The Role of Family Needs in Emotional Distress Among Next of Kin of Critically Ill Patients: A Cross‐Sectional Study

BACKGROUND: Next of kin of critically ill patients frequently experience distress. Although family needs have been associated with psychological outcomes, their potential role as a pathway linking clinical and relational factors to emotional distress remains poorly understood. AIM: To examine whether family needs mediate the relationships between ventilatory support, relationship to the patient and emotional distress among the next of kin of critically ill patients. STUDY DESIGN: A cross-sectional study was conducted in an adult Intensive Care Unit in Portugal between September 2024 and February 2025. Emotional distress was assessed using the Depression, Anxiety and Stress Scales-21 and family needs using the Family Needs Inventory in the Intensive Care Unit. Mediation analysis was performed using maximum likelihood estimation with bias-corrected bootstrap confidence intervals (5000 resamples). The study followed the A Guideline for Reporting Mediation Analyses (AGReMA) Statement. RESULTS: Data from 130 critically ill patient-next of kin dyads were analysed. Next of kin of patients receiving invasive mechanical ventilation and those with closer relational proximity (spouses and sons/daughters) reported significantly higher emotional distress (p < 0.001). Family needs statistically mediated the relationship between ventilatory support and emotional distress (β = 2.386, p = 0.006), and between the relationship to the patient and emotional distress (β = 2.384, p = 0.012). Family needs were a significant predictor of emotional distress (β = 0.232, p < 0.001). The model explained 36.5% of the variance in emotional distress. CONCLUSIONS: Emotional distress among next of kin of critically ill patients was associated with clinical and relational factors. Family needs were identified as a significant mediating factor in these relationships, suggesting that they may represent an explanatory pathway linking critical illness experiences to psychological distress. RELEVANCE TO CLINICAL PRACTICE: Systematic assessment of family needs may help identify relatives at greater risk of emotional distress. Structured communication, emotional support and family involvement may help improve family-centred care in intensive care settings.