Emilie Marty-Petit, Emilie Aebischer, Cathy Gonzales, Jean-Philippe Rigaud, Gaelle Freitas-Terzi, Anne Renault, Charlotte Garret, Anne-Françoise Rousseau, Guillaume Thiéry
{"title":"Presence of psychologists in the French intensive care units: a gap between requirements and practice","authors":"Emilie Marty-Petit, Emilie Aebischer, Cathy Gonzales, Jean-Philippe Rigaud, Gaelle Freitas-Terzi, Anne Renault, Charlotte Garret, Anne-Françoise Rousseau, Guillaume Thiéry","doi":"10.1186/s13054-025-05373-z","DOIUrl":null,"url":null,"abstract":"<p>Experiencing a stay in an intensive care unit (ICU) can be traumatic for critically ill patients who are exposed to a technical environment and the fear of dying. At least one third of the survivors develop psychological disorder, including anxiety, depression or post-traumatic stress disorder [1]. There is also evidence that the relatives can suffer from emotional distress during and after the ICU stay of their loved one, leading to the so-called post-intensive care syndrome-family [2]. The burden is also considerable for relatives of patients who die in ICU, leading potentially to a complicated bereavement.</p><p>Patient- and family-cantered care in ICU is a holistic model of health care recognizing the importance of a humanized environment to improve recovery, in which psychologists may play a key role [3]. In 2021, the French government asked the scientific societies to draw up an overview of the presence of psychologists in ICUs. A national decree was also published in April 26th, 2022, recommanding the presence of psychologists in French ICUs (https://www.legifrance.gouv.fr/eli/decret/2022/4/26/SSAH2206984D/jo/texte). However, how this decree is translated into practice is unknown. (https://igas.gouv.fr/L-offre-de-soins-critiques-reponse-au-besoin-courant-et-aux-situations). In this context, the aim of the present study was to describe the presence of psychologists in French ICUs and to identify the potential obstacles to their effective integration in ICU teams.</p><p>A questionnaire was designed by the Patients and Relatives Working Group of the French Society of Intensive Care Medicine (SRLF). The first question was <i>“Does your ICU team include a dedicated psychologist caring for patients and relatives?”</i>. In case of positive answer, the next question was <i>“What proportion of his working time is dedicated to ICU?”</i>. In case of negative answer, two further questions were asked: “<i>Do you have access to psychologists from other departments in your hospital?”</i> and <i>“What are the main barriers preventing the inclusion of a psychologist in your ICU team?”.</i> The following barriers were explored: 1) no financial resources, 2) hospital management decision, 3) no interest.\n</p><p>The survey was conducted between January and December 2023. A total of 322 ICUs were identified, representing approximately 90% of all the ICUs in the country. The medical director and/or the head nurse of each ICU were contacted by telephone or email. Twenty ICUs did not respond (response rate: 302/322, 97%). The characteristics of the participating ICUs are described in Table 1. The presence of a dedicated psychologist was confirmed in half of the participating ICUs (156/302, 51.6%), committing 0.5 (0.3–0.75) working time equivalent (WTE) to this function. In these ICUs the psychologist-to-bed ratio was 1/40. ICUs located in university hospitals were more likely to have a psychologist (79/109, 72%) than the other ICUs (77/193, 39%) (<i>p</i> < 0.001). Among the 146 ICUs without dedicated psychologist, 115 (79%) had access to psychologists from other departments in their hospitals, and 8 (5%) have no access to any psychologists at all. The main barriers precluding the presence of a psychologist in the 42/146 (29%) responding ICUs were: no financial resources (25, 60%), refusal of the hospital management (17, 40%), not interested (9, 21%), interested but not a priority (6,14%) and interested but no candidate (4, 10%) (Fig. 1).</p><figure><figcaption><b data-test=\"table-caption\">Table 1 Characteristics of the participating ICUs</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05373-z/MediaObjects/13054_2025_5373_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"333\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05373-z/MediaObjects/13054_2025_5373_Fig1_HTML.png\" width=\"685\"/></picture><p>Infographic showing the main results of the survey</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>This survey shows that despite legal obligation, a number of ICUs in France do not benefit from the presence of a dedicated psychologist. The main barrier is the lack of financial ressources and the refusal of the hospital management.</p><p>Evidence supports the positive impact of psychological interventions during the ICU stay on long-term psychological disorders in critically ill patients and families [4]. However, the role of ICU psychologists extends well beyond interventions for patients and families. Working with ICU staff members, psychologists can help them to process the emotional burden of their work, can train staff in best psychological care for patients and relatives, can provide skills of communication with patients, and can support the implementation of ICU humanization strategies. Altogether, they contribute to ICU staff wellbeing, that is known to be closely associated to quality of care and medical outcomes. These benefits at the hospital system level could help arguing against the described financial barriers.</p><p>All these areas of input justify a significant working time in the ICU [5]. Compared to the recommendations of 1 WTE psychologist for 20 ICU beds in United Kingdom (https://ics.ac.uk/resource/integrated-practitioner-psychologists-guidance.html), the described availability of psychologists in the French ICUs may result in insufficiently met needs in terms of patient support and teams. Alternative models to ICU dedicated psychologists exist in daily practice, such as resource mutualisation with other hospital departments or regional ICUs. However, their efficiencies have not been investigated.</p><p>The present survey format did not allow a comprehensive analysis of the facilitators and barriers to psychologist presence in ICU. The findings, however, highlight the gap between national recommandations and practices. Integration of psychologists in each ICU can help enhancing patients and family members ICU experience and well being at work, and can thus lessen the burden of critical care on the public health system.</p><p>The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Rousseau AF, Prescott HC, Brett SJ, Weiss B, Azoulay E, Creteur J, et al. Long-term outcomes after critical illness: recent insights. Crit Care. 2021;25(1):108.</p><p>PubMed PubMed Central Google Scholar </p></li><li data-counter=\"2.\"><p>Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med févr. 2012;40(2):618–24.</p><p>Google Scholar </p></li><li data-counter=\"3.\"><p>Renner C, Jeitziner MM, Albert M, Brinkmann S, Diserens K, Dzialowski I, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care. 2023;27(1):301.</p><p>PubMed PubMed Central Google Scholar </p></li><li data-counter=\"4.\"><p>Peris A, Bonizzoli M, Iozzelli D, Migliaccio ML, Zagli G, Bacchereti A, et al. Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care. 2011;15(1):R41.</p><p>PubMed PubMed Central Google Scholar </p></li><li data-counter=\"5.\"><p>Landbeck A, Witt A, Marty Petit E, Aebischer E, Poujol AL, Nguyen S, et al. What clinical practices for intensive care psychologists in France? A national survey. Crit Care. 2024;28(1):204.</p><p>PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>The authors would like to thank the Executive Committee of the French Intensive Care Society for promoting and supporting the Patients and Relatives Working Group. The authors would also like to thank Ms. Christelle Caillette, Ms. Stephanie Accolas and Ms. Wiana Buisson, who were themselves intensive care patients or relatives of intensive care patients and who actively participated in the work of the working group from the very beginning.</p><p>No funding.</p><span>Author notes</span><ol><li><p>Emilie Marty-Petit and Emilie Aebischer have contributed equally.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Servie de Médecine Intesnsive Réanimation, Centre Hospitalier Intercommunal de Poissy – Saint-Germain en Laye, Poissy, France</p><p>Emilie Marty-Petit</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Créteil, Créteil, France</p><p>Emilie Aebischer</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier de Martigues, Martigues, France</p><p>Cathy Gonzales</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France</p><p>Jean-Philippe Rigaud</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier d’Arras, Arras, France</p><p>Gaelle Freitas-Terzi</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Brest, Brest, France</p><p>Anne Renault</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France</p><p>Charlotte Garret</p></li><li><p>Intensive Care Department, University Hospital of Liège, Liège, Belgium</p><p>Anne-Françoise Rousseau</p></li><li><p>Research Unit for a Life-Course Perspective On Health & Education (RUCHE), University of Liège, Liège, Belgium</p><p>Anne-Françoise Rousseau</p></li><li><p>Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Avenue Albert Raymond, 42270, Saint-Etienne, Saint-Priest-en-Jarez, France</p><p>Guillaume Thiéry</p></li><li><p>Université Jean Monnet, Saint-Etienne, France</p><p>Guillaume Thiéry</p></li><li><p>Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France</p><p>Guillaume Thiéry</p></li></ol><span>Authors</span><ol><li><span>Emilie Marty-Petit</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Emilie Aebischer</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Cathy Gonzales</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Jean-Philippe Rigaud</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Gaelle Freitas-Terzi</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Anne Renault</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Charlotte Garret</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Anne-Françoise Rousseau</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Guillaume Thiéry</span>View author publications<p><span>You can also search for this author in</span><span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Consortia</h3><h3>the Patients and Relatives Working Group of the Société de Réanimation de Langue Française</h3><h3>Contributions</h3><p>GT, EMP, EA, CG, AR, CG, JPR, GT designed the research; EMP, EA, CG, conducted the research; GT, EA, EMP analyzed the data; AFR, GT, EMP, EA wrote the paper; JPR, AR, CG, GT critically reviewed paper. All authors approved the submitted manuscript.</p><h3>Corresponding author</h3><p>Correspondence to Guillaume Thiéry.</p><h3>Ethical approval</h3>\n<p>Not applicable.</p>\n<h3>Consent for publication</h3>\n<p>Not applicable.</p>\n<h3>Competing interests</h3>\n<p>All authors declare that they have no competing interests.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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Abstract
Experiencing a stay in an intensive care unit (ICU) can be traumatic for critically ill patients who are exposed to a technical environment and the fear of dying. At least one third of the survivors develop psychological disorder, including anxiety, depression or post-traumatic stress disorder [1]. There is also evidence that the relatives can suffer from emotional distress during and after the ICU stay of their loved one, leading to the so-called post-intensive care syndrome-family [2]. The burden is also considerable for relatives of patients who die in ICU, leading potentially to a complicated bereavement.
Patient- and family-cantered care in ICU is a holistic model of health care recognizing the importance of a humanized environment to improve recovery, in which psychologists may play a key role [3]. In 2021, the French government asked the scientific societies to draw up an overview of the presence of psychologists in ICUs. A national decree was also published in April 26th, 2022, recommanding the presence of psychologists in French ICUs (https://www.legifrance.gouv.fr/eli/decret/2022/4/26/SSAH2206984D/jo/texte). However, how this decree is translated into practice is unknown. (https://igas.gouv.fr/L-offre-de-soins-critiques-reponse-au-besoin-courant-et-aux-situations). In this context, the aim of the present study was to describe the presence of psychologists in French ICUs and to identify the potential obstacles to their effective integration in ICU teams.
A questionnaire was designed by the Patients and Relatives Working Group of the French Society of Intensive Care Medicine (SRLF). The first question was “Does your ICU team include a dedicated psychologist caring for patients and relatives?”. In case of positive answer, the next question was “What proportion of his working time is dedicated to ICU?”. In case of negative answer, two further questions were asked: “Do you have access to psychologists from other departments in your hospital?” and “What are the main barriers preventing the inclusion of a psychologist in your ICU team?”. The following barriers were explored: 1) no financial resources, 2) hospital management decision, 3) no interest.
The survey was conducted between January and December 2023. A total of 322 ICUs were identified, representing approximately 90% of all the ICUs in the country. The medical director and/or the head nurse of each ICU were contacted by telephone or email. Twenty ICUs did not respond (response rate: 302/322, 97%). The characteristics of the participating ICUs are described in Table 1. The presence of a dedicated psychologist was confirmed in half of the participating ICUs (156/302, 51.6%), committing 0.5 (0.3–0.75) working time equivalent (WTE) to this function. In these ICUs the psychologist-to-bed ratio was 1/40. ICUs located in university hospitals were more likely to have a psychologist (79/109, 72%) than the other ICUs (77/193, 39%) (p < 0.001). Among the 146 ICUs without dedicated psychologist, 115 (79%) had access to psychologists from other departments in their hospitals, and 8 (5%) have no access to any psychologists at all. The main barriers precluding the presence of a psychologist in the 42/146 (29%) responding ICUs were: no financial resources (25, 60%), refusal of the hospital management (17, 40%), not interested (9, 21%), interested but not a priority (6,14%) and interested but no candidate (4, 10%) (Fig. 1).
Table 1 Characteristics of the participating ICUsFull size tableFig. 1
Infographic showing the main results of the survey
Full size image
This survey shows that despite legal obligation, a number of ICUs in France do not benefit from the presence of a dedicated psychologist. The main barrier is the lack of financial ressources and the refusal of the hospital management.
Evidence supports the positive impact of psychological interventions during the ICU stay on long-term psychological disorders in critically ill patients and families [4]. However, the role of ICU psychologists extends well beyond interventions for patients and families. Working with ICU staff members, psychologists can help them to process the emotional burden of their work, can train staff in best psychological care for patients and relatives, can provide skills of communication with patients, and can support the implementation of ICU humanization strategies. Altogether, they contribute to ICU staff wellbeing, that is known to be closely associated to quality of care and medical outcomes. These benefits at the hospital system level could help arguing against the described financial barriers.
All these areas of input justify a significant working time in the ICU [5]. Compared to the recommendations of 1 WTE psychologist for 20 ICU beds in United Kingdom (https://ics.ac.uk/resource/integrated-practitioner-psychologists-guidance.html), the described availability of psychologists in the French ICUs may result in insufficiently met needs in terms of patient support and teams. Alternative models to ICU dedicated psychologists exist in daily practice, such as resource mutualisation with other hospital departments or regional ICUs. However, their efficiencies have not been investigated.
The present survey format did not allow a comprehensive analysis of the facilitators and barriers to psychologist presence in ICU. The findings, however, highlight the gap between national recommandations and practices. Integration of psychologists in each ICU can help enhancing patients and family members ICU experience and well being at work, and can thus lessen the burden of critical care on the public health system.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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The authors would like to thank the Executive Committee of the French Intensive Care Society for promoting and supporting the Patients and Relatives Working Group. The authors would also like to thank Ms. Christelle Caillette, Ms. Stephanie Accolas and Ms. Wiana Buisson, who were themselves intensive care patients or relatives of intensive care patients and who actively participated in the work of the working group from the very beginning.
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Author notes
Emilie Marty-Petit and Emilie Aebischer have contributed equally.
Authors and Affiliations
Servie de Médecine Intesnsive Réanimation, Centre Hospitalier Intercommunal de Poissy – Saint-Germain en Laye, Poissy, France
Emilie Marty-Petit
Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Créteil, Créteil, France
Emilie Aebischer
Service de Médecine Intensive Réanimation, Centre Hospitalier de Martigues, Martigues, France
Cathy Gonzales
Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
Jean-Philippe Rigaud
Service de Médecine Intensive Réanimation, Centre Hospitalier d’Arras, Arras, France
Gaelle Freitas-Terzi
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Brest, Brest, France
Anne Renault
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
Charlotte Garret
Intensive Care Department, University Hospital of Liège, Liège, Belgium
Anne-Françoise Rousseau
Research Unit for a Life-Course Perspective On Health & Education (RUCHE), University of Liège, Liège, Belgium
Anne-Françoise Rousseau
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Avenue Albert Raymond, 42270, Saint-Etienne, Saint-Priest-en-Jarez, France
Guillaume Thiéry
Université Jean Monnet, Saint-Etienne, France
Guillaume Thiéry
Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
Guillaume Thiéry
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the Patients and Relatives Working Group of the Société de Réanimation de Langue Française
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GT, EMP, EA, CG, AR, CG, JPR, GT designed the research; EMP, EA, CG, conducted the research; GT, EA, EMP analyzed the data; AFR, GT, EMP, EA wrote the paper; JPR, AR, CG, GT critically reviewed paper. All authors approved the submitted manuscript.
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Marty-Petit, E., Aebischer, E., Gonzales, C. et al. Presence of psychologists in the French intensive care units: a gap between requirements and practice. Crit Care29, 142 (2025). https://doi.org/10.1186/s13054-025-05373-z
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Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.