Can mindfulness reduce depression and anxiety in ICU survivors?

Mindfulness was associated with a reduction in psychological symptoms in patients who survived the ICU after cardiorespiratory failure. Encouraging reductions were seen in depressive symptoms, anxiety, and PTSD, overall improving patients’ quality-of-life. This finding is particularly relevant since there are no other verified options to improve psychological symptoms in this patient population.

“Symptoms of psychological distress, such as depression, anxiety, and PTSD are common, severe, and persistent after critical illness [1],” explained Dr Catherine Hough (Oregon Health & Science University, OR, USA).“Despite many efforts, no approach has proven to improve psychological outcomes after critical illness. So maybe it’s time to think out-of-the-box.” The LIFT-2 study (NCT04038567) is a randomised-controlled trial with a 2x2x2 factorial design and using a multiphase optimisation study [2]. The manipulated factors were: introduction to the intervention via a therapist or the app, the dose of mindfulness, once or twice daily, and the response to symptoms, either communicated via a therapist or the mobile app. The participants were ICU survivors with acute cardiopulmonary failure and post-discharge depressive symptoms (n=247). Participants received a self-directed, 4-week, app-based mindfulness intervention.

Mindfulness was associated with a reduction in depressive symptoms (delta -4.0 on PHQ-9 scale), anxiety (delta -2.0 on GAD-7 scale), PTSD symptoms (delta -4.0 on PTSS), and an overall improvement of quality-of-life. Considering the various factorial elements of the study, the investigators observed that the higher dose of mindfulness (twice daily) was related to a larger
decrease in depressive symptoms than the lower dose (once daily). The other two factors did not influence the outcomes. Also, the higher dose appeared to result in lower anxiety scores at 3 months compared with the lower-dose mindfulness intervention.

“This was not an efficacy trial,” noted Dr Hough. “We did see that a higher mindfulness dose yielded a larger effect on psychological symptoms than a lower dose. We can use these findings to design a larger phase 3 study.”

1. Huang M, et al. Crit Care Med. 2016 May;44(5):954-65.
2. Hough C, et al. Optimizing a self-directed mobile mindfulness intervention for improving cardiorespiratory failure survivor’s psychological distress: the Lift 2 randomized trial. Late-breaking abstracts: science that will impact clinical care. ATS 2024, 17–22 May, San Diego, USA.

Medical writing support was provided by Robert van den Heuvel.

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Posted on 11 June 202411 June 2024