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Process evaluation and the development of behavioural interventions to improve psychological distress among survivors of critical illness
  1. Ann M. Parker1,2,
  2. Albahi Malik1,2,
  3. Megan Hosey2,3
  1. 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  2. 2 Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
  3. 3 Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  1. Correspondence to Dr Ann M. Parker, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore MD 21205, USA ; aparke36{at}

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Depressive, anxiety and post-traumatic stress disorder (PTSD) symptoms are common, long-lasting and associated with worse quality of life among intensive care unit (ICU) survivors.1–4 There are few clinical trials evaluating interventions to improve these symptoms. Cox and colleagues evaluated the feasibility of a mobile mindfulness training application (App) to address psychological stress after critical illness.5 Mindfulness promotes non-judgmental awareness of the present and acceptance of emotions, thoughts (eg, ‘I’m broken’, ‘I’m dependent’) and physiological states (eg, pain, shortness of breath), thus improving engagement with thoughts and behaviours related to illness along with coping and medical management of disease.6

This multisite pilot randomised controlled trial (RCT) randomised 80 participants to one of the three groups: mobile App, telephone mindfulness training or education control. Eligibility criteria included adults in the ICU ≥24 hours with cardiorespiratory failure. Participants randomised to mobile mindfulness intervention interacted with the App over 4 weekly mindfulness training sessions. Participants in the telephone group completed 4 weekly telephone mindfulness sessions (~30 min each) with a trained psychologist. The education control group received two telephone calls and a self-directed web-based programme focused on the nature and treatment of critical illness. Primary outcomes included feasibility, acceptability and usability. Secondary outcomes included depressive, anxiety and PTSD symptoms.

Approximately 83% (n=66) of patients completed the study. Loss to follow-up was 29%, 10% and 11% in the mobile mindfulness, telephone mindfulness and education groups, respectively. The percentage of participants who were not lost to follow-up completing all intervention sessions was ≥92% in each group. The results demonstrated ‘strong’ acceptability and usability with qualitative feedback considered overall ‘positive’ regarding the App. At 3-month follow-up, preliminary data demonstrated no significant improvement from baseline (before hospital discharge) in anxiety and depressive symptoms in the education control group while there was a trend toward improvements in these symptoms in the mobile and …

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  • Contributors AP: contributed to the manuscript as the author primarily responsible for drafting the manuscript and incorporating coauthors' edits. MH and AM: contributed by making important additions to the content, editing and reviewing for completeness/accuracy.

  • Funding AMP receives salary support from an NIH grant (K23HL138206).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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