Abstract Background: Expressed emotion refers to the attitudes, feelings, and behavioral responses exhibited by family caregivers toward individuals living with schizophrenia. Expressed emotion typically manifests through frequent criticism, hostility, or emotional over- involvement from family members, which can increase psychological stress, exacerbate symptoms, and impair emotional regulation. Objectives: The aim of this study is to assess the prevalence and associated factors of high expressed emotion among caregivers of people with severe mental illness who attends psychiatric service unit of specialized hospitals found in Bahir Dar city, in 2025/2026. Method: Hospital based cross sectional study, with sample size of 419 was be conducted from January to February,2026 using proportional sampling from the 2 comprehnsive spesialized hospitals and systematic sampling was be used in each hospital. Family questionnaire was used to assess the prevalence of expressed emotion. Data were collected by electronics kobo tool software and exported to STATA version 14 for analysis. Binary logistic regression and multivariable logistic regression analysis were used to identify factors associated with high expressed emotion. Model fitness was checked using Hosmer- Lemeshow goodness of fit test. Adjusted odds ratio at 95% confidence interval and p-values < 0.05 were used to declare significant association. Result: This study found that the overall prevalence of high expressed emotion was 39.86% with (95%CI:35.15, 44.56). This study revealed that social support (AOR= 3.67; 95%CI: 1.56, 8.63), severity of illness, perceived burden (AOR= 5.61; 95%CI:2.63, 11.98), perceived stigma (AOR: 2.16; 95%CI:1.14, 4.11), poor medication adherence (AOR= 3.69; 95%CI:1.35, 8.72), schizophrenia (AOR= 2.17; 95%CI:1.05, 4.47), and daily caregiving hours (AOR= 3.20; 95%CI:1.38, 7.42) were factors significantly associated with high expressed emotion. Conclusion: This study found that the prevalence of high expressed emotion among caregivers of people living with severe mental illness was high. High expressed emotion was significantly associated with poor social support, severity of patient illness, perceived caregiving burden, perceived stigma, patient medication non-adherence, and prolonged daily caregiving hours.