79 4 DISCLOSURE IN THE MILITARY - A QUALITATIVE STUDY INTRODUCTION Worldwide, many workers in high-risk occupations are exposed to stressors at work, increasing their risk of developing Mental Health Conditions and Substance Abuse (MHC/SA) (e.g. soldiers/police officers/medical doctors) (1-4). Specifically, soldiers have an increased risk of developing MHC/SA as a result of deployment (2, 5). Additionally, these occupations are often in male-dominated workplaces, where masculinity norms such as self-reliance are high, which is associated with poorer mental health (6). This subsequently poses a threat to sustainable employment through a higher risk for sick leave and unemployment (7-9). A crucial decision for them is whether or not to disclose MHC/SA at work. The decision to disclose a MHC/SA is complex, with far-reaching consequences for health, well-being and ultimately sustainable employment (7, 10, 11). Disclosure can lead to advantages such as improved relationships at work, being able to be one’s true self, work accommodations and a more inclusive workplace culture. Alternatively, disclosure can also lead to stigmatization and discrimination (10-12), which often has serious negative consequences for wellbeing and sustainable employment. However, non-disclosure can be helpful to avoid stigma and discrimination, but can also lead to dropout because when MHC/SA are ignored, workers miss out on opportunities for workplace support (e.g. social support and workplace adjustments) that can be crucial to stay at work (7, 13). This disclosure dilemma is expected to be even more prominent for high-risk occupations within male-dominated workplaces, such as the military, where workers are expected to be ‘strong’ and to meet masculine norms (12, 14). Disclosure may yield less positive outcomes within these workplaces (12). Previous research also found that disclosure decisions within male-dominated workplaces were entirely driven by considerations of negative aspects (15). Additionally, masculinity is associated with poorer health literacy (16) and difficulty in talking about feelings and emotions (17), potentially making it harder to make a well-informed disclosure decision. Generally, low mental health literacy in workplaces can lead to MHC/SA being unaddressed (18). As yet, there is a lack of research (7), especially within the military, on the decision to disclose (19). A qualitative study within the German military examined attitudes towards disclosure of MHC/SA and found that soldiers indeed feared disclosure would lead to stigmatization, gossip, discrimination and negative career consequences (20). A quantitative study on the disclosure dilemma showed that 25% of Dutch workers would not disclose a MHC/SA, which was influenced by the perceived relationship with the supervisor, a preference for self-management and fear of negative consequences (21). Another study among Dutch workers found that of those who had disclosed MHC/ SA, almost 50% indicated this was due to a good relationship with their manager, and
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