Post-Traumatic Stress Disorder in ICU Survivors

Survival rates in intensive care have improved, but about 20% of ICU survivors develop post-traumatic stress disorder (PTSD), which often goes undiagnosed and can severely impact quality of life, work, and health. Contributing factors include life-threatening experiences, invasive treatments, isolation, and loss of control. Early screening and targeted interventions are crucial to reduce long-term psychiatric complications.

Although awareness of PTSD after ICU care is growing, access to effective treatments like cognitive behavioural therapy and eye movement desensitisation and reprocessing (EMDR) remains limited due to wait times and workforce shortages. Since many patients re-engage with the healthcare system through general practitioners (GPs), primary care could play a key role in early identification and support. However, structured PTSD interventions in primary care settings are still largely lacking.

A recent study addressed the lack of primary care PTSD interventions by testing a brief, GP-led narrative exposure therapy for ICU survivors. Conducted across 319 general practices in Germany, the randomised controlled trial involved three structured GP consultations and eight nurse follow-ups. The primary outcome measured was PTSD symptom severity at six months using the PDS-5 scale, with a six-point change considered clinically meaningful.

The study found the GP-led intervention to be feasible, with over 90% of GPs following the structured protocol. Nearly one-third of patients in the intervention group experienced over a 50% reduction in PTSD symptoms, compared to 12.6% in the control group. Despite being brief and low-intensity, the intervention led to clinically meaningful improvements and also showed benefits in depression, disability, and quality of life, suggesting broader psychosocial impacts.

While the intervention showed promising results, it did not meet the predefined six-point threshold for clinical significance in PTSD symptom reduction. At six and twelve months, group differences were 4.7 and 5.4 points, respectively. The intervention also failed to significantly affect core PTSD symptoms like avoidance and hyperarousal. This suggests that while narrative therapy may help with cognitive-affective symptoms, additional exposure-based or emotionally activating components may be needed to fully address the range of PTSD symptoms.

Despite only moderate treatment effects, the intervention’s value lies in its scalability and accessibility, making it a promising step towards developing trauma-informed care in primary care settings, particularly where specialist resources are limited.

Integrating structured PTSD interventions and trauma-informed principles into GP training, including brief screening tools and stepped care models, could help address the mental health burden, especially in underserved areas. In addition, embedding trauma insights into routine care, such as anticipatory guidance and validating trauma-related symptoms, may further improve recovery and resilience.

Addressing PTSD in ICU survivors requires a comprehensive approach, including improved coordination between ICU and primary care, early integration of trauma-informed diagnostics in the treatment process, and preventive measures during ICU stays.

The PICTURE trial marks a significant step in trauma-informed primary care by bridging acute care and long-term psychotherapeutic support. While not a substitute for specialised psychiatric treatment, this approach offers a practical way to reduce the psychological burden of critical illness. Delivering low-risk psychotherapy in a familiar setting is valuable, but feasibility should not be the sole measure of success. Future research should refine these interventions, improving therapy content, care delivery, and integration into healthcare systems to enhance effectiveness.

Source: BMJ

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