Functional disability after critical illness in patients with post-traumatic stress disorder symptoms in primary care: A secondary analysis of the PICTURE randomized controlled trial.

BACKGROUND

Survivors of critical illness often experience persistent functional disability alongside psychological distress. We examined baseline determinants and domain-specific patterns of disability, and the longitudinal effects of a brief primary care intervention for post-traumatic stress disorder (PTSD).

METHODS

In the PICTURE randomized controlled trial, 319 adults aged 18-85 years with PTSD symptoms at least 3 months after intensive care unit (ICU) discharge were randomized to three general practitioner (GP)-led narrative exposure consultations or to improved usual care based on PTSD guidelines. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) at baseline, 6, and 12 months. Baseline determinants, disability profiles, and longitudinal changes in disability were evaluated using descriptive analyses and adjusted linear regression models.

RESULTS

Depressive and anxiety symptoms were the strongest correlates of baseline disability, exceeding associations with ICU-related factors. Disability showed distinct domain-specific patterns, with emotional difficulties predominating at lower disability levels and progressively broader impairments at higher levels. No meaningful between-group difference was observed at 6 months, whereas disability showed a greater decline in the intervention group by 12 months (adjusted β = -4.31, 95% CI -8.25 to -0.37). Exploratory item-level analyses suggested the greatest improvements in emotional distress, friendships, and work-related activities.

CONCLUSIONS

During the later stages of post-ICU recovery in primary care, psychological symptoms appear to become stronger determinants of functional disability than characteristics of the preceding critical illness. Functional benefits following brief trauma-focused care may emerge gradually, suggesting that psychological recovery translates into broader gains over time.