Post-traumatic stress disorder after prolonged hospitalization and intensive care: A systematic review

¹Sestre milosrdnice University Hospital Center, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Vinogradska cesta 29, Zagreb, 10000, Croatia 
²University of Novo Mesto, Faculty of Health Sciences, Na Loko 2, Novo Mesto, 8000, Slovenia

Abstract

Introduction: Post-traumatic stress disorder (PTSD) is increasingly recognized as a significant component of the psychological consequences following prolonged hospitalization and treatment in the intensive care unit (ICU). This systematic review aimed to describe the prevalence of PTSD among adult ICU survivors; identify the most common risk factors and associated psychological outcomes; and examine interventions relevant to clinical practice.

Methods: A systematic literature search was conducted in January 2026 in the PubMed and Scopus databases in accordance with the PRISMA 2020 guidelines. Studies published between 2021 and 2026; available in English; with access to an abstract and full-text were included. Clinical and observational studies conducted in adult populations after ICU stay were analyzed. Studies focusing on pediatric populations, family members, and caregivers (PICS-F); healthcare professionals; as well as qualitative studies; study protocols; and single case reports were excluded.

Results: A total of 175 records were identified; 149 articles were screened after duplicate removal, and 26 studies were included in the final synthesis. The prevalence of PTSD ranged from 13% to 60%, depending on population characteristics, follow-up duration, and the assessment instruments used. The factors most frequently associated with post-traumatic stress disorder symptoms included delirium, hallucinations and delusional memories, deep sedation, prolonged mechanical ventilation, and dyspnea, while lower levels of social support were associated with poorer psychological outcomes after intensive care.

Conclusion: PTSD is a common and long-term psychological consequence of intensive care. The findings highlight the need for systematic psychological screening, early identification of high-risk patients, and the integration of psychological care into standard post-ICU follow-up and rehabilitation pathways.