78 4 CHAPTER 4 ABSTRACT Objectives. Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing Mental Health Conditions and Substance Abuse (MHC/SA). Disclosure can lead to both positive (e.g. support) and negative (e.g. discrimination) work outcomes and therefore both disclosure and nondisclosure can affect health, wellbeing and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives. Design. Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach. Setting. The study took place within the Dutch military. Participants. In total, 46 people participated in 8 homogenous focus groups, including three perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16). Results. Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent. Conclusions. Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and wellbeing. Supervisor knowledge, attitudes and behavior were critical for disclosure, and supervisors thus have a key role in improving health, wellbeing and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.
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