Translation and Validation of Family Stigma Stress Scale (FSSS) Among Caregivers of Patients With Mental Illness in Pakistan

The stigma among caregivers is significantly creating stress for them, which is ultimately disturbing their well-being and quality of life. The aim of the current study is to translate and validate the Family Stigma Stress Scale (FSSS) in Urdu among caregivers of patients with mental illness in Pakistan. A purposive sample of 421 caregivers above 18 years of age (M=39.43, SD=12.41) participated in the present research, where 42.3% were men and 57.7% were women. All the participants completed FSSS and self-structured demographic sheet. For translating the scale, WHO guidelines were followed. Data were analysed through SPSS version 26 and AMOS version 24. To test the internal consistency of the translated scale, we apply the alpha reliability test. The result indicated that the internal consistency of the overall FSSS is good (alpha=0.85), while its subscale perceived harm (alpha=0.90) and perceived coping resources (alpha=0.87) also showed excellent internal consistency. To check that the translated version confirmed the same items, we applied confirmatory factor analysis (CFA) through AMOS version 24. The results of CFA showed that the model is in the acceptable to good fit range with chi 2/df (3.16), CFI (0.98), TLI (0.97), IFI (0.98), NFI (0.97), and RMSEA (0.07). An independent sample t-test was used to check the gender difference and illness differences related to caregiving on subscales of FSSS. Results of t-test showed that significant gender differences were observed only on perceived harm indicating that women caregivers perceived more harm as compared to men caregivers of patients with mental illness. Moreover, we also found that caregivers of patients with psychotic disorders perceived more coping resources than caregivers of patients with neurotic disorders. By integrating the FSSS into routine assessments and screenings in healthcare settings, professionals can identify caregivers experiencing high levels of stigma-related stress accurately. Healthcare professionals can advocate for policies and social programs that reduce stigma surrounding mental illness and provide resources for caregivers. Apart from these implications, there are some limitations in the present research, and this scale may not fully account for cultural sensitivity which potentially impacts the scale's applicability and generalizability. Participants may provide socially desirable responses, especially when dealing with sensitive topics like family stigma. This response bias can affect the accuracy and validity of the scale. Future researchers should focus on these limitations and try to fill these gaps.