Stigma by association revealed in a survey conducted among UNAFAM members

Stigma by association (also known as secondary, family, or courtesy stigma) adds to public stigma and self-stigma. First described by Erwin Goffman in 1963, it affects those close to stigmatized individuals, particularly people with mental health conditions. King et al.'s scale from 2007 models public stigma based on three components: Discriminatory Reactions, Disclosure Concerns, and Positive Aspects.

King's scale was adapted for use by family members and administered through UNAFAM's (National Union of Families and Friends of People with Mental Health Conditions) online survey. The sample included 3650 participants (2962 women). Confirmatory and exploratory factor analyses were conducted to examine the scale's structure. We explored the effects of sex and kinship on factor scores using ANOVA/ANCOVA models.

While confirmatory factor analyses showed significant deviation from the original structure, exploratory analyses largely recovered the three original dimensions. The "Discrimination" dimension revealed experienced and perceived prejudice along with resulting reactions. The "Disclosure" dimension demonstrated persistent difficulties in discussing a family member's mental health condition due to fears of personal and professional consequences. The "Positive Aspects" dimension showed that respondents became more understanding and tolerant toward their family member with a mental health condition, although only 40% reported becoming more resilient through this experience.

The adapted King's scale can now be used to investigate determinants and consequences of stigma by association in other populations, including neurodevelopmental disorders (such as autism spectrum disorder and attention-deficit/hyperactivity disorder), schizophrenia, mood disorders, substance use disorders, and dementias.