Development of the Family Stigma Stress Scale (FSSS) for Detecting Stigma Stress in Caregivers of People With Mental Illness

Chih Cheng Chang, Jian An Su, Kun Chia Chang, Chung Ying Lin (Corresponding Author), Mirja Koschorke, Nicolas Rüsch, Graham Thornicroft

Research output: Journal article publicationJournal articleAcademic researchpeer-review

11 Citations (Scopus)


People with mental illness and their family caregivers often perceive public stigma, which may lead to stigma-related stress (or stigma stress). However, no instruments have been developed to measure this stress for family caregivers of people with mental illness. We modified an instrument that measures the stigma stress of people with mental illness (i.e., the cognitive appraisal of stigma as a stressor) and examined the psychometric properties of the scores of the newly developed instrument: the Family Stigma Stress Scale (FSSS). Primary family caregivers of people with mental illness in Southern Taiwan (n = 300; mean age = 53.08 ± 13.80; 136 males) completed the FSSS. An exploratory factor analysis showed that the FSSS score had two factors; both factor scores had excellent internal consistency (α =.913 and.814) and adequate test–retest reliability (r =.627 and.533; n = 197). Significant correlations between FSSS factor scores and other instruments supported its concurrent validity and the ability of the FSSS to differentiate between clinical characteristics, for example, having been previously hospitalized or not. The FSSS is a brief and effective measure of the stigma stress of family caregivers of people with mental illness.

Original languageEnglish
Pages (from-to)148-168
Number of pages21
JournalEvaluation and the Health Professions
Issue number2
Publication statusPublished - 1 Jun 2019


  • caregiver
  • Chinese culture
  • family member
  • severe mental illness
  • stigma stress

ASJC Scopus subject areas

  • Health Policy

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