Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

Rebecca Bogaers; Elbert Geuze; Jaap van Weeghel; Fenna Leijten; Nicolas Rüsch; Dike van de Mheen; Piia Varis; Andrea Rozema; Evelien Brouwers

doi:10.1136/bmjopen-2021-049370

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

BMJ Open. 2021 Oct 27;11(10):e049370. doi: 10.1136/bmjopen-2021-049370.

Authors

Rebecca Bogaers^{1

2}, Elbert Geuze^{2

3}, Jaap van Weeghel⁴, Fenna Leijten⁵, Nicolas Rüsch⁶, Dike van de Mheen⁴, Piia Varis⁷, Andrea Rozema⁴, Evelien Brouwers⁴

Affiliations

¹ Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands r.i.bogaers@tilburguniversity.edu.
² Brain Research and Innovation Centre, Netherlands Ministry of Defence, Utrecht, The Netherlands.
³ Brain Center Rudolf Magnus, University Medical Centre Utrecht Psychiatry, Utrecht, The Netherlands.
⁴ Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands.
⁵ Strategic Military Healthcare Department, Netherlands Ministry of Defence, Utrecht, The Netherlands.
⁶ Department of Psychiatry II, University of Ulm, Ulm, Germany.
⁷ Department of Culture Studies, Tilburg School of Humanities and Digital Sciences Tilburg University, Tilburg, The Netherlands.

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 (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being 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 homogeneous focus groups, including 3 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 well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being 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.

Keywords: human resource management; mental health; occupational & industrial medicine; qualitative research; substance misuse.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Focus Groups
Humans
Mental Disorders*
Mental Health
Military Personnel*
Social Stigma
Substance-Related Disorders*