A mixed-methods approach to understanding mental health-related phenomena, health-related goals, and perceived barriers and facilitators to mental health care in critical illness survivors: a feasibility study

Approximately 20% of survivors of critical illness develop symptoms consistent with posttraumatic stress disorder (PTSD). Limited access to specialized mental health services may place rural survivors at heightened risk for unmet mental health needs while simultaneously reducing care-seeking behaviors. We aimed to explore influences on mental health care-seeking behaviors among rural and nonrural ICU survivors and to evaluate the feasibility and utility of a mixed methods research approach. Eligible participants were adults discharged from an ICU within a large health care system in central Texas, United States. Using a convergent mixed methods study design, participants completed a cross-sectional survey collecting demographic and health information and measures for powerlessness, self-efficacy, and PTSD symptoms. Volunteers from the survey group completed interviews to determine health-related goals and perceived barriers to and facilitators of seeking mental health care. Data analysis included independent samples t-tests to compare rural and nonrural participants’ responses and Pearson’s r to examine the relationships among variables. Qualitative data were analyzed using thematic analysis and integrated with quantitative findings. Thirty survey responses were received; one was incomplete ( n = 29). Fourteen percent of participants reported PTSD symptoms; 75% of those were rural. Powerlessness was significantly correlated with PTSD symptoms (r = 0.70, p < 0.01) and self-efficacy (r = − 0.67, p < 0.01). All quantitative instruments demonstrated strong internal consistency. Qualitative data indicated that rural and nonrural survivors shared similar health goals, but rural survivors were more likely to experience barriers to seeking mental health care. Differences were noted in quantitative and qualitative responses. Critical illness survivors experience considerable mental health phenomena, including powerlessness that may inhibit survivors from seeking care despite experiencing mental health symptoms. Mixed methods research is essential and feasible in post-ICU populations, providing critical insights that may not be captured through quantitative approaches alone, particularly when examining rural populations.