Effects of a general practitioner-led brief narrative exposure intervention on symptoms of post-traumatic stress disorder after intensive care (PICTURE): multicentre, observer blind, randomised controlled trial.

Summary

In 319 ICU survivors with PTSD symptoms, a brief GP-led narrative exposure intervention reduced PDS-5 scores by 4.7 points at 6 months and 5.4 points at 12 months versus enhanced usual care, though below the pre-specified MCID of 6 points. Benefits extended to depression, health-related quality of life, and disability, with high follow-up retention.

Key Findings

• At 6 months, PDS-5 decreased by a mean 4.7 points versus control (95% CI 1.6 to 7.8; P=0.003; d=0.37).
• At 12 months, PDS-5 decreased by 5.4 points (95% CI 1.8 to 9.0; P=0.003; d=0.41), indicating sustained benefit.
• Secondary outcomes showed improvements in depression, health-related quality of life, and disability.
• Follow-up completion was high (85% at 6 months; 77% at 12 months); trial was registered (NCT03315390).

Clinical Implications

Post-ICU follow-up programs can integrate brief GP-led narrative exposure with nurse contacts to reduce PTSD symptoms and improve patient-centered outcomes; however, expectations should be tempered given effects just below MCID.

Limitations

• Effect size did not exceed the predefined minimal clinically important difference
• Self-reported PTSD scale and healthcare system context (Germany) may limit generalizability

Future Directions

Evaluate implementation at scale in diverse health systems, refine the intervention dose/timing, and test combinations with digital tools or trauma-focused therapies to achieve or exceed MCID.