Prevalence and Severity of Depression Among Primary Family Caregivers of Patients Admitted in Medical and Surgical Intensive Care Units (ICUs) Using the Patient Health Questionnaire-9 (PHQ-9): A Multicenter Cross-Sectional Study at Tertiary Care Hospitals in Pakistan

PURPOSE In Pakistan, strong familial bonds make family members as primary caregivers for patients admitted to intensive care units (ICUs). Despite continuous multidisciplinary care in ICUs, caregivers’ mental health needs are often overlooked, creating a significant psychological burden alongside critical decision-making responsibilities. This multicenter cross-sectional study assessed the prevalence and severity of depression among primary caregivers of ICU patients in tertiary-care hospitals in Karachi, Pakistan. METHOD This study was conducted from February to July 2025 in the ICUs of Jinnah Postgraduate Medical Centre (JPMC), Liaquat National Hospital (LNH), and Civil Hospital Karachi (CHK). A total of 161 primary caregivers of medical and surgical ICU patients were enrolled. Participants completed the validated Urdu version of the Patient Health Questionnaire-9 (PHQ-9) and provided sociodemographic as well as clinical data. Eligible participants were first-degree relatives or friends able to communicate in English, Urdu, or Sindhi. Data were analyzed using SPSS version 26 with descriptive statistics, chi-square tests, and multivariable linear regression to identify independent factors associated with PHQ-9 scores. RESULTS The median PHQ-9 score was 6 (IQR: 2–11). Depression severity included 41.6% minimal, 25.5% mild, 19.3% moderate, 9.9% moderately severe depression, and 3.7% severe depression. On multivariable linear regression, admission to a medical ICU, patient mechanical ventilation, and a higher number of caregiver comorbidities were independently associated with higher PHQ-9 scores. Sleep disruption and witnessing other patients’ suffering were strongly associated with increased depressive symptoms. CONCLUSION Primary family caregivers of ICU patients experience a substantial burden of depressive symptoms, highlighting the need for targeted psychological support, language-sensitive communication, and institutional policies addressing caregiver mental health in resource-limited settings.