The Hidden Burden After Critical Illnesses: A Systematic Review of Psychological Outcomes and Their Associated...

Survival following critical illness has improved substantially; however, many individuals experience persistent psychological sequelae after discharge from intensive care units. These outcomes may adversely affect long-term recovery, quality of life, and reintegration into daily roles, underscoring the need for a comprehensive synthesis of current evidence.

To synthesize evidence published between 2021 and 2025 on psychological outcomes among ICU survivors and identify associated factors.

This systematic review employed a convergent integrated approach for data synthesis. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six electronic databases (PubMed, MEDLINE via EBSCO, ScienceDirect, Scopus, Nursing & Allied Health Premium, and the Cochrane Library) were searched for studies published between 2021 and 2025. Studies were included if they reported psychological outcomes and associated factors among adult ICU survivors. Data were synthesized following the Joanna Briggs Institute methodology.

Thirteen studies met the inclusion criteria. The most frequently reported psychological outcomes were depression, (9 studies; 69.2%), anxiety (8 studies; 61.5%), post-traumatic stress disorder (8 studies; 61.5%), and stress-related symptoms (1 study; 7.7%). Associated factors were grouped into seven domains: personal characteristics, length of stay, distress-related factors, pre-existing mental health or substance use, physical and cognitive function, and protective factors. Women were more frequently reported to experience higher psychological distress across several studies, while some evidence suggested higher symptom burden among patients with longer ICU stays and poorer physical or cognitive function. While consistent patterns were observed, the strength of evidence varied across domains.

Psychological outcomes are commonly reported among ICU survivors and appear to be influenced by multiple interrelated factors. However, given the limited number, heterogeneity, and predominantly observational nature of included studies, these findings should be interpreted with caution. Further research is warranted to strengthen the evidence base and inform targeted interventions.