Effects of a brief primary care intervention for post-traumatic stress disorder symptoms after critical illness on health-related quality of life – A secondary analysis of the PICTURE randomised controlled trial
AI Summary
Brief GP-delivered narrative exposure improved HRQoL: transient EQ VAS improvement at 6 months (β = 5.85) and delayed EQ-5D-5L index improvement at 12 months (β = 0.075).
Approximately one quarter of the 12-month EQ-5D-5L index improvement was mediated by PTSD symptom reduction at 6 months.
Domain analyses showed greater gains in anxiety and depression and in mobility, indicating clinically meaningful benefits emerging over time beyond PTSD symptom change.
BACKGROUND: Intensive care unit (ICU) survivors frequently experience symptoms of post-traumatic stress disorder (PTSD) and reduced health-related quality of life (HRQoL), yet evidence for effective post-ICU interventions in primary care remains limited. This secondary analysis of the PICTURE randomised controlled trial provides an in-depth evaluation of HRQoL trajectories and potential treatment mechanisms.
METHODS: The analysis included 319 adult ICU survivors with at least moderate PTSD symptoms, randomised to a brief general practitioner (GP)-delivered narrative exposure intervention or enhanced usual care. Longitudinal mixed-effects models estimated treatment-by-time effects on HRQoL, based on EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS), with mediation via PTSD symptom change assessed using structural equation modelling.
RESULTS: The mean baseline EQ index was 0.71 ± 0.27 and EQ VAS was 60.7 ± 19.4. Mixed-effects models showed a transient improvement in EQ VAS at 6 months in the intervention group (ß = 5.85; 95% CI 0.84-10.87), followed by a delayed improvement in the EQ index at 12 months (ß = 0.075; 95% CI 0.014-0.136). About one quarter of the 12-month EQ index effect was mediated by PTSD symptom reduction at 6 months. Domain-level analyses indicated greater improvement in anxiety/depression and mobility.
CONCLUSIONS: In ICU survivors with PTSD symptoms, a brief GP-delivered psychological intervention was associated with clinically meaningful improvements in health-related quality of life over 12 months, with effects emerging over time and only partly explained by PTSD symptom reduction.
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