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Meta-Analysis
. 2023 Jun 9:11:e15260.
doi: 10.7717/peerj.15260. eCollection 2023.

Follow-up focused on psychological intervention initiated after intensive care unit in adult patients and informal caregivers: a systematic review and meta-analysis

Shodai Yoshihiro  1 , Shunsuke Taito  2   3 , Kota Yamauchi  4 , Shunsuke Kina  5 , Takero Terayama  6 , Yusuke Tsutsumi  3   7   8 , Yuki Kataoka  3   9   10   11 , Takeshi Unoki  12
Affiliations
Meta-Analysis

Follow-up focused on psychological intervention initiated after intensive care unit in adult patients and informal caregivers: a systematic review and meta-analysis

Shodai Yoshihiro et al. PeerJ. .

Abstract

Psychological dysfunction is one of the considerable health-related outcomes among critically-ill patients and their informal caregivers. Follow-up of intensive care unit (ICU) survivors has been conducted in a variety of different ways, with different timing after discharge, targets of interest (physical, psychological, social) and measures used. Of diverse ICU follow-up, the effects of follow-ups which focused on psychological interventions are unknown. Our research question was whether follow-up with patients and their informal caregivers after ICU discharge improved mental health compared to usual care. We published a protocol for this systematic review and meta-analysis in https://www.protocols.io/ (https://dx.doi.org/10.17504/protocols.io.bvjwn4pe). We searched PubMed, Cochrane Library, EMBASE, CINAHL and PsycInfo from their inception to May 2022. We included randomized controlled trials for follow-ups after ICU discharge and focused on psychological intervention for critically ill adult patients and their informal caregivers. We synthesized primary outcomes, including depression, post-traumatic stress disorder (PTSD), and adverse events using the random-effects method. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence. From the 10,471 records, we identified 13 studies (n = 3, 366) focusing on patients and four (n = 538) focusing on informal caregivers. ICU follow-up for patients resulted in little to no difference in the prevalence of depression (RR 0.89, 95% CI [0.59-1.34]; low-certainty evidence) and PTSD (RR 0.84, 95% CI [0.55-1.30]; low-certainty evidence) among patients; however, it increased the prevalence of depression (RR 1.58 95% CI [1.01-2.46]; very low-certainty evidence), PTSD (RR 1.36, 95% CI [0.91-2.03]; very low-certainty evidence) among informal caregivers. The evidence for the effect of ICU follow-up on adverse events among patients was insufficient. Eligible studies for informal caregivers did not define any adverse event. The effect of follow-ups after ICU discharge that focused on psychological intervention should be uncertain.

Keywords: Critical care; Intensive care units; Mental disorders; Post intensive care syndrome.

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Conflict of interest statement

Shunsuke Taito, Yusuke Tsutsumi, and Yuki Kataoka are affiliated Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, JAPAN, which is an academic research group. Kota Yamauchi is employed by the Steel Memorial Yawata Hospital. Yuki Kataoka is employed by the Kyoto Min-iren Asukai Hospital. Yusuke Tsutsumi is employed by the National Hospital Organization Mito Medical Center. The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. PRISMA flow.
Figure 2
Figure 2. Forest plot and funnel plot of primary outcomes for patients.
(A) Depression, (B) Post-traumatic stress disorder. Adverse events were not pooled.
Figure 3
Figure 3. Forest plot and funnel plot of primary outcomes for informal caregivers.
Post-traumatic stress disorder. Since the outcome of depression was reported in only 1 RCT, we do not show the forest plot and funnel plot. Adverse events were not pooled.
See this image and copyright information in PMC

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