The intensive care unit (ICU) has been portrayed as psychologically stressful, with a growing body of research substantiating elevated rates of depression, posttraumatic stress disorder (PTSD), and other psychological disruptions in populations of critical care survivors. To explain these psychopathology elevations, some have proposed a direct effect of ICU admission upon the later development of psychopathology, whereas others highlight the complex interaction between the trauma of a life-threatening illness or injury and the stressful life-saving interventions often administered in the ICU. However, the conclusion that the ICU is an independent causal factor in trauma-related psychological outcomes may be premature. Current ICU research suffers from important methodological problems including lack of true prospective data, failure to employ appropriate comparison groups, sampling bias, measurement issues, and problems with statistical methodology. In addition, the ICU literature has yet to investigate important risk and resilience factors that have been empirically validated in the broader stress-response literature. The authors propose the application of these important constructs to the unique setting of the ICU. This review focuses on multiple aspects of the important but complex research question of whether the ICU confers risk for psychological distress above and beyond the traumatic impact of the serious health events that necessitate ICU treatment. (PsycINFO Database Record

Adjustment to chronic disability is a topic of considerable focus in the rehabilitation sciences and constitutes an important public health problem given the adverse outcomes associated with maladjustment. While existing literature has established an association between disability onset and elevated rates of depression, resilience and alternative patterns of adjustment have received substantially less empirical inquiry. The current study sought to model heterogeneity in mental health responding to disability onset in later life while exploring the impact of socioeconomic resources on these latent patterns of adaptation. Method: Latent growth mixture modeling was utilized to identify trajectories of depressive symptoms surrounding physical disability onset in a population sample of older adults. Individuals with verified disability onset (n ϭ 3,204) were followed across four measurement points representing a 6-year period. Results: Four trajectories of depressive symptoms were identified: resilience (56.5%), emerging depression (17.2%), remitting depression (13.4%), and chronic depression (12.9%). Socioeconomic resources were then analyzed as predictors of trajectory membership. Prior education and financial assets at the time of disability onset robustly predicted class membership in the resilient class compared to all other classes. Conclusion: The course of adjustment in response to disability onset is heterogeneous. Our results confirm the presence of multiple pathways of adjustment surrounding late-life disability, with the most common outcome being near-zero depressive symptoms for the duration of the study. Socioeconomic resources strongly predicted membership in the resilient class compared with all other classes, indicating that such resources may play a protective role during the stress of physical disability onset. Impact and ImplicationsThe current analysis helps to establish that the course of adjustment to disability onset in later life is heterogeneous, with the most common trajectory being resilience, followed by alternative patterns of adjustment that indicate more significant depressive burden. Socioeconomic variables strongly predicted membership in the resilient class compared to other classes, suggesting that such resources may buffer against the psychological stress of functional decline. Current findings suggest that older adults with lower socioeconomic status are most at risk for elevated depressive symptoms following disability onset. Socioeconomic factors may thus be important predictors of adjustment difficulty, which has important policy implications for the guidance and targeted distribution of treatment resources.

Objective: To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood. Setting: The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City. Participants: A total of 143 individuals with TBI or their family members. Design: An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test. Main Measures: Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories. Results: Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor. Conclusion: Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.

Unexpected traumatic events, including life-threatening medical conditions, brain injuries, and pandemics, can be catalysts for patients and clinicians to consider existential issues, including meaning in life. The existential–humanistic and relational perspectives on therapeutic interventions emphasize creating meaning, taking responsibility for one’s own life and self-narratives, choosing and actualizing ways of being in the world that are consistent with values, and expanding the capacity for agency, commitment, and action. Myriad factors have made the COVID-19 pandemic upsetting and potentially traumatic for individuals, including the novel experience of self and other as possibly infectious and dangerous, a sense that anyone is vulnerable, and protracted uncertainty about the duration of the crisis and its consequences. The vignettes included in this article explore risk and reliance factors relevant to patients with preexisting medical conditions during COVID-19 and highlight the benefits of exploring values, priorities, and assumptions, asking open-ended questions about meaning in life and posttraumatic growth, learning for each emotion, and interpretation of dreams. The existential–humanistic and relational approaches offer unique insights into how practitioners might help their patients to reflect on the unanticipated changes and anxieties ignited by COVID-19, while reinforcing the potential to live with greater purpose and intention.