• Christopher E Cox, Catherine L Hough, Shannon S Carson, Douglas B White, Jeremy M Kahn, Maren K Olsen, Derek M Jones, Tamara J Somers, Sarah A Kelleher, and Laura S Porter.
• 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
• Am. J. Respir. Crit. Care Med. 2018 Jan 1; 197 (1): 66-78.

RationaleMany survivors of critical illness and their family members experience significant psychological distress after patient discharge.ObjectivesTo compare the effects of a coping skills training (CST) program with an education program on patient and family psychological distress.MethodsIn this five-center clinical trial, adult patients who received mechanical ventilation for more than 48 hours and one family member of each patient were randomized to six weekly CST telephone sessions plus access to a study website or a critical illness education program.Measurements And Main ResultsThe primary outcome was the patient Hospital Anxiety and Depression Scale (HADS) score at 3 months. Secondary outcomes included 3- and 6-month HADS subscales and the Impact of Events Scale-Revised. Among the 175 patients randomized to CST (n = 86) or education (n = 89), there was no significant difference between CST and education in either 3-month HADS scores (difference, 1.3; 95% confidence interval [CI], -0.9 to 3.4; P = 0.24) or secondary patient and family outcomes. In prespecified analyses, among patients with high baseline distress (n = 60), CST recipients had greater improvement in 6-month HADS score (difference, -4.6; 95% CI, -8.6 to -0.6; P = 0.02) than the education group. Among patients ventilated longer than 7 days (n = 47), education recipients had greater improvement in 3-month HADS score (difference, -4.0; 95% CI, -8.1 to -0.05; P = 0.047) than the CST group.ConclusionsCST did not improve psychological distress symptoms compared with an education program. However, CST improved symptoms of distress at 6 months among patients with high baseline distress, whereas the education program improved distress at 3 months among those ventilated for more than 7 days. Future efforts to address psychological distress among critical illness survivors should target high-risk populations. Clinical trial registered with www.clinicaltrials.gov (NCT01983254).

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