Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting – results from a qualitative sub-study of the PICTURE trial

Research output: Contribution to journalResearch articleContributedpeer-review


  • Ludwig Maximilian University of Munich
  • University of Konstanz


Background: The results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study. Methods: Qualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories. Results: The study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention. Conclusion: The primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach. Trial registration: The main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.


Original languageEnglish
Article number113
Pages (from-to)1-11
Number of pages11
JournalBMC Primary Care
Issue number1
Publication statusPublished - Dec 2023

External IDs

PubMed 37149603
ORCID /0000-0003-3953-3253/work/150330446


Sustainable Development Goals

ASJC Scopus subject areas


  • Mental health, Narrative exposure therapy, Post-intensive care syndrome, Post-traumatic stress disorder, Qualitative analysis, Intensive Care Units, Humans, Middle Aged, Male, Psychosocial Intervention, Physician-Patient Relations, Emotions, Female, Primary Health Care

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