To the best of our knowledge, no study has demonstrated the general attitudes of society towards the decision to marry an individual with MS. This study not only provides quantitative data on the public's stigmatization of MS but also delves into the most significant concerns of individuals regarding this decision. The results of this study indicate that 77.6% of respondents are unwilling to marry someone with MS. The primary concerns of individuals regarding this decision include the physical disability of the spouse, the possibility of having children with MS, treatment costs, unemployment, and infertility. Additionally, 47.2% of participants would not consider marriage if their spouse's parents were affected, with the possibility of their spouse and children contracting MS in the future and the physical disability of their parents being the most significant concerns. Furthermore, 46.6% and 28.2% of individuals would not consider marriage if their siblings and second-degree relatives were affected by MS, respectively. Concerning the spouse and children getting MS in the future would be the main criteria for this decision.
Abolhassani et al.'s study, which examined the social aspects of individuals with MS, identified marriage-related issues as one of the primary challenges faced by these patients (25). The existing literature on marriage and MS primarily focuses on the attitudes of individuals with MS towards marriage, which is often associated with fear and anxiety regarding marital problems and avoidance of marriage (25). Alternatively, research has explored the impact of an MS diagnosis on one partner and the potential for divorce, examining factors such as age of onset, length of marriage, having children, education level, physical ability, and employment status. In the study conducted by Pfleger et al., which examined a total of 2538 patients diagnosed with MS, it was found that after five years of MS diagnosis, the rate of maintaining a relationship did not differ significantly compared to the control group. However, after 24 years, the probability of remaining in a relationship was 33% in the patient group and 53% in the control group, indicating a significant difference. Interestingly, a significantly increased risk of separation was observed in men or in couples without children (23). It is important to note that this study was conducted on a sample of individuals whose disease onset and the start of the study occurred between 1980 and 1989. The prospects and outcomes of relationships, as well as divorce rates, may vary across different generations and time periods. Furthermore, it is worth mentioning that in this study, the term "relationship" refers not only to marital unions but also includes informal partnerships lasting at least one year prior to the diagnosis of the MS.
Therefore, it is logical to assume that informal relationships are more susceptible to separation compared to formal marriages in any given region. Hence, in a more recent investigation, we can make reference to the study conducted by Landfeldt et al. The aforementioned study examined the long-term consequences of MS on the likelihood of divorce in a sample of 3988 patients, comparing it with a control group of 15992 individuals from the general population of Sweden. The findings revealed that the risk of divorce among women did not differ significantly. However, in the case of men, the risk of divorce was observed to be 21% higher(24). Additionally, in Morales-Gonzalez's study involving 371 Spanish patients, the incidence of divorce and separation after 10 years was reported to be 31%(26).
There has been limited research conducted on the stigma associated with the decision to marry an individual who is a patient. Epilepsy as a chronic non-infectious neurological disease can be more closely similar to MS.Aydemir (2019) conducted an assessment of the general public's perception of epilepsy, revealing that a significant proportion of 27% expressed reluctance to enter into matrimony with an individual affected by this condition(27).According to Goodall et al, patients with epilepsy exhibited elevated levels of functional disability, perceived stigma to a greater extent, were less inclined towards forming relationships or harboring marriage expectations, and demonstrated a lower likelihood of pursuing education, paid employment, or vocational training(22)(28).
The current study found that a greater level of familiarity with MS patients and a lower level of education are more strongly linked to the apprehension surrounding children who are at risk of developing MS in the future. Additionally, in regard to the anxiety stemming from the physical disability of the spouse with MS, a significantly higher level of education was observed among the respondents (29).
The study is subject to certain limitations, namely the relatively small sample size and the cross-sectional design. It is important to note that, prior to this study, no research had been conducted on the stigma associated with marrying an individual with MS within the general population. Consequently, a validated questionnaire specifically tailored to this topic was not available, necessitating the use of a researcher-developed questionnaire. Owing to the scarcity of available resources pertaining to the matter of marrying an individual afflicted with an illness within society, it is unfeasible to make a direct comparison between the level of stigma toward MS patients and those suffering from other diseases. Consequently, it is inconclusive whether the respondent’s stigma toward MS is primarily attributed to their state of illness or if it is influenced by the inherent nature and characteristics of MS disorder It is suggested to conduct further studies with a larger sample size and incorporate a control group for other diseases. Moreover, it is feasible to assess individuals' stigmatization levels prior to and subsequent to providing information about MS to ascertain the potential impact of public education on society's perception of these individuals.