Psychosocial coping with intensive care delirium: a mixed-methods systematic review of patient and family perspectives

Objective This review aims to identify, synthesize, and critically appraise evidence on psychosocial coping strategies employed by intensive care unit (ICU) patients and their family caregivers during an episode of ICU delirium, organized within the transactional model of stress and coping. Design Mixed-methods systematic review (MMSR) following the Joanna Briggs Institute (JBI). Information sources A systematic search was conducted in MEDLINE (PubMed), CINAHL, PsycINFO, and PSYNDEX. The literature search concluded on the 6th of November 2025. Methods Following JBI methodology for mixed-methods systematic reviews, qualitative findings were analyzed using the JBI meta-aggregation approach. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The transactional model of stress and coping served as the theoretical framework. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results Ten qualitative studies were included, originating from seven countries, published between 1999 and 2025. No quantitative studies meeting the eligibility criteria were identified, representing a significant gap in literature. Patients employed problem-focused coping strategies (active sense-making, reality orientation, proactive avoidance of delirium triggers), emotion-focused strategies (social connection, distancing, self-control), and meaning-based strategies (positive reappraisal, identity restoration). Families directed coping efforts both at supporting the patient through emotional presence, active reorientation, cognitive stimulation, and collaboration with the healthcare team, and at managing their own distress through information-seeking, avoidance, and positive reappraisal. Conclusions Both ICU patients and their families actively employ a broad range of coping strategies in response to delirium, consistent with the transactional model of stress and coping. Family caregivers emerge as a primary coping resource for patients while simultaneously managing their own psychological burden. These findings suggest that coping strategies may directly influence the trajectory of delirium-related psychological distress, and provide an evidence base for developing patient- and family-centered, coping-informed psychosocial interventions in ICU delirium care.