Non-pharmacological interventions to reduce ICU-related psychological distress: A systematic review

Dorothy M. Wade*, Zoe Moon, Sula S. Windgassen, Anthony M. Harrison, Lucy Morris, John A. Weinman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)


INTRODUCTION: Patients frequently suffer stress in intensive care units (ICU5) and many develop serious psychological morbidity after discharge. Little is known about the nature and efficacy of interventions to reduce ICU-related distress. There is growing evidence that administering sedative drugs can be harmful. Therefore we carried out a systematic review of non-pharmacological interventions to reduce ICU-related distress. EVIDENCE ACQUISITION: A systematic search was conducted using Medline, Embase, Psychinfo, Cinahl and the Web of Science. Included studies evaluated the effect of non-pharmacological interventions to reduce ICU stress. Study populations were adults in mixed or general ICUs. Outcomes were stress or psychological distress in or after the ICU, using self-report or physiological measures. No meta-Analysis was possible due to heterogeneity, therefore studies were arranged according to intervention type, and outcomes examined together with risk of bias criteria. EVIDENCE SYNTHESIS: Twenty-Three studies were eligible, including 15 randomized controlled trials. Non-pharmacological interventions included music therapy (11 studies), mind-body practices (5) and psychological interventions (7). 12 studies showed a beneficial effect. However only three of the 12 had a low risk of bias, and many studies in the review were under-powered to detect an effect. Only 5 studies measured a medium long term psychological outcome such as PTSD or depression at 2-12 months. CONCLUSIONS: Evidence indicates that non-pharmacological approaches to reducing ICU distress, in particular psychological interventions, may be beneficial. The evidence base would be strengthened by the implementation of fully-powered studies using robust designs, that measure longer-Term outcomes.

Original languageEnglish
Pages (from-to)465-478
Number of pages14
JournalMinerva Anestesiologica
Issue number4
Publication statusPublished - 1 Apr 2016


  • Intensive care units
  • Music therapy
  • Psychotherapy


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