90 4 CHAPTER 4 fear of career consequences remained of such strong influence on disclosure. The study within the German military found that soldiers with MHC/SA on a fixed-term contract did not want to disclose due to their goal of getting a permanent contract, and that soldiers with MHC/SA on a permanent contract found it easier to disclose (20). Another qualitative study in a civilian setting also found that perceived job security was of influence on the disclosure decision (30). Since the current study as well as the study within the German military and among civilians are all qualitative, future quantitative research should further examine the relationship between contract type and disclosure decision. Furthermore, the military culture formed a barrier for disclosure. While existing research into disclosure within the military is scarce, masculine workplace culture has been found as a barrier in similar occupations. Research showed that working in a maledominated workplace makes it hard to disclose (4, 15). Increasing mental health literacy in these male-dominated workplaces, specifically the military, could potentially facilitate disclosure decisions (35). This also relates to the lack of communication skills surrounding MHC/SA found in the current study. A study among firefighters also found managers’ unease to discuss mental health as a barrier for disclosure (36). In order to increase communication skills, interventions proven to be effective in other settings should be transformed to be applicable within the Dutch military. For example, a mental health training for managers in an Australian fire and rescue service improved confidence in communicating with their employees and could be adapted for use within the military (37). Majority of facilitators were also related to workplace culture. When a soldier experienced support from their supervisor this made it easier to disclose. Importance of supervisors for the disclosure decision has been found both in a military population (20), other male-dominated workplaces (15), and in regular civilian workplaces (21, 38). Therefore, it is important to provide training to supervisors to improve their knowledge, attitudes and communication skills surrounding MHC/SA, as mentioned before, and to improve employee-manager relationships through team building and lower turnover. Additionally, the current study showed that it was easier to disclose work-related MHC/ SA, i.e., a result of a work-related incident. There are two explanations for this finding. First, the current study showed that there was more respect for MHC/SA related to deployment than if those health issues were not seen as the result of work. Second, a study within the German military showed that officers thought that PTSD could be dealt with better compared to other MHC/SA, because there was more knowledge and awareness about PTSD (20). If disclosure is easier when there is more knowledge and awareness, this highlights the importance of increasing knowledge and awareness of other MHC/SA within the military.
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