Delivering Cognitive Behavioral Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App

Post-ICU Care: Why, What, When and How? ISCCM Position Statement

How to cite this article: Ramakrishnan N, Abraham BK, Barokar R, Chanchalani G, Jagathkar G, Shetty RM, et al. Post-ICU Care: Why, What, When and How? ISCCM Position Statement. Indian J Crit Care Med 2024;28(S2):S279-S287.

[Psychosocial Care in the Intensive Care Unit]

The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.

Anxiety and Depression in Family Members of Critically Ill Covid-19 Inpatients: Brief Psychological Interventions via Telephone, an Exploratory Study

Purpose

This study aimed to assess the level of anxiety and depression in relatives of critically ill COVID-19 patients admitted to the intensive care unit (ICU), and to perform an exploratory pilot study on the implementation of telephone psychological interventions to reduce the initial levels of anxiety and depression in this population.

Patients and Methods

Family members of COVID-19 inpatients at ICU answered GAD-7, PHQ-9 and questions on socio-demographic data. A brief psychological intervention was applied via telephone based on the needs of the participants (with adequate adaptation, with symptoms of anxiety, depression, or both). After intervention, participants completed the Patient Global Impression of Change Scale.

Results

A total of 1307 relatives were included (66.5% female), 34% and 29% had anxiety and depressive symptoms, respectively. These symptoms were associated with female gender, unemployment, and being the parent or partner of the patient. After intervention, 57.9% reported felt better, 31.3% a little better and 6.6% much better; and with emotional regulation techniques and psychoeducation, higher percentages of feeling better or much better were reported.

Conclusion

Brief interventions to reduce the psychological impact of inpatient family members could be effective but will need to be explored further in future studies.

Self-Care Mental Health App Intervention for Post-Intensive Care Syndrome-Family: A Randomized Pilot Study

BACKGROUND

Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management.

OBJECTIVE

To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients.

METHODS

The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use.

RESULTS

The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app.

CONCLUSIONS

Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms.

The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial

BACKGROUND

With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs.

OBJECTIVE

This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population.

METHODS

In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion.

RESULTS

A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups.

CONCLUSIONS

Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.