Affiliate stigma among family caregivers of people with mental disorders: results from a national survey in Italy

Purpose: Affiliate stigma-the internalization of public stigma by family caregivers of people with mental disorders-has been associated with emotional distress, burden, and reduced well-being. However, evidence from European contexts remains limited, and no national studies have been conducted in Italy. This study aimed to (1) assess levels of affiliate stigma among Italian family caregivers and (2) identify sociodemographic, relational, and psychological determinants of stigma. Methods: A cross-sectional online survey was conducted in Italy among 508 caregivers of people with mental disorders recruited through national and regional family associations. Measures included the Affiliate Stigma Scale (ASS), the Involvement Evaluation Questionnaire (IEQ), the Manchester Short Assessment of Quality of Life (MANSA), and the Three-Item Loneliness Scale (TILS). Multivariate linear regression was used to identify determinants of affiliate stigma. Results: Caregivers reported moderate levels of affiliate stigma, with the affective dimension scoring highest. The multivariate model explained 27.2% of the variance in ASS total scores. Higher affiliate stigma was independently associated with female sex (β = 0.331, p = 0.004), non-acceptance of diagnosis by the relative (β = 0.251, p = 0.011), psychotic disorder diagnosis (β = 0.233, p = 0.011), absence of contact in the last four weeks (β = 0.391, p < 0.001), loneliness (β = 0.263, p < 0.001), psychological distress (β = 0.196, p < 0.001), and caregiver burden (β = 0.149, p = 0.002). Conclusion: Affiliate stigma is a significant component of the caregiving experience in Italy and is associated with a range of emotional, relational, and caregiving-related factors. Findings underscore the need for stigma-informed, family-centred interventions that address caregivers' psychological well-being, social connectedness, and support needs. Longitudinal studies are needed to clarify temporal relationships and inform targeted strategies within community mental health services.