Difficulty Paying for Medical Care: Associations With Psychological Distress and Perceptions of Healthcare Among ICU Caregivers

Objectives: – Examine ICU caregivers’ experience of patient-related financial strain and its association with caregiver psychological distress (i.e., posttraumatic stress, anxiety, and depressive symptoms) and healthcare perceptions (i.e., medical mistrust, decisional regret). Design: – Cross-sectional secondary analysis using baseline data from an ongoing, multicenter randomized controlled trial intervention study (ClinicalTrials.gov identifier NCT05587517). Setting: – Three medical ICU sites in the United States. Subjects: – Family caregivers (n = 97) of patients in medical ICUs admitted from October 2022 to December 2025, with a mean age of 52.32 years, of whom 67 (69.1%) were female, and 42 (43.3%) were the spouse/partner of the patient. Interventions: – None. Measurements and Main Results: – Caregivers completed measures assessing degree of difficulty paying for patient medical care, posttraumatic stress symptoms, anxiety symptoms, depressive symptoms, medical mistrust, and decisional regret. Analyses found 63.9% participants reported difficulty paying for patient medical care and that financial strain was positively associated with severity of posttraumatic stress symptoms (r = 0.35; p < 0.001; 95% CI, 0.15–0.52), anxiety symptoms (r = 0.22; p < 0.05; 95% CI, 0.02–0.41), depressive symptoms (r = 0.27; p < 0.01; 95% CI, 0.07–0.45), decisional regret (r = 0.30; p < 0.05; 95% CI, 0.03–0.52), and medical mistrust (r = 0.30; p < 0.01; 95% CI, 0.10–0.48). Conclusions: – Over half of ICU caregivers endorsed difficulty paying for patient medical care. Caregivers with greater difficulty paying for patient medical care had more severe posttraumatic stress symptoms, anxiety symptoms, and depressive symptoms; greater decisional regret; and higher levels of medical mistrust.