Better understanding of patient and family member experiences of delirium and related distress during critical care is required to inform the development of targeted nonpharmacologic interventions. To examine and synthesize qualitative data on patient and family member delirium experiences and relieving factors in the Intensive Care Unit (ICU). We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family quotes about delirium during critical care, published in English in a peer-reviewed journal since 1980. Data sources included PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane and Clinicaltrials.gov. Systematic searches yielded 3238 identified articles, of which 14 reporting 13 studies were included. Two reviewers independently extracted data into a Microsoft Excel spreadsheet. Qualitative meta-synthesis was performed through line-by-line coding of relevant quotes, organization of codes into descriptive themes, and development of analytical themes. Five patients/family members with experience of ICU delirium contributed to the thematic analysis. Qualitative meta-synthesis resulted in four major themes and two sub-themes. Key new patient and family-centric insights regarding delirium-related distress in the ICU included articulation of the distinct emotions experienced during and after delirium (for patients, predominantly fear, anger and shame); its 'whole-person' nature; and the value that patients and family members placed on clinicians' compassion, communication, and connectedness. Distinct difficult emotions and other forms of distress are experienced by patients and families during ICU delirium, during which patients and families highly value human kindness and empathy. Future studies should further explore and address the many facets of delirium-related distress during critical care using these insights and include patient-reported measures of the predominant difficult emotions.

Background: Posttraumatic stress disorder (PTSD) and/or specific PTSD symptoms may evoke maladaptive behaviors (e.g., compulsive buying, disordered eating, and an unhealthy lifestyle), resulting in adverse cardiometabolic events (e.g., hypertension and obesity), which may implicate the treatment of this complex condition. The diagnostic criteria for PTSD have lately expanded beyond the three common symptoms (intrusion, avoidance, and hyperarousal). Including additional symptoms such as emotional numbing, sleep disturbance, and irritability strengthens the representation of the Impact of Event Scale-Revised (IES-R), suggesting that models with four, five, or six dimensions better capture its structure compared to the original three-dimensional model. Methods: Using a convenience sample of 58 Russian dental healthcare workers (HCWs: mean age = 44.1 ± 12.2 years, 82.8% females), this instrumental study examined the convergent, concurrent, and criterion validity of two IES-R structures: IES-R3 and IES-R6. Results: Exploratory factor analysis uncovered five factors, which explained 76.0% of the variance in the IES-R. Subscales of the IES-R3 and the IES-R6 expressed good internal consistency (coefficient alpha range = 0.69–0.88), high convergent validity (item total correlations r range = 0.39–0.81, and correlations with the IES-R’s total score r range = 0.62–0.92), excellent concurrent validity through strong correlations with the PTSD Symptom Scale-Self Report (PSS-SR: r range = 0.42–0.69), while their criterion validity was indicated by moderate-to-low correlations with high body mass index (BMI: r range = 0.12–0.39) and the diagnosis of hypertension (r range = 0.12–0.30). In the receiver-operating characteristic (ROC) curve analysis, all IES-R models were perfectly associated with the PSS-SR (all areas under the curve (AUCs) > 0.9, p values < 0.001). The IES-R, both hyperarousal subscales, and the IES-R3 intrusion subscale were significantly associated with high BMI. Both avoidance subscales and the IES-R3 intrusion subscale, not the IES-R, were significantly associated with hypertension. In the two-step cluster analysis, five sets of all trauma variables (IES-R3/IES-R6, PSS-SR) classified the participants into two clusters according to their BMI (normal weight/low BMI vs. overweight/obese). Meanwhile, only the IES-R, PSS-SR, and IES-R3 dimensions successfully classified participants as having either normal blood pressure or hypertension. Participants in the overweight/obese and hypertensive clusters displayed considerably higher levels of most trauma symptoms. Input variables with the highest predictor importance in the cluster analysis were those variables expressing significant associations in correlations and ROC analyses. However, neither IES-R3 nor IES-R6 contributed to BMI or hypertension either directly or indirectly in the path analysis. Meanwhile, age significantly predicted both health conditions and current smoking. Irritability and numbing were the only IES-R dimensions that significantly contributed to current smoking. Conclusions: The findings emphasize the need for assessing the way through which various PTSD symptoms may implicate cardiometabolic dysfunctions and their risk factors (e.g., smoking and the intake of unhealthy foods) as well as the application of targeted dietary and exercise interventions to lower physical morbidity in PTSD patients. However, the internal and external validity of our tests may be questionable due to the low power of our sample size. Replicating the study in larger samples, which comprise different physical and mental conditions from heterogenous cultural contexts, is pivotal to validate the results (e.g., in specific groups, such as those with confirmed traumatic exposure and comorbid mood dysfunction).