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

INTRODUCTION: Patients frequently suffer stress in intensive care units (ICUs) 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.

Parents' perceptions of postschool years for young adults with developmental disabilities.

This qualitative study investigated parents' perceptions of the various roles they played in their adult children's lives during the post-high school years. Individual face-to-face interviews were conducted with 9 families of young adults with developmental disabilities. Findings indicated that families perceived the complexity of their roles as balancing between advocating for their adult children's needs while promoting independence and self-determination. The roles parents assumed as their children entered into adult life were those of collaborators, decision makers, and program evaluators, role models, trainers, mentors and instructors, and systems change agents. Parents often felt they were the safety net for their children and the back-up plan for service agencies. Parents' quotes illustrated the complexity of the roles they played as their young adult children with developmental disabilities entered adulthood.