Patient perspectives on stress after ICU and a short primary care based psychological intervention – results from a qualitative sub‑study of the PICTURE trial
Authors: Beutel Antina , Sanftenberg Linda , Friemel Chris M. , Kosilek Robert Philipp , Schauer Maggie , Elbert Thomas , Reips Ulf-Dietrich , Schubert Tomke , Gehrke-Beck Sabine , Schmidt Konrad , Gensichen Jochen ,   for the PICTURE study group, Adrion Christine , Angstwurm Matthias , Bergmann Antje , Bielmeier Gerhard , Bischhoff Andrea , Bogdanski Ralph , Brettner Franz , Brettschneider Christian , Briegel Josef , Bürkle Martin , Dohmann Johanna , Falkai Peter , Felbinger Thomas , Fisch Richard , Förstl Hans , Fohr Benjamin , Franz Martin , Friederich Patrick , Gallinat Jürgen , Gerlach Herwig , Güldner Andreas , Hardt Hanna , Heintze Christoph , Heinz Andreas , Heller Axel , von Heymann Christian , Hoppmann Petra , Huge Volker , Irlbeck Michael , Jaschinski Ulrich , Jarczak Dominik , Joos Stefanie , Kaiser Elisabeth , Kerinn Melanie , Klefisch Frank-Rainer , Kluge Stefan , Koch Roland , Koch Thea , Kowalski Michelle , König Hans-Helmut , Kosilek Robert Philipp , Lackermeier Peter , Laugwitz Karl-Ludwig , Le Tri , Lemke Yvonne , Lies Achim , Linde Klaus , Lindemann Daniela , Lühmann Dagmar , May Stephanie , Ney Ludwig , Oltrogge Jan , Pankow Wulf , Papiol Sergi , Ragaller Maximilian , Rank Nikolaus , Reill Lorenz , Richter Hans-Peter , Riessen Reimer , Ringeis Grit , Rüchhardt Ann , Schelling Gustav , Schelling Jörg , Scherag André , Scherer Martin , Schneider Antonius , Schneider Gerhard , Schneider Jürgen , Schnurr Julia , Schultz Susanne , Schulze Thomas G , Schumacher Karin , Singhammer John , Spieth Peter , Theisen Kerstin , Thurm Franka , Vogl Thomas , Voigt Karen , Walther Andreas , Wassilowsky Dietmar , Wäscher Cornelia , Wehrstedt Regina , Weiss Björn , Weierstall-Pust Roland , Weis Marion , Weiss Georg , Well Harald , Christian Zöllner , Zwissler Bernhard 
Published: January 2025

Abstract

Background
Approximately 20–25% of patients who survive medical treatment at an intensive care unit (ICU) develop post-traumatic stress symptoms. There is currently a gap in follow-up care for them. As part of the PICTURE study, general practitioners (GPs) carried out a brief interview-based intervention. The aim of this sub-study is to record the most distressing memories of ICU treatment from the patient’s perspective and their evaluation of a GP-based brief psychological intervention.

Methods
Participants were recruited from the intervention group of the main PICTURE study using selective sampling. All of them had experienced an ICU stay with mechanical ventilation and severe organ failure in the previous two years. They were interviewed about their experience of psychological stress during their ICU stay and their retrospective evaluation of the intervention. Semi-structured, guideline-based telephone interviews were conducted for this purpose, processed, and analyzed using the structuring qualitative content analysis based on Mayring.

Findings
When asked N = 8 patients about the most stressful memory of their stay at ICU, the main themes were helplessness, pain, fixation, inability to communicate and sleep disturbances. The question of amnesia regarding the stay in the ICU was answered affirmatively by half of the interviewees but was not experienced as stressful. The brief trauma-focused intervention carried out by their GPs was well received by all respondents.

Conclusions
The interviewees confirm that aversive traumatizing experiences are often associated with intensive care treatment and reinforce each other. These are due to the treatment setting but should be reduced wherever possible. In view of chronification and the lack of specific follow-up treatment options for these patients and the long waiting times for psychotherapy, the implementation of low-threshold treatment options by GPs appears to be ideally suited to closing this gap in care, particularly for patients with mild to moderate symptoms of a post-traumatic stress disorder.

Trial registration
The main trial was registered at ClinTrials gov (NCT03315390) and at the German Register of Clinical Trials (DRKS, DRKS00012589) on 17/10/2017.