The Perceived Burden on Family Scale (PBFS)

Abstract

The Perceived Family Burden Scale (PFBS) is a psychological instrument developed to quantify the burden experienced by family members and caregivers of patients diagnosed with schizophrenia. Recognizing that attention often focuses solely on the patient, the PFBS addresses the significant emotional, social, and practical difficulties faced by relatives who often assume intensive caregiver roles.

This 24-item tool utilizes a modified Likert-type response format to capture both the objective presence of problematic patient behaviors and the subjective degree to which those behaviors distress the relative. The development and initial validation of the PFBS were published by Levene, Lancee, and Seeman in 1996.

Keywords

Perceived Family Burden Scale, PFBS, Family Burden, Schizophrenia, Caregiving, Mental Illness, Psychological Assessment, Likert Scale.

Authors

Levene, J. E., Lancee, W. J., Seeman, M. V.

Purpose

The primary purpose of the Perceived Family Burden Scale (PFBS) is to provide a standardized measurement of the psychological and practical burden experienced by relatives of individuals suffering from schizophrenia.

The scale is unique in its structure, allowing for the concurrent assessment of two distinct dimensions of burden: the objective presence of problematic behaviors exhibited by the patient, and the subjective impact or distress these behaviors cause the family member. This dual measurement approach allows researchers and clinicians to differentiate between measurable patient symptoms and the emotional toll they inflict upon the caregiver.

Construct

The PFBS measures the construct of Family Burden, specifically tailored to the context of chronic mental illness. This construct encompasses the strain, difficulty, and distress experienced by relatives due to the patient’s symptoms and associated behaviors.

The scale is divided conceptually into two components during scoring: the Objective Burden Score, which counts the number of reported problem behaviors present in the patient (Column A in the instrument), and the Subjective Burden Score, which assesses the emotional distress or “bother” experienced by the relative due to these behaviors (Column B in the instrument). These two scores are crucial for understanding the overall level of perceived burden.

Validity

The validity of the Perceived Family Burden Scale (PFBS) was primarily established in the seminal 1996 article by Levene, Lancee, & Seeman. This study focused on demonstrating the scale’s ability to accurately reflect the burden associated with caring for a relative with schizophrenia.

The validation process confirmed that the scale effectively captures both the frequency of distressing patient behaviors and the subjective emotional reaction of the family member, indicating strong construct validity for the dual nature of family burden. The scale’s focused application to specific schizophrenia symptoms enhances its content validity within this clinical population.

Reliability

The reliability of the PFBS, concerning its internal consistency and stability, was documented in the original psychometric analysis. High internal consistency is crucial for scales measuring complex constructs like burden.

Reliability analyses typically focus on the correlation between the 24 individual items and the overall total score, ensuring that all items consistently measure the underlying construct. The developers derived three variables for validation: the total score, an objective score, and a subjective score, all of which demonstrated acceptable levels of reliability in the initial study, confirming the instrument’s utility as a dependable measure of caregiver burden.

Factor Analysis

While the original presentation of the PFBS focuses on the combination of objective and subjective scores, subsequent research has often explored the underlying factor structure of the 24 items to identify sub-dimensions of burden.

Factor analyses of family burden scales commonly reveal distinct dimensions, such as factors related to disruptive behavior, social withdrawal/negative symptoms, and dependency. Although the PFBS is often scored based on the three established variables, empirical studies may support a refined, multidimensional model, reflecting the complex nature of symptom presentation in schizophrenia and the varied ways these symptoms contribute to family distress.

Instrument

Test Type: Self-report questionnaire completed by a family member or caregiver.

Format: 24 items rated on a 5-point Likert-type scale (ranging from “Not at all” to “A great deal”), with an additional categorical option to indicate if the behavior is present.

Language Available: Original English.

Population Group: Family members and primary caregivers.

Age Group: Adult caregivers (typically 18+).

Population Details: Relatives providing care for individuals diagnosed with schizophrenia or other severe mental illnesses.

Test Methodology: Retrospective self-report, asking the rater to consider the patient’s behavior and the resulting emotional impact over the past month.

Keywords

Psychometrics, Objective Burden, Subjective Burden, Validation, Family Distress, Mental Health Assessment, Psychiatric Scales.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Not provided in source material.

Correspondence Address: Not provided in source material.

Permissions & Fee and Test Year

The PFBS was published and validated in 1996. Specific information regarding current copyright permissions, test manuals, and applicable usage fees should be sought directly from the primary authors (Levene, Lancee, & Seeman) or the journal publisher, Schizophrenia Research.

Reference’s

• Levene, J. E., Lancee, W. J., Seeman, M. V. (1996). The perceived family burden scale: measurement and validation. Schizophrenia Research, 22(2), 151–157.

Items of the The Perceived Family Burden Scale (PFBS)

W.LANCEE, MV.SEEMAN, J.LEVENE

Instruction: Please rate the following: 1) Indicate if the behavior is displayed by your relative who suffers from schizophrenia; 2) Indicate the extent to which the behavior bothers you. (The time period considered is the past month).

A                                                                         B

Mark an “x” if                                          Indicate degree to which behavior bothered you behavior is present

INSTRUCTIONS FOR RATERS

The Perceived Family Burden Scale is rated on a five point scale, with a range from 0 to 5.

Ratings:

0 = the behaviour isn’t present and doesn’t bother the relative

1 = the behaviour is present and doesn’t bother the relative

2 = the behaviour is present and bothers the relative “a little”.

3 = the behaviour is present and bothers the relative “considerably”.

4 = the behaviour is present and bothers the relative “a great deal”.

In our study, we derived three variables which were used in the validation study:

• the total score
• an “objective score” (the number of problem behaviours identified by the informant).
• a “subjective score” (the extent to which the behaviour “bothers” the relative).