Introduction

The Family Burden Scale (FBS-23) is a psychometric instrument developed to assess the burden experienced by family members who provide care and support to individuals living with chronic illnesses, disabilities, or mental health conditions. Family caregivers often face substantial emotional, physical, social, and financial challenges that can significantly affect their quality of life, psychological well-being, and overall family functioning. As the prevalence of chronic diseases and long-term care needs continues to increase worldwide, the systematic assessment of caregiver burden has become an essential component of clinical practice, health services research, and psychosocial intervention planning. The FBS-23 provides healthcare professionals and researchers with a Family Burden Scale [FBS-23]

Scale Description

The Family Burden Scale (FBS-23) is a psychometric instrument designed to assess the burden experienced by family members who provide care or ongoing support to a relative with a chronic illness, disability, mental health condition, or increased care needs.

The scale consists of 23 items and approaches family burden as a multidimensional phenomenon. It does not focus solely on the physical demands of caregiving, but also examines emotional, social, financial, and functional consequences that may substantially affect the quality of life and overall well-being of the family.

Purpose

The main purpose of the FBS-23 is to provide a systematic assessment of the burden associated with caring for a family member.

Long-term caregiving may require substantial time, energy, financial resources, and changes in daily routines. It may also affect employment, social relationships, psychological well-being, and the caregiver’s overall quality of life.

By assessing these areas, the scale can help identify families experiencing considerable strain and highlight specific domains in which additional support may be required.

Dimensions of Family Burden

Family burden is a complex construct that may affect several areas of everyday life.

Emotional burden refers to psychological strain, stress, sadness, frustration, anxiety, or emotional exhaustion related to the caregiving role.

Physical burden concerns fatigue, insufficient rest, sleep disruption, and the physical demands associated with providing regular or intensive care.

Social burden reflects limitations in social activities, leisure time, interpersonal relationships, and participation in community life as a result of caregiving responsibilities.

Financial burden may involve direct expenses related to treatment and care, as well as indirect consequences such as reduced employment, absence from work, or loss of income.

The scale may also capture functional family burden, referring to changes in family roles, responsibilities, routines, and the overall organization of family life.

Objective and Subjective Burden

Contemporary research on family caregiving commonly distinguishes between objective burden and subjective burden.

Objective burden refers to observable consequences of caregiving, such as financial difficulties, loss of personal time, changes in employment, increased responsibilities, and disruption of everyday routines.

Subjective burden refers to the caregiver’s personal perception and emotional response to these demands, including feelings of pressure, exhaustion, frustration, or distress.

This distinction is important because families facing similar objective caregiving demands may experience very different levels of perceived burden.

Administration

The FBS-23 is generally completed by a family member who has a significant role in the care or support of the person with increased needs.

Respondents are asked to evaluate statements reflecting different consequences of caregiving on their personal and family life. Responses are usually recorded using a Likert-type scale, indicating the intensity or frequency of the burden experienced.

The instrument can be used both in research settings and as part of a broader psychosocial assessment of family caregivers.

Scoring

Responses to the individual FBS-23 items are scored according to the specified response format and may be summed to produce an overall family burden score.

Where supported by the structure of the version being used, separate scores may also be calculated for specific domains of burden.

In general, higher scores indicate greater family burden, whereas lower scores indicate a lower level of perceived burden.

Interpretation should ideally be based on the psychometric properties of the relevant population rather than on arbitrary classifications such as “low,” “moderate,” or “high” burden when validated cut-off scores are not available.

Psychometric Evaluation

Psychometric evaluation of the FBS-23 may include assessment of internal consistency, factorial structure, and different forms of validity.

Internal consistency can be examined using indices such as Cronbach’s alpha and McDonald’s omega, while structural validity can be investigated through Exploratory Factor Analysis or Confirmatory Factor Analysis.

When the scale is used in a different clinical, linguistic, or cultural population, its psychometric properties should be reassessed rather than assumed to be identical to those reported in previous samples.

Applications

The FBS-23 can be used in a wide range of healthcare and social care settings, including mental health services, hospitals, rehabilitation units, chronic care facilities, social services, family counseling centers, and caregiver support programs.

It may also be applied in studies examining caregiver burden, family functioning, quality of life, psychological well-being, social support, financial strain, and the impact of chronic illness on family systems.

The scale may be particularly useful for identifying caregivers at increased risk of emotional exhaustion and for evaluating the effectiveness of psychosocial or supportive interventions.

Statistical Analysis

In research applications, descriptive statistics such as means, standard deviations, medians, and ranges may be calculated for individual items, subscales, and the total score.

Internal consistency can be examined using Cronbach’s alpha or McDonald’s omega, while the factorial structure of the scale may be investigated using Exploratory Factor Analysis (EFA) or Confirmatory Factor Analysis (CFA).

FBS-23 scores may also be examined in relation to caregiver age, duration of caregiving, daily hours of care, severity of the care recipient’s condition, social support, depression, anxiety, and quality of life.

More advanced analyses may include regression models, mediation analysis, moderation analysis, or structural equation modeling to explore factors associated with family burden.

Clinical and Research Significance

Assessment of family burden is particularly important because family caregivers often play a central role in the long-term management and support of individuals with chronic health conditions.

High levels of caregiver burden may affect not only the caregiver’s physical and psychological health but also family functioning, continuity of care, and the quality of support provided to the care recipient.

The FBS-23 can therefore contribute to the early identification of unmet needs and support the development of targeted interventions such as counseling, psychological support, respite care, social assistance, or caregiver education.

Conclusion

The Family Burden Scale [FBS-23] is a useful instrument for the multidimensional assessment of the impact that long-term caregiving may have on families.

By examining emotional, physical, social, financial, and functional aspects of burden, the scale provides a more comprehensive understanding of the caregiver experience and can support both research and the development of more effective family-centered interventions.

References

Montgomery, R. J. V., Gonyea, J. G., & Hooyman, N. R. (1985). Caregiving and the experience of subjective and objective burden. Family Relations, 34(1), 19–26.

Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594.

Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. JAMA, 282(23), 2215–2219.

Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655..