Severity of perceived stress among primary family caregivers of patients admitted to medical and surgical intensive care units (ICUs) at tertiary care hospitals in Pakistan

Primary caregivers of critically ill ICU patients experience substantial psychological stress, yet this burden remains understudied in lower middle-income countries such as Pakistan. This study assessed the magnitude and predictors of perceived stress among primary family caregivers of patients admitted to medical and surgical ICUs at three tertiary care hospitals in Karachi. A cross-sectional study was conducted among 161 primary caregivers at Jinnah Postgraduate Medical Center, Civil Hospital Karachi, and Liaquat National Hospital. Data were collected through interviews using the Perceived Stress Scale (PSS-10; range 0–40). Ethical approval and informed consent were obtained. Univariable multinomial logistic regression identified factors associated with stress levels, followed by multivariable multinomial logistic regression including significant or clinically relevant predictors. Overall, 65.8% experienced moderate stress (n = 106), 24.8% (n = 40) low stress, and 9.3% (n = 15) high stress. Female caregivers experienced significantly higher stress than males (p = 0.03), and those with comorbidities had elevated stress (40.0%, p = 0.02). Caregivers of medical ICU patients reported greater stress than those in surgical ICUs (p < 0.001). Sepsis, severe infection, and neurological diagnoses predicted moderate stress. Previous hospitalizations and ICU admissions were also associated with higher caregiver stress. Over half reported unaddressed psychological distress (51.2%, n = 82), and 65.4% (n = 104) had unmet mental health needs. After adjustment, medical ICU admission, caregiver comorbidities, and prior ICU admission independently predicted higher stress. Caregivers of critically ill patients experience clinically significant stress, particularly those caring for medical ICU patients and those with comorbidities. High level of unmet psychological needs highlights the urgent requirement for improved communication, targeted interventions, and the integration of psychological support in routine ICU protocols. This could help reduce caregiver burden and enhance patient care in low-resource settings.