Post-Intensive Care Syndrome: Multidimensional Repercussions and Evidence for Mental Health Interventions
Intensive Care Medicine Intensive Care Unit; Post-Intensive Care Syndrome; Mental Health; Family; Virtual
Reality
Post-Intensive Care Syndrome (PICS) comprises physical, cognitive, and psychological impairments
that may persist after discharge from the Intensive Care Unit (ICU), affecting both patients and family
members. This thesis aimed to investigate mental health outcomes, functionality, and cognition in
patients during the post-intensive care period, as well as the mental health of family members, and to
synthesize evidence regarding mental health interventions, with emphasis on virtual reality. This thesis
consists of three analytical cross-sectional observational studies and two systematic reviews. The
observational studies were conducted in a university hospital in Northeastern Brazil and included 80
patients, 80 family members, and 80 patient-family dyads assessed on the fifth day after ICU
discharge. Validated instruments were used to assess anxiety, depression, post-traumatic stress,
functionality, and cognition. The systematic reviews followed PRISMA 2020 guidelines and included
randomized clinical trials investigating mental health interventions in the post-ICU context. The results
showed a high frequency of anxiety, depression, and post-traumatic stress symptoms in patients and
family members, as well as significant functional impairment in patients. Emotional outcomes were
associated with socioeconomic factors, previous psychological distress, and preexisting health
conditions. Dyadic analysis indicated partial emotional interdependence between patients and family
members, with predominance of intrapersonal effects and limited interpersonal influence. The
systematic reviews demonstrated that evidence regarding mental health interventions, including virtual
reality, remains limited, heterogeneous, and methodologically weak. In conclusion, post-ICU outcomes
present a multidimensional and clinically relevant profile, reinforcing the need for systematic
screening strategies, longitudinal follow-up, and the development of evidence-based multidisciplinary
interventions for patients and family members.