Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Apr 19, 2023; 13(4): 191-217
Published online Apr 19, 2023. doi: 10.5498/wjp.v13.i4.191
COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review
Laura Monti, Elisa Marconi, Maria Grazia Bocci, Georgios Demetrios Kotzalidis, Marianna Mazza, Carolina Galliani, Sara Tranquilli, Giovanni Vento, Giorgio Conti, Gabriele Sani, Massimo Antonelli, Daniela Pia Rosaria Chieffo
Laura Monti, Elisa Marconi, Daniela Pia Rosaria Chieffo, UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Maria Grazia Bocci, Massimo Antonelli, UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Georgios Demetrios Kotzalidis, Marianna Mazza, Gabriele Sani, UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Georgios Demetrios Kotzalidis, NESMOS Department, Facoltà di Medicina e Psicologia, Sant’Andrea University Hospital, Rome 00189, Italy
Marianna Mazza, Gabriele Sani, Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Carolina Galliani, Sara Tranquilli, Daniela Pia Rosaria Chieffo, Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Giovanni Vento, UOC Neonatologia, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Giovanni Vento, UOC Neonatologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Giorgio Conti, UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Giorgio Conti, UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Massimo Antonelli, Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Author contributions: Monti L and Marconi E contributed equally to this work and share first authorship. Monti L, Marconi E, and Bocci MG conceived the review; Kotzalidis GD, Mazza M, Galliani C, and Tranquilli S made literature searches and shaped the review; Vento G and Conti G implemented the database; Monti L, Marconi E, Bocci MG, Kotzalidis GD, Mazza M, Galliani C, and Tranquilli S provided the first draft; Sani G, Antonelli M, and Chieffo DPR supervised the writing of the manuscript; Monti L, Tranquilli S, and Kotzalidis GD provided the final draft; and all authors read and approved the final draft and revision.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marianna Mazza, MD, PhD, Assistant Professor, UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy. marianna.mazza@policlinicogemelli.it
Received: December 10, 2022
Peer-review started: December 10, 2022
First decision: January 31, 2023
Revised: February 6, 2023
Accepted: March 27, 2023
Article in press: March 27, 2023
Published online: April 19, 2023
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.

AIM

To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.

METHODS

We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.

RESULTS

Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.

CONCLUSION

As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.

Keywords: COVID-19, Intensive care unit, Psychological interventions, Pandemic, Mental health, Health care professionals

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic produced changes in patient care and organization of intensive care units (ICUs). The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. We carried out a systematic review of the psychological issues raised in ICUs during the COVID-19 pandemic which concerned patients, their relatives, and the ICU staff. Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Promising results were obtained for some psychological programmes and interventions using digital tools and virtual reality aiming at improving psychological measures in all ICU categories.