Understanding dependance on institutions and wellbeing: A mixed-methods study of institutional betrayal

Abstract

Individuals rely on institutions (e.g., health care systems, legal systems, universities) for a wide range of important needs. Too often, institutions betray those who rely on them by failing to protect or respond appropriately to individuals who have experienced traumatic events, further compounding the harm of traumatic stress. This is known as institutional betrayal (Smith & Freyd, 2014). While studies on interpersonal betrayal have found that victims who have higher levels of dependence on their abusers experience greater negative impacts to their wellbeing, this association has not yet been directly examined in relationships in which the perpetrator of harm is an institution. To address this gap in research, the present study used a mixed-methods approach to explore institutional dependence as a construct and assess how it may impact wellbeing when institutional betrayal occurs. Institutional dependence was examined in the context of either a negative health care experience or a student sexual assault. Survey participants (N = 480) completed an online survey with measures of mental and social wellbeing, adverse experiences, institutional betrayal, and a novel measure of institutional dependence developed for this study. Interview participants (N = 21) completed a semistructured interview to expand on details of their experiences with institutions following an adverse event. Quantitatively, exploratory factor analysis of the novel measure of institutional dependence supported the creation of two factors, which were labeled the General Dependence (α = .84) and Relationship Anxiety (α = .72) subscales. Regression analyses found that higher scores on the General Dependence subscale significantly predicted more severe depression (β = .14, p = .020, r = .13) and anxiety (β = .14, p = .025, r = .14) symptoms. Greater scores on the Relationship Anxiety subscale significantly predicted lower social satisfaction (β = −.15, p = .014, r = −.19). Qualitatively, thematic analysis was used to generate five themes reflecting the necessity of institutional relationships, concerns about compromising institutional relationships, harmful impacts to wellbeing, posttraumatic growth, and considerations for diverse identities. Integration of quantitative and qualitive findings demonstrated that the General Dependence and Relationship Anxiety subscales corresponded with the qualitative themes of necessary institutional relationships and concerns about compromising institutional relationships, respectively. Additionally, the subscales predicting adverse wellbeing outcomes aligned with the theme of harmful impacts to wellbeing. Overall, quantitative, qualitative, and integrated findings each provided unique insights into the concept of institutional dependence and its role in the experience of institutional betrayal.