Non-pharmacological interventions for the treatment of post-intensive care family syndrome in caregivers: A systematic review and meta-analysis

Background: Family members of intensive care unit patients are at risk of post-intensive care syndrome-family (PICS-F), including anxiety, depression, post-traumatic stress disorder (PTSD), and reduced quality of life. Non-pharmacological interventions such as counseling, education, and support programs may help, but evidence is limited. Evaluating these interventions is essential to guide tailored strategies that improve caregiver well-being. This systematic review aimed to evaluate the effectiveness of different non-pharmacological interventions for improving post-intensive care family symptoms in family members and caregivers of adult patients. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were performed in PubMed, Scopus, Web of Science, and ClinicalTrials.gov. Randomized controlled trials (RCTs) evaluating non-pharmacological interventions in adult caregivers of critically ill patients were included. Variables such as anxiety, depression, PTSD, and quality of life were analyzed. Risk of bias was assessed using the Cochrane RoB-2 tool. Results: Seven RCTs involving 1026 participants, predominantly women, were included. Most interventions did not demonstrate statistically significant improvements in PICS-F symptoms. However, 2 multicomponent interventions that combined structured follow-up, personalized support, and active professional involvement showed significant reductions in anxiety, depression, and PTSD symptoms, as well as improvements in quality of life. In contrast, brief, standardized, or self-guided interventions without sustained professional support were generally ineffective. Conclusion: Most non-pharmacological interventions evaluated did not show consistent efficacy in reducing PICS-F symptoms. Interventions incorporating longitudinal follow-up, personalized emotional support, and multicomponent approaches appeared to provide greater benefit. Further high-quality RCTs using standardized diagnostic and outcome measures are needed to establish robust therapeutic recommendations.