Professional Abstract

Objective

To compare a telephone- and web-based coping-skills training program with an educational program about critical illness to reduce anxiety and depression symptoms in patients discharged from the hospital following mechanical ventilation in the intensive care unit (ICU) and their family members

Study Design

Design Element	Description
Study Design	Randomized controlled trial
Population	175 patients who were discharged following mechanical ventilation in the ICU and 86 of their family members
Interventions/ Comparators	Telephone- and web-based coping-skills training program  Educational program with web-based, video, and printed information about critical illness
Outcomes	Primary: summary score on the Hospital Anxiety and Depression Scale (HADS) Secondary: HADS anxiety and depression subscale scores, posttraumatic stress disorder (PTSD), quality of life, mental and physical health status, coping behaviors, self-efficacy
Timeframe	6-month follow-up for primary outcome

In this randomized controlled clinical trial, the research team compared a telephone- and web-based coping-skills training program with an educational program that included web-based, video, and printed information about critical illness. The primary outcome was combined symptoms of depression and anxiety. Secondary outcomes were depression symptoms, anxiety symptoms, posttraumatic stress disorder (PTSD) symptoms, mental and physical health status, quality of life, positive coping behaviors, and self-efficacy in patients and their family members.

Patients and family members in the coping-skills training program received weekly 30-minute phone calls from a psychologist for six weeks to discuss coping skills for managing emotional distress and physical disabilities. They also received links to online materials with information about these coping skills. Patients and family members in the educational program received six informational videos, as well as print and web-based information about patients’ illnesses, a phone call with a researcher to review materials, and a follow-up call with a researcher to answer participants’ questions.

This study included 175 patients who were discharged from four hospitals’ ICUs after receiving mechanical ventilation for at least 48 hours. About 57% of patients were male, and 71% of patients were white. The mean patient age was 52. The study also included 86 family members, most of whom were spouses or parents.

The research team interviewed study participants three times: prior to randomization, three months after the start of the trial, and six months after the start of the trial.

Results

Overall, compared with the educational program, the coping-skills training program did not reduce symptoms of depression, anxiety, or PTSD for patients or their family members. Similarly, there were no significant differences in quality of life, physical health status, or mental health status. However, among patients who had high levels of depression and anxiety at baseline, those in the coping-skills training program had reduced psychological distress symptoms at six months compared with those in the educational program (p = 0.02).

Limitations

Almost 40% of the patients who consented to the study while in the hospital did not participate. The primary reason for lack of participation was persistent or worsening illness.

Conclusions and Relevance

Among the patients who received mechanical ventilation in the ICU and their family members, the coping-skills training program did no better than the educational program in reducing depression and anxiety symptoms. However, patients with high baseline levels of anxiety and depression had improved anxiety and depression after the coping-skills training program.

Future Research Needs

To help patients discharged from the ICU after mechanical ventilation and their family members, future research could consider ways to improve the delivery of therapies focused on coping skills to patients who have high levels of distress after they arrive home.