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

Study Overview

This study aimed to see how a new brief therapy led by general practitioners (GPs) could help reduce symptoms of post-traumatic stress disorder (PTSD) in patients who had been in intensive care.

Study Design

The research was conducted in 319 general practices across Germany. It involved 319 adults aged 18 to 85 who had survived serious illness and showed signs of PTSD after being discharged from intensive care. Participants were randomly divided into two groups: one received the new therapy (160 patients), while the other received standard care (159 patients).

Intervention Details

Those in the intervention group had three therapy sessions with a GP and eight follow-up contacts with a nurse. The control group received improved usual care based on existing guidelines for PTSD treatment in Germany.

Key Outcomes Measured

The main outcome was the change in PTSD symptoms measured by a specific scale (PDS-5) at six months. Secondary outcomes included changes in depression, anxiety, quality of life, and disability at six and twelve months.

Results Summary

From October 2018 to January 2023, 1,283 patients were screened, and 319 were included in the study. The average age of participants was about 58 years, with a majority being male. Most participants completed follow-up assessments at six and twelve months.

The intervention group showed a reduction in PTSD symptoms, with a difference of 4.7 points at six months and 5.4 points at twelve months compared to the control group. Improvements were also noted in depression, quality of life, and disability for those receiving the new therapy.

Conclusions

The brief narrative exposure therapy led by GPs was effective in reducing PTSD symptoms, although the reduction was slightly below the minimum clinically important difference. The positive effects were maintained at twelve months, suggesting that this approach could be beneficial in primary care settings.

Next Steps

Based on these findings, clinics should consider implementing this brief therapy as a pilot project. Tracking results will help assess its real-world impact on patients with PTSD after intensive care.