Impact of ICU and post-ICU interventions on the psychological dimensions of patients' PICS: A systematic review with narrative synthesis

Various interventions have been developed to prevent or reduce the risk of Post-Intensive Care Syndrome (PICS) in patients during and after intensive care. This systematic review with narrative synthesis aimed to identify, categorize, and synthesize evidence on interventions delivered during the ICU stay or up to 1 year after discharge that may be associated with improved HRQoL and reduced anxiety, depression, and PTSD symptoms in survivors . Following PRISMA guidelines, we searched five databases for interventional studies assessing psychological outcomes in ICU survivors. Quantitative, qualitative, and mixed-methods designs were eligible. Study quality was assessed using RoB 2, ROBINS-I V2, and MMAT. Among 3494 records identified, 39 studies were included. Interventions were grouped into seven categories: physical ( n = 8), self-management education strategies ( n = 6), evaluative follow-up ( n = 2), narrative ( n = 10), EMDR (n = 1), ICU simulation with virtual reality (n = 1), and multimodal interventions ( n = 11). The evidence remained heterogeneous and methodologically fragile: 14 studies reported improvement in at least one psychological outcome, 23 reported no benefit, and two evaluative interventions were associated with worse outcomes . Narrative and multimodal interventions showed the most consistent signals of benefits, particularly for PTSD, depression, and HRQoL, although evidence often came from studies with methodological limitations. Conversely, interventions focused on assessment, information provision, or unguided self-management did not provide robust evidence of benefit . Future research should prioritize adequately powered, standardized, multimodal programs involving mental health professionals and longer follow-up to better capture delayed psychological outcomes after critical illness trajectories .