to participate in this type of study. Additionally, those with mental illness reported high symptom severity, making it more likely that they had to seek treatment, leading to the underrepresentation of personnel with mild symptoms and those who have not sought help. This may have caused an underestimation of the associations, as the effects were mainly driven by symptom severity. To minimise the effects of a small sample size, a correction was used during the analysis. Finally, as this study was cross-sectional, further longitudinal research is needed to examine causality in relationships. Implications To facilitate early treatment seeking, and thereby prevention, interventions should align with a high preference for self-management and should not focus on increasing treatment effectiveness beliefs, but on decreasing stigma. Social encouragement can facilitate, while fear of social rejection can be a barrier to seeking treatment; supervisor and peer-to-peer training is needed, as it can both decrease stigma and increase social encouragement (29, 32). Finally, a clear indication of where to seek treatment at a discrete location, and with professionals with military experience, should be provided. Future research should further examine treatment seeking, longitudinally, to examine which factors, such as stigma, affect the various phases of symptom development to better understand treatment seeking.
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