The Severity of Perceived Stress Among Primary Family Caregivers of Patients Admitted in Medical and Surgical Intensive Care Units (ICUs): A Multicenter Cross-sectional Study at Tertiary Care Hospitals in Pakistan

Background 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. Methods 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. Results Most caregivers reported moderate stress (65.8%), while 24.8% had low and 9.3% high stress. Female caregivers experienced significantly higher stress than males (p = 0.0266), and those with comorbidities had elevated stress (40.0%, p = 0.0188). Caregivers of medical ICU patients reported greater stress than those in surgical ICUs (p = 0.0002). Patient diagnoses of sepsis, severe infection, and neurological conditions strongly predicted moderate stress (odds ratios 28.50 and 16.50). Previous hospitalizations and ICU admissions were also associated with higher caregiver stress. Notably, 51.2% reported that their psychological distress was not addressed, and 65.4% had unmet mental health needs. Conclusions Caregivers of critically ill patients in Pakistan 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 psychological support to reduce caregiver burden and enhance patient care in low-resource settings.