Tele-delivered psychotherapeutic intervention for family members of patients in intensive care-a non-randomized pilot study.
Academic Article
Overview
abstract
RATIONALE: Family members of patients in intensive care units (ICU) experience psychological distress both during and after the ICU stay. Yet, past interventions are few and largely ineffective. OBJECTIVE: We developed a flexible, tele-delivered psychotherapeutic intervention based on contemporary cognitive therapeutic methods and tested its feasibility in a one-arm pilot study. Although evaluated in family members of patients with COVID-19, the intervention was developed to be broadly applicable to mental health problems in ICU family caregivers. METHODS: Adult family members of patients with COVID-19 in five ICUs across Denmark received weekly sessions with clinical psychologists during the ICU stay and on a needs basis for eight weeks post-discharge. The intervention manual specified a catalog of treatment principles and methods from contemporary cognitive therapies. Questionnaires evaluating peritraumatic distress, anxiety, depression, stress, rumination, worry, and tolerance of uncertainty were administered at pre-intervention, post-intervention, six-, and twelve-month follow-up. Mixed-effects models estimated the change in mental health symptoms over time. A subset of family members and psychologists completed in-depth interviews post-intervention analyzed with thematic analysis. RESULTS: Of 43 eligible family members, 40 (93%) participated. Two withdrew consent during the intervention. On average, family members received 6 sessions (range: 0-15) over 9 to 118 days. Both the tele-delivery format and the intervention methods were found feasible and acceptable by family members as well as psychologists, and family members found the intervention beneficial in validating and addressing their evolving needs and helping them manage distress. Preliminary effects at post-intervention were large reductions in mental health symptoms for peritraumatic distress (Hedges' g = -0.86, 95% confidence interval (CI) = [-1.2 to -0.25]), anxiety (g = -2.46, [-2.36 to -1.51]), and depression (g = -1.77, [-2.5 to -0.88]), also seen at follow-up, together with medium improvements for perceived stress. CONCLUSIONS: This tele-based psychotherapeutic intervention for family members of patients in ICUs was feasible and acceptable, and tele-delivered contemporary cognitive therapies present a promising approach for reducing peritraumatic distress, anxiety, and depression. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04409821).
