POPPI: Provision Of Psychological support to People in Intensive care


Many patients experience severe stress, including hallucinations and delusions, in critical care units.

This stress is linked to the development of longer-term psychological problems such as post-traumatic stress disorder (PTSD). Little is done to help prevent these problems because there is limited evidence for what works. Previously, a preventive psychological intervention was developed by this research team, to be led by nurses, to address this problem. The intervention had three elements:

1. create a therapeutic environment in critical care

2. provide three stress support sessions for patients identified as acutely stressed

3. provide a relaxation and recovery programme for patients identified as acutely stressed.


In this study [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)], an education package was created to ensure that the intervention could be delivered across several units. A study was then conducted in which two units tested delivering the intervention and patients and staff were asked if it was acceptable. In another study, trial procedures were tested. The information was used to improve all the parts for a clinical trial to find out if the intervention was effective. In the trial, staff at 12 units were trained to deliver the intervention (group 1). At another 12 units, staff were not trained (group 2).


A total of 1458 patients took part. How patients in each group felt 6 months later was compared. It was found that the intervention did not reduce development of PTSD symptom severity and it was very uncertain if the intervention was cost-effective.


In its current form, the research team do not recommend that the psychological intervention is brought into the NHS.

Who led this study?

  • Professor Kathy Rowan, ICNARC
  • Dr Dorothy Wade, University College Hospital, London

This study was funded by the National Institute for Health Research (NIHR) – Health Services & Delivery Research (HS&DR) Programme (Project: 12/64/124)


Mason AJ, Grieve RD, Richards-Belle A, Mouncey PR, Harrison DA, Carpenter JR. A framework for extending trial design to facilitate missing data sensitivity analyses. BMC Med Res Methodol 2020; 20(1):66. http://dx.doi.org/10.1186/s12874-020-00930-2

Wade DM, Mouncey PR, Richards-Belle A, Wulff J, Harrison DA, Sadique MZ, Grieve RD, Emerson LM, Mason AJ, Aaronovitch D, Als N, Brewin CR, Harvey SE, Howell DCJ, Hudson N, Mythen MG, Smyth D, Weinman J, Welch J, Whitman C, Rowan KM. Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients: A Randomized Clinical Trial. JAMA 2019; 321(7):665-75. http://dx.doi.org/10.1001/jama.2019.0073

Wulff J, Sadique Z, Grieve R, Howell D, Mouncey P, Wade D, Rowan KM, Harrison DA. Psychological outcomes following a nurse-led preventative psychological intervention for critically ill patients trial: Statistical and health economic analysis plan. J Intensive Care Soc 2018; 0(0):1751143718755016. http://dx.doi.org/10.1177/1751143718755016

Wade D, Als N, Bell V, Brewin C, D’Antoni D, Harrison DA, Harvey M, Harvey S, Howell D, Mouncey PR, Mythen M, Richards-Belle A, Smyth D, Weinman J, Welch J, Whitman C, Rowan KM. Providing psychological support to people in intensive care: development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity. BMJ Open 2018; 8(7). http://dx.doi.org/10.1136/bmjopen-2017-021083

Richards-Belle A, Mouncey PR, Wade D, Brewin CR, Emerson LM, Grieve R, Harrison DA, Harvey S, Howell D, Mythen M, Sadique Z, Smyth D, Weinman J, Welch J, Rowan KM. Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI): protocol for a cluster-randomised clinical trial of a complex intervention. BMJ Open 2018; 8(2). http://dx.doi.org/10.1136/bmjopen-2017-020908