4). Previous studies identified several behavioral, social, personality traits and trauma- or ICU-related experiences as predictors free copy for PTSD symptoms at 1 year post-ICU treatment [4,9,11]. In the present study, we cannot confirm what was previously reported because our primary interest was generally to assess the effects of early psychological intervention in a patient population affected by serious illness that arose acutely; this must be considered a limitation of the study. Also, despite the presence of the same internal standardized protocol for sedation in both groups, we cannot exclude the possibility that differences in sedative drug administration could have partially influenced the results. In the present study, we cannot show results concerning cognitive status: These data are lacking because that investigation of this feature started in 2010.

Another limitation is the possible presence of pre-existing levels of depression and anxiety (not referred to during intensivist and clinical psychologist anamnesis collection). Moreover, potential data collection bias cannot be excluded. The interviewers were not aware of the study, but they were aware of the change in the ICU setting with the implementation of the Clinical Psychological Service. Finally, the difference in the percentage of patients who declined to participate at follow-up between the control and intervention groups (14.4% vs. 10.8%, respectively) (Figure (Figure1),1), although comparable and not statistically significant, must be taken into consideration as a limiting factor.

Also, the difference in mortality rates observed between patients eligible as controls (26%) and in the intervention group (18%) could have partially influenced the results of the study.ConclusionsOur data suggest that implementing ICU treatment with the presence of an intra-ICU clinical psychologist may help critically ill trauma patients recover from this acute, stressful experience. Although we await confirmation by further studies, since clinical psychologist intervention is not associated with any adverse effects, implementing this service should be considered in the ICU setting.Key messages? Psychological disorders are frequent among ICU survivors.? Early intra-ICU psychological intervention can decrease the risk of PTSD, anxiety and depression at 12 months after ICU discharge.

AbbreviationsAIS: Abbreviated Injury Scale; GCS: Glasgow Coma Scale; HADS: Hospital Anxiety and Depression Scale; ICU: intensive care unit; ISS: injury severity score; IES-R: Impact of Event Scale-Revised; LOS: length of stay; PTSD: posttraumatic stress disorder; SAPS II: Simplified Acute Physiology GSK-3 Score II.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsAP, VG and LB organized the Clinical Psychological Service. AP, MB, MLM, DI and AB designed the study. AP, MB and GZ reviewed the literature.