Talking therapy by GPs eases PTSD symptoms after critical illness

A brief spell of talking therapy with a general practitioner reduces symptoms of post-traumatic stress disorder (PTSD) for survivors of critical illness, finds a trial from Germany published by The BMJ today.

The effects of this brief psychological intervention were modest, but may help to bridge long waiting times between discharge from an intensive care unit (ICU) and access to specialist mental health services, say the researchers.

Around one in five patients experience PTSD symptoms after intensive care. Most aftercare is provided in general practice as access to mental health services is often limited with long waiting lists, but structured interventions for PTSD symptoms in primary care have been largely absent.

To address this gap, researchers set out to test the effect of a brief GP-led narrative exposure intervention tailored for people discharged from intensive care.

The trial involved 319 adults (average age 58; 61% men) at general practices across Germany who received either three structured GP consultations and eight follow-up nurse interactions targeting PTSD symptoms (intervention group), or improved usual care (control group).

The main outcome was the severity of PTSD symptoms at six months, measured using the post-traumatic diagnostic scale (PDS-5, range 0-80, higher scores indicating more severe symptoms). The predefined minimal clinically important difference was six points.

At the start of the trial, the average PDS-5 score was 30.6 in both groups. At six months, the average PDS-5 score declined by 6.2 points in the intervention group compared with 1.5 points in the control group (a difference of 4.7 points). By 12 months, the average PDS-5 score had declined by 7.9 points in the intervention group compared with 2.5 points in the control group (a difference of 5.4 points).

These results are below the minimal clinically important six point difference, but the researchers say this may be related to the brief and low intensity nature of the intervention, which limits a substantial symptom reduction.

Improvements in other outcomes such as depression, disability, and quality of life, highlight the broader impact of reducing PTSD symptoms on patient wellbeing, they add.

They acknowledge several limitations, such as excluding people with severe PTSD symptoms and providing only brief training for GPs, and they can't rule out the possibility that other unmeasured factors may have influenced their results.

However, they say "given the prevalence of PTSD symptoms following critical illness, and the long waiting lists for mental health specialists service, the intervention may be feasible and beneficial for general practice."

This trial "represents an important advance in trauma informed primary care interventions, bridging acute care and long term psychological support," write researchers in a linked editorial. 

While not a replacement for specialised psychiatric treatment, they say such models offer a pragmatic strategy to reduce the psychological burden of critical illness, especially in healthcare systems facing limited specialist resources.

As research continues, the challenge will be to refine these early interventions without diluting their therapeutic effectiveness, while future research "should focus on refining content of therapy, optimizing delivery of care, and ensuring broad integration across healthcare systems," they conclude.