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. Author manuscript; available in PMC: 2023 May 1.
Published in final edited form as: Clin Gerontol. 2020 Nov 27;45(3):696–707. doi: 10.1080/07317115.2020.1838982

The Geriatric Feelings of Burdensomeness Scale (GFBS)

Julie Lutz 1, Emma Katz 1, Jarred Gallegos 1, Rachael Spalding 1, Barry Edelstein 1
PMCID: PMC8155102  NIHMSID: NIHMS1641396  PMID: 33245252

Abstract

Objectives:

The present article describes the development and psychometric evaluation of the Geriatric Feelings of Burdensomeness Scale using two samples of older adults collected through Amazon Mechanical Turk. The scale is a 25-item measure of general subjective feeling of being a burden on or problem for others. The goal of the measure is to capture a broad conceptualization of burdensomeness that is relevant to a variety of important psychological variables.

Method:

Two studies are described, including item development and selection, and the examination of reliability and validity evidence in a sample of 192 older adults.

Results:

The estimates of reliability (coefficient alpha and average interitem correlations) were strong. Preliminary examination of convergent validity evidence found significant moderate correlations between the Geriatric Feelings of Burdensomeness Scale and measures of conceptually related constructs (hopelessness, suicidality, perceived burdensomeness, thwarted belongingness). Small, non-significant correlations were found between three indices of religiosity, providing preliminary discriminant validity evidence.

Conclusions:

Our results provide initial psychometric support for a more general and inclusive assessment tool for measuring older adults’ feelings of burdensomeness.

Clinical Implications:

With further research on clinical significance of feelings of burdensomeness and predictive validity, this measure may be used to identify concerns and beliefs about burdensomeness among distressed older adults.

Keywords: older adults, aging, assessment, measurement, mental health, burden

As older adults age, the potential to develop cognitive, physical, or health issues may lead to a perception of becoming a burden on their families, caregivers, and friends (Delgado-Guay, De La Cruz, & Epner, 2013; Juratovac, Morris, Zauszniewski, & Wykle, 2012; Pinquart & Sorensen, 2011). This perception has been linked to negative consequences, including depression, feelings of guilt and shame, hopelessness, and suicidal behaviors (Cukrowicz, Jahn, Graham, Poindexter, & Williams, 2013; Lyberg, Holm, Lassenius, Bergrren, & Severinsson, 2013; Jahn, Van Orden, & Cukrowicz, 2013; Jahn, Cukrowicz, Linton, & Prabhu, 2011; Joiner, 2005; Marty, Segal, Coolidge, & Klebe, 2012). Feelings of burdensomeness have been studied in relation to suicide, with the belief that others would be better off if one was dead (“perceived burdensomeness;” Jahn et al., 2013; Joiner, 2005); in relation to chronic conditions (e.g., cancer), with fears of causing burden to caregivers and others (“self-perceived burden;” Simmons, 2007); and in relation to end-of-life decision-making (e.g., Winter & Parks, 2011). However, feelings of burdensomeness have not been assessed broadly in older adults; they have primarily been examined in contexts related to specific constructs (i.e., suicide, chronic conditions) in which a very specific range of burdensomeness features are targeted, rather than examined more broadly in an aging context.

A broader range of feelings of burdensomeness is important to measure because burdensomeness is a factor that appears to be related to a range of psychological or behavioral phenomena. For example, Iskandarsyah et al. (2014) found that some women who delayed seeking help or treatment for breast cancer listed concerns about being an emotional burden on their husbands and children due to the energy and time-consuming nature of treatment as one reason for the delay. In another study, one category of reported disadvantages of seeking help from family or friends was having an adverse effect on one’s family or friends, including burdening them (Griffiths, Crips, Barney, & Reid, 2011). Adults also report increased distress at the need for more assistance due to a medical problem or financial aid (Filiberti et al., 2001)

Feelings of burdensomeness constitute an important issue among older adults. While developing a measure of fear in older adults, fear of being a burden was found to be one of the relevant fears reported by several older adults (Kogan & Edelstein, 2004). As older adults develop more health and/or cognitive problems, they may fear that they will become more of a burden on their caregivers (Juratovac et al., 2012; Pinquart & Sorensen, 2011). In a study of older adults with cancer (Chouliara, Kearney, Stott, Molassiotis, & Miller, 2004), participants reported not wanting to become a burden on loved ones by leaving their illness untreated and then having their health deteriorate as a reason that treatment side effects would not discourage them from receiving care. In addition, older adults also view themselves as a burden on society as a whole, with one study (Beresford, 2013) reporting that 61% of older adults believe that society sees them as a burden. There are facets of burdensomeness that may be more common among older than younger adults, such as needing help for everyday activities, the burdens of health declines and disability, and financial burdensomeness. Therefore, development of a scale that measures a broader concept of feelings of burdensomeness in older adults is important, as feelings of burdensomeness appear to have a potential influence on behavior in a variety of settings and under a variety of conditions. In addition, appropriate measurement of feelings of burdensomeness in older adults may allow researchers and clinicians to focus interventions, such as cognitive behavioral therapy, on inaccurate beliefs about burdensomeness, therefore leading to behavior change and improvements in mood and the alleviation of other problems.

The Interpersonal Needs Questionnaire’s (INQ) perceived burdensomeness subscale is the most widely used measure of burdensomeness (Van Orden, Cukrowicz, Witte, & Joiner, 2012). Though it includes items both related to suicide/death (i.e., feeling as if others would be better off if one was dead) and more general feelings of burdensomeness, items representing the most severe presentations of perceived burdensomeness are overrepresented due to the focus on suicide risk. In addition, though it exhibits adequate psychometric properties among older adults, the INQ was not originally developed specifically for the issues faced by older adults and there may be some differences in how burdensomeness presents in this age group compared to younger adults (Lutz & Fiske, 2017). The Self-Perceived Burden Scale (SPBS; Simmons, 2007) is a questionnaire designed to assess cancer patients’ own perceived burden on their caregivers. However, this and similar measures focus on a specific sub-population of patients with chronic conditions who require caregivers. Additionally, this measure was not designed specifically for older adults; the content is focused on the patient-caregiver relationship, rather than issues related to aging. Other questions and measures have been used to assess feelings about burdening others, such as the three-item measure of reluctance to burden others used by Winter and Parks (2011) to examine the association between concerns about burdensomeness and end-of-life decision making. The questions used in these studies have minimal data to support their reliability and validity and, similar to the INQ and SPBS, are designed around specific issues or sub-populations.

The purpose of this study was to develop a new measure of feelings of burdensomeness especially for older adults, which detects a wide range of feelings of burdensomeness, and examine its psychometric properties. Feelings of burdensomeness is defined as an older individual’s general subjective feeling of being a burden on or a problem for others. This is distinct from and broader than perceived burdensomeness as found in the suicide literature, where one perceives oneself as so much of a burden that one feels others would be better off if one was dead, and from self-perceived burden, which is relevant to individuals with chronic health conditions who have caregivers. The scope of this measure includes various contexts in which older adults may feel as if they are a burden (as demonstrated by studies cited above) – emotionally or psychologically burdensome, physiologically burdensome or causing detriment to others’ health, financially burdensome, burdensome to others’ time, and burdensome to society. Establishing this measure would allow measurement of a broader construct of burdensomeness that is relevant not only to suicidality or chronic illness but also several other important constructs in late life. Such a measure will allow for more research into the role of feelings of burdensomeness in late life.

We developed the Geriatric Feelings of Burdensomeness Scale (GFBS) in three steps – item development, an initial study to select final items, and a second study to examine the psychometric properties of the final measure. The approach taken for item and inventory development was consistent with that recommended by Clark & Watson (1995; 2019) and Devellis (2016). All studies were approved by the West Virginia University Institutional Review Board.

Item Development

Fifty-nine items were created to address the different ways in which people may feel like a burden on others (i.e., on others’ time, financially, physically, and emotionally or psychologically) and to whom they may feel like a burden (to loved ones or close others and to society in general). These item content categories and individual item content were based in part on the item content of current measures of perceived burdensomeness, self-perceived burden, and caregiver burden - the INQ (Van Orden et al., 2012), SPBS (Simmons, 2007), and Zarit Burden Interview (Zarit & Zarit, 1987) and a review of related literature.

Next, these items were sent to five experts for feedback on the content validity and wording of items. Experts were identified as authors who have published multiple studies in relevant related topics such as gerontology, perceived burdensomeness, and caregiver burden. Responses were received from four of the experts – two experts in the area of perceived burdensomeness and suicidality, one of whom is also an expert in late life issues; one in the area of caregiver burden; and one in the area of end-of-life issues. Experts were provided a definition of the intended construct and subsequently rated the relevance of each item to the construct on a scale from 1 (“not relevant”) to 5 (“very relevant”). Experts also provided general comments for improvement (e.g., need to address additional construct content, item wording). The majority (86%) of items that were rated on average above 2 on the 1 to 5 scale of relevance to the construct/topic (indicating the item was at least “somewhat relevant” to the construct) were retained in original or reworded form for the purpose of further assessing their psychometric properties in a sample of older adults. Other items were eliminated due to issues highlighted in the reviewers’ comments. Two of six items rated 2 or lower on average were retained for the next round of analyses based on the desire for adequate content validity. Based on the ratings and comments, 10 items were eliminated and others were reworded, for a new total of 49 items.

Item Selection

Method

Participants.

Participants were English-reading adults age 60 and older residing in the United States. Participants were recruited via Amazon Mechanical Turk (MTurk).

Procedure.

Participants responded to a study description advertised on MTurk. Interested participants were directed to the questionnaire on SurveyMonkey. First, participants read a cover page that provided informed consent information and indicated their consent by advancing to the next page. Participants completed the items and a brief demographics questionnaire.

To check for valid age reporting, participants were asked to provide their year of birth at the beginning and end of the survey. Participants also reported their age in years at the beginning of the survey. Consistency between age and year of birth and consistency between both year responses were examined (i.e., age and birth year match within 1 year and birth years reported at the beginning and end of the survey match).

At the conclusion of the survey, participants received a code to confirm participation and obtain payment through MTurk. This study was approved by the West Virginia University Institutional Review Board.

Measure.

The initial pool of 49 GFBS items was administered with a 5-point Likert-type scale with the anchors “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” and “strongly agree.” Items were coded 1 through 5, with higher scores indicative of greater feelings of burdensomeness.

Analyses.

Frequencies and distributions of responses on each of the items and correlations among all items were examined. Also, overall content validity and previous comments from experts informed decisions about item retention. Retention was based on a number of characteristics: 1) the item distribution was not excessively skewed and participants utilized the entire response scale; 2) the item had at least moderate correlations with other items; 3) items with very strong correlations were considered to be redundant or covering the same content area, and one representative item was retained; and 4) the item contributed to the overall content validity of the scale (i.e., all content areas listed above in Item Development were represented by retaining relevant items in each area). In addition, throughout the decision process, comments and feedback from the experts in the previous stage of development were considered.

Results

Sample characteristics.

Two hundred forty-three participants completed the MTurk survey. Of these participants, 218 were included in the analyses. Twenty-five (10%) were eliminated due to failure to meet the validity standards outlined above. Participants’ mean age was 64.42 (SD = 5.10), and the sample was 54% male and 85% white/Caucasian. The sample was well educated, with 49% having completed 4 or more years of college.

Item selection.

In the pool of 49 items, there were no excessively-skewed items (i.e., all skew values ˂ |2|), though the majority of items had some level of positive skew ranging up to 1.28. All items had responses ranging from 1 to 5, with no points on the scale being unused. Generally, items worded in the negative direction (e.g. “Other people benefit from interacting with me”), with the lower end of the scale indicating greater feelings of burden, were not utilized in a manner consistent with positively-oriented items. These negatively-oriented items had poor correlations with other items in the pool (i.e., all |r|s < .40, with the majority < .30). Therefore, only items worded in the positive direction (i.e., with the higher end of the scale indicating greater feelings of burden) were retained.

In total, 25 items were retained for the next stage of scale development, based on the method described above.

Reliability and Validity

Method

Procedure.

The second study used a procedure similar to that used in the first study. Participants completed the shortened version of the scale and a number of questionnaires that were included to obtain convergent and discriminant validity evidence for the GFBS. Participants first completed a demographics questionnaire. The order of the other questionnaires, except for the Geriatric Suicide Ideation Scale (GSIS), was randomized. The GSIS was administered last to allow for presentation of mental health referral information immediately afterwards. The same validity checks on age were used as in Study One. In addition, eight validity items were randomly distributed throughout the survey that prompted participants to provide a certain response to indicate that they thoroughly read the item (e.g.,“To check that you are reading the item, please select ‘True’”). If the participant responded incorrectly on more than one of these items, their data were not included in the final analyses.

Measures.

Demographic information including age, gender, racial/ethnic background, and education level was collected. The Interpersonal Needs Questionnaire-15, Beck Hopelessness Scale, and Geriatric Suicide Ideation Scale were administered to examine convergent validity evidence for the GFBS, and the Duke University Religion Index and Marlowe-Crowne Social Desirability Scale were administered to examine discriminant validity.

Geriatric Feelings of Burdensomeness Scale (GFBS).

The 25 retained items, now termed the GFBS, were administered. Responses were on the same 5-point Likert-type scale, for a total possible score of 25 to 125, with higher scores indicating greater feelings of burdensomeness.

Interpersonal Needs Questionnaire - 15 (INQ-15).

The INQ-15 measures the degree to which respondents feel as if their needs for belongingness are met (“thwarted belongingness”) and the degree to which they feel like a burden on others (“perceived burdensomeness”) (Van Orden et al., 2012). The measure comprises 15 self-report items, which respondents rate on a 7-point scale indicating how true each item is for them, ranging from 1 (“Not at all true”) to 7 (“Very true for me”). Higher scores indicate higher levels of thwarted belongingness and perceived burdensomeness. Items in the INQ-15 demonstrate good internal consistency among adult samples, α = .81–.90, and strong factorial validity (Hill & Pettit, 2014). Among two samples of older adults, the 6-item perceived burdensomeness subscale of the INQ-15 demonstrated similarly strong internal consistency reliability, α = .84–.94 (Lutz & Fiske, 2017). Convergent validity evidence was also established for this subscale through positive correlations with measures of depression, suicidal ideation, and hopelessness (Lutz & Fiske, 2017). Scores on the INQ-15 have been divided into the thwarted belongingness (INQ-TB) and perceived burdensomeness (INQ-PB) subscales.

Beck Hopelessness Scale (BHS).

The BHS is a 20-item self-report measure of hopelessness (Beck, Weissman, Lester, & Trexler, 1974). Respondents provide true-false ratings of each item. Responses to items are keyed as 0 or 1 based on whether they indicate a negative attitude about the future. Total scores range from 0 to 20, where higher scores indicate more hopelessness. Among older respondents, the measure demonstrates good internal consistency reliability (α = .85–.93), and validity evidence is provided by positive associations with measures of suicidality (r = .43) and depression (r = .51) among samples of older adults (Cukrowicz, Jahn, Graham, Poindexter, & Williams, 2013; Lutz & Fiske, 2017).

Duke University Religion Index (DUREL).

The DUREL measures religiosity through five self-report items (Koenig & Büssing, 2010). The measure provides three scores; the first two are the scores on the first two individual items, whereas the third is the total score on items 3 to 5. On the first item, respondents indicate on a 6-point scale the frequency with which they attend public religious activities, such as church services. Frequency ratings for this item range from 1 (“Never”) to 6 (“More than once a week”). The second item asks respondents to indicate on a 6-point scale the frequency with which they engage in private religious activities, such as prayer or meditation. Frequency ratings for this item range from 1 (“Rarely or never”) to 6 (“More than once a day”). The final three items measure intrinsic religiosity, such as experiencing the presence of a higher power, on a 5-point scale ranging from 1 (“Definitely not true of me”) to 5 (“Definitely true of me”). These items of intrinsic religiosity demonstrate adequate internal consistency reliability (α = .78–.91). Adequate convergent validity evidence was established through strong correlations with other religiosity measures (r = .71–.86; Koenig & Büssing, 2010).

Marlowe-Crowne Social Desirability Scale.

The shortened form C of the Marlowe-Crowne Social Desirability Scale (Reynolds, 1982) measures the extent to which respondents indicate allegiance to a socially desirable response style. Respondents rate 13 self-report items as true or false. Total scores range from 0 to 13 and higher scores indicate more socially desirable responding. Among an undergraduate sample, the instrument demonstrated good internal consistency reliability (Kuder-Richardson Formula 20 = 0.76) and a strong correlation with the original Marlowe-Crowne Social Desirability measure (r = .90; Reynolds, 1982).

Geriatric Suicide Ideation Scale (GSIS).

The GSIS measures suicidal ideation among older adults (Heisel & Flett, 2006). Respondents rate their agreement to 31 self-report items presenting a series of symptoms. Agreement responses range from 1 (“strongly disagree”) to 5 (“strongly agree”). Total scores range from 31 to 155 and higher scores indicate greater levels of suicidal ideation. Heisel & Flett (2006) found that the measure exhibited good internal consistency (a = .90–.93) and test-retest reliability (r = .86, intraclass correlation = .53–.81) with older adult samples. Evidence for convergent validity was demonstrated through moderate to strong correlations with the Geriatric Depression Scale (r = .43–.77) and Beck Scale for Suicide Ideation (r = .62) among an older adult sample.

Results

Sample characteristics.

Two hundred twenty-nine participants completed the MTurk survey. Of these participants, 192 were included in the analyses. Thirty-seven (16%) were eliminated due to failure to meet validity standards as described in the method. Participants’ mean age was 63.93 (SD = 3.82), and the sample was 50% female and 80% white/Caucasian. The sample was well-educated, with 54% having completed 4 or more years of college. For each of the individual analyses, pairwise deletion was used for missingness, such that if participants had complete data on the variables included in a given analysis, their data were included.

Item and total score distributions.

Individual item distributions were again examined among this sample. All points of the scale were utilized for each item. See Table 1 for item-level descriptive statistics. Items exhibited some positive skew, but not excessive (skews ranged up to 1.65).

Table 1.

Descriptive Statistics of Individual Items on the GFBS

Item n Mean S.D. Skew Kurtosis Corrected item-total correlation (n = 182)
1 192 2.39 1.21 0.50 −0.85 .49
2 190 1.93 1.03 1.01 0.35 .78
3 192 2.51 1.33 0.32 −1.17 .50
4 192 1.89 1.03 1.09 0.41 .80
5 191 1.84 1.07 1.15 0.33 .79
6 191 1.76 1.07 1.38 0.96 .75
7 192 1.82 1.14 1.32 0.73 .75
8 192 1.70 0.95 1.28 0.80 .81
9 192 1.66 0.96 1.65 2.36 .74
10 191 1.76 1.02 1.38 1.23 .80
11 192 2.04 1.13 0.86 −0.27 .81
12 192 2.07 1.22 0.90 −0.37 .68
13 191 1.87 1.09 0.99 −0.12 .68
14 192 1.86 1.04 0.94 −0.26 .77
15 191 1.91 1.06 0.97 0.02 .69
16 190 1.89 1.11 1.05 0.07 .89
17 191 1.92 1.10 0.93 −0.35 .80
18 192 2.04 1.16 0.78 −0.59 .81
19 192 1.92 1.14 1.14 0.36 .82
20 190 1.97 1.14 1.00 0.03 .69
21 192 1.93 1.12 1.02 −0.03 .83
22 191 1.80 1.06 1.37 1.19 .75
23 191 1.84 1.06 1.20 0.71 .72
24 192 1.78 0.94 1.07 0.41 .81
25 192 1.77 1.04 1.44 1.41 .74
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Note. S.D. = standard deviation. Standard error for skew estimates is 0.18, and standard error for kurtosis estimates is 0.35.

Total scores ranged from 25 to 110, with 14% of the sample scoring 25. The distribution of total scores was relatively normally-distributed, with skew of .66 and kurtosis of −.61. This was compared to scores on the INQ-PB, which evidenced more skewed responses representative of a floor effect. Total scores on this subscale ranged from 6 to 40, with 60% of respondents scoring 6, and the distribution was somewhat skewed (skew = 1.48). See Figure 1 to visually compare the distributions of responses on these two measures.

Figure 1.

Figure 1.

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Comparison of distributions of scores on A) the Geriatric Feelings of Burdensomeness Scale (GFBS) and B) the Interpersonal Needs Questionnaire Perceived Burdensomeness subscale (INQ-PB). GFBS scores are less skewed, with greater distribution of scores across the full range of total scores.

Internal reliability.

Cronbach’s alpha was .97 for the GFBS. Inter-item correlations ranged from r = .26 to .84, with an average inter-item correlation of r = .58; item-total correlations ranged from r = .49 to .83 (see Table 1; Clark & Watson, 1995).

Convergent and discriminant validity.

See Table 2 for correlations among all measures. Total scores on the GFBS were very strongly positively correlated with INQ-PB and GSIS scores, and also strongly positively correlated with BHS and GDS scores (strength of correlations based on criteria by Cohen, 1988). The GFBS had a small but significant positive correlation with the SDS, and was not significantly correlated with the DUREL. Correcting alpha cut-offs for multiple correlations using the Bonferroni method (.05 / 9 correlations between GFBS and validity measures = .006), the correlation with the SDS was no longer statistically-significant, while the correlations with INQ-PB, BHS, and GDS remained statistically significant.

Table 2.

Correlations and Means of Study Measures

1 2 3 4 5 6 7 8 9 10
1. GFBS - .83*** .62*** .80*** .69*** .63*** −.23** −.07 −.13 −.13
2. INQ-PB - .66*** .80*** .67*** .63*** −.19* −.01 −.05 −.09
3. INQ-TB - .70*** .75*** .71*** −.32*** −.17* −.07 −.10
4. GSIS - .75*** .72*** −.27*** −.08 −.11 −.13
5. GDS - .79*** −.36*** −.13 −.04 −.12
6. BHS - −.28*** −.19* −.11 −.18*
7. SDS - .18* .16* .22**
8. DUREL1 - .62*** .69***
9. DUREL2 - .75***
10. DUREL3-5 -
N 182 190 188 177 183 187 186 191 190 191
Mean 48.11 11.09 24.36 58.94 4.08 5.22 9.92 2.49 2.83 8.47
SD 20.90 8.17 12.74 24.92 3.99 4.81 3.85 1.67 1.92 4.59
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Note. GFBS = Geriatric Feelings of Burdensomeness Scale; INQ = Interpersonal Needs Questionnaire; PB = INQ Perceived Burdensomeness subscale of INQ; TB = INQ Thwarted Belongingness subscale; GSIS = Geriatric Suicide Ideation Scale; GDS = Geriatric Depression Scale; BHS = Beck Hopelessness Scale; IPIP = International Personality Item Pool; SDS = Social Desirability Scale; DUREL = Duke University Religion Index; DUREL1 = attendance at public religious activities; DUREL2 = participation in private religious activities; DUREL3-5 = intrinsic religiosity.

*

p < .05

**

p < .01

***

p < .001

Exploratory factor analysis.

Though this measure is intended to be used in total (i.e., no designated or intended subscales), we conducted an exploratory factor analysis to examine the dimensionality of the measure. Using principal axis factoring with a promax (oblique) rotation allowing factors to correlate, we found that while three factors fit the data best based on a combination of eigenvalues greater than 1 (Factor 1: 15.005, Factor 2: 1.470, Factor 3: 1.016) and scree plot showing flattening following the third factor, the factors were strongly correlated (see Table 3) with several items loading highly on multiple factors. These results support the use of a total score rather than scores for the individual factors.

Table 3.

Exploratory Factor Analysis of GFBS

Item Factor 1 Factor 2 Factor 3
1. financially difficult −.134 .382 .299
2. burden on others −.034 .423 .478
3. feel bad about self −.180 .812 −.062
4. weigh down people −.003 .439 .458
5. more trouble than worth −.167 .385 .670
6. burden on society −.137 .227 .750
7. happier without me .049 −.025 .808
8. not enough time for themselves .413 −.216 .699
9. neglect health .519 −.266 .571
10. make things harder .218 .346 .338
11. worry about trouble I cause .267 .682 −.031
12. bothered by being a burden .031 .695 .042
13. feel guilty financially .262 .464 .038
14. physically difficult .217 .088 .551
15. give up other plans .518 .132 .123
16. make things worse .305 .184 .504
17. create problems for others .344 .323 .235
18. tired of bringing others down .285 .683 −.053
19. cause a lot of stress .296 .543 .082
20. spend a lot of money .785 .110 −.126
21. make others tired .456 .328 .140
22. cause conflict .665 .042 .123
23. spend a lot of time 1.040 −.055 −.170
24. take up others’ time .803 .020 .085
25. cause strain in relationships .721 −.116 .225
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Note. Pattern matrix for principal axis factoring with promax rotation. Correlation Factor 1 & Factor 2 r =.707; Factor 1 & Factor 3 r = .763; Factor 2 & Factor 3 r = .740. Factor 1 accounted for 60.02% of variance, Factor 2 accounted for 5.88%, and Factor 3 accounted for 4.06%.

Discussion

This paper describes the development and initial psychometric evaluation of a new measure of feelings of burdensomeness for older adults. The GFBS was developed to assess feelings of being a burden on loved ones, family members, or society in general. The GFBS is intended to provide clinicians and researchers with a more general and inclusive assessment tool to measure an individual’s feelings of burdensomeness. The measure differs from previous measures such as the INQ and Self-Perceived Burden Scale in two ways. First, it assesses a wider range of feelings of burdensomeness, as opposed to more specifically-focused forms of burdensomeness measures such as the INQ. Second, the GFBS was developed specifically with older adults. This study provides evidence that the GFBS is more sensitive to distinguishing varying levels of feelings of burdensomeness at the less extreme end of the spectrum, and therefore provides greater opportunity for examining associations between a wide range of feelings of burdensomeness and psychosocial outcomes in older adults.

The results of the multi-phase study provide reliability and validity evidence for the GFBS. The GFBS total score had strong positive correlations with measures of depressive symptoms, hopelessness, suicidality, and a measure of perceived burdensomeness, providing convergent validity evidence. The scale was not significantly correlated with participant religiosity, providing discriminant validity evidence. Scores on the GFBS had a small association with social desirability. Though it is unclear what contributed to the association between the GFBS and social desirability, the desire to be perceived by others in a positive light may be associated with feeling more like a burden when they require assistance from others.

The current measure taps into greater variation in a broader construct of general feelings of burdensomeness than previously developed measures of burdensomeness. The current measure includes broader item content and is reflective of a wider conceptualization of the construct of burden, as demonstrated by the wider distribution of responses (see Figure 1), though it also demonstrates an association with the more specific construct of perceived burdensomeness. Also, the wide range of participant response totals and use of the entire response scale was found in a non-clinical, community-dwelling population, and exhibited associations with several psychological variables, including depression and suicidality. These findings suggest that associations found between burdensomeness and other psychological variables are applicable even when examining less extreme degrees of burdensomeness and burdensomeness around broader issues of aging, and thus the importance of the ability to detect wider variation in feelings of burdensomeness in late life.

The studies are not without limitations. While IRT analysis was not used for item development, it an approach that could be used to further refine the item content of the GFBS. Participants were recruited via Amazon Mechanical Turk, which potentially limits the generalizability of the findings. As a function of collecting data through MTurk, participants in the current studies were limited to older adults with access to computing resources and who are potentially more technologically savvy than other older adults. However, while the sample of participants in the present study does have a greater percentage of young -old than old-old and oldest-old adults, which is consistent with the general US population. Current US census figures suggest that most older adults are in the age range of 65–69 (5.4%), with decreasing percentages through the age of 85. Nevertheless, further research that includes older samples (e.g. ages 75 and older) would extend the generalizability of the findings across ages. Participants were mostly white/Caucasians and well-educated, which limits the ability to generalize the current findings to ethnic minority populations or participants with lower educational attainment.

The utilization of items keyed in the same direction (i.e., higher agreement representing greater levels of feelings of burdensomeness) may be seen as a limitation of the measure. However, studies on other measures have demonstrated that older adults tend to respond disparately on oppositely-keyed items (e.g., the CES-D; Carlson et al., 2011). Based on these past studies and disparate patterns in responding on such items in the current study, oppositely-keyed items were removed.

The present study described the development and testing of a novel measure to assess feelings of burdensomeness. Future research could expand on the results of these studies to examine the psychometric properties of this measure in older adults with varying levels of physical and cognitive impairment, as these studies utilized samples of community-dwelling older adults. The clinical utility of the GFBS remains to be determined. A better understanding of burdensomeness and its relation to relevant clinical variables is needed. This is something that could be explored in the future and that could enable us to move forward on understanding burdensomeness in a range of contexts. However, with the use of the GFBS, future research could expand our knowledge of how feelings of burdensomeness are associated with clinically-relevant issues related to well-being in late life, such as help seeking, engagement in care, social connectedness, and anxiety.

Clinical Implications.

  • Feelings of burdensomeness are relevant to many aging-related issues.

  • Existing measures of feelings of burdensomeness were not originally designed for older adults, and focus on specific sub-populations (e.g., those with suicidal ideation, those with chronic illnesses who have caregivers, those making end-of-life decisions).

  • The Geriatric Feelings of Burdensomeness Scale (GFBS) is a more general and inclusive assessment tool that measures a range of feelings of burdensomeness, and demonstrates good psychometric properties among community-dwelling older adults.

Acknowledgments

Supported by funding from the National Institute of Mental Health T32 MH020061.

Appendix. Geriatric Feelings of Burdensomeness Scale

Please think about whether each item applies to you, and select the extent to which you agree with each item.

1. It is financially difficult for my loved ones to care for me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
2. I am a burden on others.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
3. Being a burden makes me feel bad about myself.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
4. I weigh down other people with my problems.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
5. I am more trouble than I am worth.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
6. I am a burden on society.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
7. My loved ones would be happier without me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
8. My loved ones don’t have enough time for themselves because of me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
9. My friends and family neglect their own health to help me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
10. I make things harder on my family and friends.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
11. I worry about the trouble I cause other people.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
12. I am bothered by being a burden on others.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
13. I feel guilty that my family has to care for me financially.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
14. It is physically difficult for my loved ones to care for me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
15. My friends and family give up other plans to help me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
16. I make things worse for other people.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
17. I create problems for others.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
18. I am tired of bringing others down.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
19. I cause other people a lot of stress.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
20. My family spends a lot of money on me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
21. I think being around me makes others tired.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
22. I cause conflict in my family.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
23. My family spends a lot of time caring for me.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
24. I take up a lot of other people’s time.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
25. I cause strain in my loved ones’ relationships.
Strongly disagree  Disagree  Neither Agree nor disagree  Agree Strongly agree
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Footnotes

Declaration of Interest

The authors have no conflicts of interest to disclose.

References

  1. Beck AT, Weissman A, Lester D, & Trexler L (1974). The measurement of pessimism: the hopelessness scale. Journal of consulting and clinical psychology, 42(6), 861. doi: 10.1037/h0037562 [DOI] [PubMed] [Google Scholar]
  2. Beresford P (2013, June 26). Older people don’t want to be passive recipients – they want to get involved. The Guardian. Retrieved from http://www.theguardian.com/social-care-network/2013/jun/26/older-people-passive-get-involved
  3. Carlson M, Wilcox R, Chou C, Chang M, Yang F, … & Clark F (2011). Psychometric properties of reverse-scored items on the CES-D in a sample of ethnically diverse older adults. Psychological Assessment, 23, 558–562. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chouliara Z, Kearney N, Stott D, Molassiotis A, & Miller M (2004). Perceptions of older people with cancer of information, decision making and treatment: A systematic review of selected literature. Annals of Oncology, 15(11), 1596–1602. [DOI] [PubMed] [Google Scholar]
  5. Clark L, & Watson D (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309–319. [Google Scholar]
  6. Clark L, & Watson D (2019). Constructing validity: New developments in creating objective measuring instruments. Psychological Assessment, 31(12):1412–1427. doi: 10.1037/pas0000626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cohen J (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers. [Google Scholar]
  8. Cukrowicz KC, Jahn DR, Graham RD, Poindexter EK, & Williams RB (2013). Suicide risk in older adults: Evaluating models of risk and predicting excess zeros in a primary care sample. Journal of Abnormal Psychology, 122, 1021–1030. doi: 10.1037/a0034953 [DOI] [PubMed] [Google Scholar]
  9. Delgado-Guay MO, De La Cruz MG, & Epner DE (2013). ‘I don’t want to burden my family’: Handling communication challenges in geriatric oncology, Annals of Oncology, 24, 30–35. [DOI] [PubMed] [Google Scholar]
  10. Devillis RF (2016). Scale development: Theory and applications. (4th ed.). Sage. [Google Scholar]
  11. Filiberti A, Ripamonti C, Totis A, Ventafridda V, De Conno F, Contiero P, & Tamburini M (2001). Characteristics of terminal cancer patients who committed suicide during a home palliative care program. Journal of Pain and Symptoms Management. 22, 544–553. [DOI] [PubMed] [Google Scholar]
  12. Griffiths KM, Crips DA, Barney L, & Reid R (2011). Seeking help for depression from family and friends: A qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry, 11, 196–207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Heisel MJ, & Flett GL (2006). The development and initial validation of the Geriatric Suicide Ideation Scale. The American Journal of Geriatric Psychiatry, 14(9), 742–751. doi: 10.1097/01.jgp.0000218699.27899.f9 [DOI] [PubMed] [Google Scholar]
  14. Hill RM, & Pettit JW (2014). Perceived burdensomeness and suicide-related behaviors in clinical samples: Current evidence and future directions. Journal of Clinical Psychology, 70(7), 631–643. doi: 10.1002/jclp.22071 [DOI] [PubMed] [Google Scholar]
  15. Iskandarsyah A, de Klerk C, Suardi DR, Soemitro MP, Sadarjoen SS, & Passchier J (2014). Psychosocial and cultural reasons for delay in seeking help and nonadherence to treatment in Indonesian women with breast cancer: A qualitative study. Health Psychology, 33(3), 214–21. doi: 10.1037/a0031060 [DOI] [PubMed] [Google Scholar]
  16. Jahn DR, Cukrowicz KC, Linton K, & Prabhu F (2011). The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging & Mental Health, 15, 214–220. [DOI] [PubMed] [Google Scholar]
  17. Jahn DR, Van Orden KA, & Cukrowicz KC (2013). Perceived burdensomeness in older adults and perceptions of burden on spouses and children. Clinical Gerontologist, 36, 451–459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Joiner T (2005). Why People Die By Suicide. Cambridge, MA: Harvard University Press. [Google Scholar]
  19. Joiner TE, Pettit JW, Walker RL, Voelz ZR, & Cruz J (2002). Perceived burdensomeness and suicidality: Two studies on the suicide notes of those attempting and those completing suicide. Journal of Social and Clinical Psychology, 21, 531–545. [Google Scholar]
  20. Juratovac E, Morris DL, Zauszniewski JA, & Wykle ML (2012). Effort, workload, and depressive symptoms in family caregivers of older adults: Conceptualizing and test a work-health relationship. Research and Theory for Nursing Practice: An International Journal, 26(2), 74–94. [DOI] [PubMed] [Google Scholar]
  21. Koenig HG, & Büssing A (2010). The Duke University Religion Index (DUREL): a five-item measure for use in epidemological studies. Religions, 1(1), 78–85. doi: 10.3390/rel1010078 [DOI] [Google Scholar]
  22. Kogan J, & Edelstein B (2004). Modification and psychometric examination of a self-report measure of fear in older adults. Journal of Anxiety Disorders, 18, 397–409. [DOI] [PubMed] [Google Scholar]
  23. Lutz J, & Fiske A (2017). Perceived Burdensomeness in Older and Younger Adults: Evaluation of the Psychometric Properties of the Interpersonal Needs Questionnaire. Journal of clinical psychology, 73(9), 1179–1195. doi: 10.1002/jclp.22415 [DOI] [PubMed] [Google Scholar]
  24. Lyberg A, Holm AL, Lassenius E, Bergrren I, & Severinsson E (2013). Older persons’ experiences of depressive ill-health and family support. Nursing Research and Practice, 1–8. [DOI] [PMC free article] [PubMed]
  25. Marty MA, Segal DL, Coolidge FL, & Klebe KJ (2012). Analysis of the psychometric properties of the Interpersonal Needs Questionnaire (INQ) among community-dwelling older adults. Journal of Clinical Psychology, 68, 1008–1018. [DOI] [PubMed] [Google Scholar]
  26. Pinquart M & Sorensen S (2011). Spouses, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison. Psychology and Aging, 26(1), 1–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Reynolds WM (1982). Development of reliable and valid short forms of the Marlowe-Crowne Social Desirability Scale. Journal of clinical psychology, 38(1), 119–125. [Google Scholar]
  28. Simmons LA (2007). Self-perceived burden in cancer patients: Validation of the Self-perceived Burden Scale. Cancer Nursing, 30(5), 405–411. doi: 10.1097/01.NCC.0000290816.37442.af [DOI] [PubMed] [Google Scholar]
  29. Van Orden KA, Cukrowicz KC, Witte TK, & Joiner TE Jr (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological assessment, 24(1), 197. doi: 10.1037/a0025358 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Winter L, & Parks SM (2011). The reluctance to burden others as a value in end-of-life decision making: A source of inaccuracy in substituted judgment. Journal of Health Psychology, 17(2), 179–188. doi: 10.1177/1359105311414956 [DOI] [PubMed] [Google Scholar]
  31. Zarit SH, & Zarit JM (1987). The Memory and Behavior Problems Checklist and the Burden Interview. Technical Report. University Park: Pennsylvania State University. [Google Scholar]

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