Research reveals people desire social distance from spouses of those with mental illness

LAWRENCE — The concept of stigma by association is linked to the idea that you’re judged by the company you keep.

“So if the person you’re married to is not doing well mentally, do people assume you play some type of role in that? And will they treat you differently?” said Elizabeth Felix, assistant professor of sociology at the University of Kansas.

Those questions are addressed in her new chapter titled “Public Stigma and Stigma by Association: Desire for Social Distance from People with Mental Illness and Their Spouses.” Her study employs a vignette survey experiment to investigate the extent to which the public wants social distance from people with certain mental illnesses, as well as their romantic partners. It appears in the Handbook of Social Psychology: Micro Perspective.

“When it comes to stigma by association, there has been more work focused on children and siblings,” Felix said.

“A lot of people will make those assumptions based on the genetic similarities. But spouses are a different type of relationship. One, you don’t share the genetics. Two, it’s seen as more voluntary. You opt into that marriage, whereas you’re not opting into who your parent or sibling is.”

The study examines why the spouses with more stigmatized mental illnesses could be most at risk of experiencing associative stigma. It also probes whether associative stigma is reduced by interpersonal contact.

“People often cling to the idea, for instance, that a man must be a bad partner if his wife is dealing with mental illness. Maybe he is not a supportive partner or perhaps even abusive. They might make these assumptions based on the mental health status of the partner, without any real evidence,” she said.

To test this concept, Felix conducted a vignette survey experiment that includes four behaviors meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for depression, schizophrenia, opioid dependence and alcohol dependence. This also includes a control condition of “daily troubles” that describes an individual with day-to-day problems not meeting the criteria for any disorder.

The study found that respondents are more likely to desire social distance from vignette characters displaying mental health symptoms compared to vignette characters displaying daily troubles. But it also revealed respondents are more likely to desire the same social distance from spouses of those displaying mental health symptoms.

“When you’re tied to somebody with a stigmatized identity, that may negatively affect how people view you,” Felix said. “However, the findings related to the spouses of people with depression were actually seen as less stigmatized than the control condition or the person experiencing daily troubles. That was a bit surprising.”

Several reasons could explain this finding. For one, depression is much less stigmatized than other mental health issues, according to Felix. Or if an individual is married to somebody with characteristics of depression (such as lack of energy or motivation), they might be considered a “good spouse” if they are willing to stick it out and support that partner.

“All of this is stemming from stereotypes or assumptions about a relationship. And that could not be the case at all. It could be the case that the spouse with depression is really emotionally intuitive and supportive. But this revolves around making assumptions about people without necessarily knowing those dynamics,” she said.

She said the public’s attitude regarding social stigma hasn't shifted much in the last decade.

“We haven’t seen as much shift as we thought related to the pandemic and how much mental health was talked about then. In the current climate, in terms of political divisions, we are starting to see divisions in stigma as well. More conservative and more liberal individuals are having diverging views on mental health and stigma.”

Now in her fourth year at KU, Felix is an expert in the sociology of mental health and mental health stigma. Her published work has appeared in Social Science & Medicine, Society and Mental Health and the Journal of Health and Social Behavior.

“I’m hoping this research could be helpful for policymakers or people who are trying to develop strategies for reducing stigma,” Felix said. “Because we often talk about public stigma, but a lot less attention is focused on stigma by association. It may not be as strong as public stigma, but it still is there, and it still really affects people.”