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Background <p>Intensive care unit (ICU) physicians—intensivists, anaesthesiologists, and critical care specialists who provide care for patients with the highest acuity of illness in hospital settings—face extraordinary emotional demands that place them at heightened risk for burnout, moral distress, post-traumatic stress disorder (PTSD), compassion fatigue, trauma-related disengagement, and suicide. Despite growing recognition of these challenges, the evidence base for interventions remains fragmented, and the emotional wellbeing of intensivists receives insufficient institutional attention.</p> Methods <p>A structured narrative review of the literature was conducted by searching PubMed, Embase, PsycINFO, and the Cochrane Library from inception through January 2026 using combinations of the following terms: “ICU,” “intensive care,” “physician,” “intensivist,” “burnout,” “moral distress,” “resilience,” “emotional health,” “wellbeing,” “compassion fatigue,” “PTSD,” and “wellness interventions.” Articles were selected based on relevance, methodological quality, and recency, with priority given to landmark trials, systematic reviews, meta-analyses, and expert consensus guidelines.</p> Objectives <p>This narrative review pursues three aims. First, it synthesises current evidence on the epidemiology, pathophysiology, risk factors, and consequences of emotional distress among ICU physicians. Second, it critically appraises the efficacy of existing care packages and interventions. Third, it identifies emerging strategies and future directions for fostering emotional resilience in critical care practice.</p> Summary of Findings <p> Burnout affects over 40% of ICU physicians globally, with emotional exhaustion and depersonalisation (a Maslach Burnout Inventory dimension that, in trauma-exposed clinicians, may overlap clinically with dissociative or trauma-related disengagement) being the most prevalent dimensions. The neurobiological underpinnings of chronic stress—including hypothalamic–pituitary–adrenal (HPA) axis dysregulation, prefrontal cortex dysfunction, and neuroinflammation—are well characterised. Moral distress, moral injury, second victim syndrome, and compassion fatigue represent distinct but overlapping psychological constructs that compound the emotional burden. Evidence from landmark trials, including the Hello trial (2025), systematic reviews, and meta-analyses supports multimodal interventions encompassing positive communication strategies, schedule restructuring, mindfulness-based therapeutic strategies, emotional intelligence training, Schwartz Rounds, death cafés, and structured reflection. Organisational-level changes—including leadership engagement, workflow optimisation, and cultures of psychological safety—are increasingly recognised as essential. However, significant gaps persist in high-quality evidence, particularly from low- and middle-income countries (LMICs), including India. This review underscores the imperative to shift from reactive, individual-focused approaches to proactive, systemic strategies that nurture compassion, resilience, and wellbeing in ICU doctors.</p>

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Raising Emotionally Healthy ICU Doctors: From Burnout to Resilience – a Comprehensive Review of the Emotional Wellbeing of Intensive Care Physicians

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Shibu Sasidharan,
  • Harpreet Dhillon,
  • Shalendra Singh,
  • Debashish Paul,
  • Vignesh Jayaprakash

摘要

Background

Intensive care unit (ICU) physicians—intensivists, anaesthesiologists, and critical care specialists who provide care for patients with the highest acuity of illness in hospital settings—face extraordinary emotional demands that place them at heightened risk for burnout, moral distress, post-traumatic stress disorder (PTSD), compassion fatigue, trauma-related disengagement, and suicide. Despite growing recognition of these challenges, the evidence base for interventions remains fragmented, and the emotional wellbeing of intensivists receives insufficient institutional attention.

Methods

A structured narrative review of the literature was conducted by searching PubMed, Embase, PsycINFO, and the Cochrane Library from inception through January 2026 using combinations of the following terms: “ICU,” “intensive care,” “physician,” “intensivist,” “burnout,” “moral distress,” “resilience,” “emotional health,” “wellbeing,” “compassion fatigue,” “PTSD,” and “wellness interventions.” Articles were selected based on relevance, methodological quality, and recency, with priority given to landmark trials, systematic reviews, meta-analyses, and expert consensus guidelines.

Objectives

This narrative review pursues three aims. First, it synthesises current evidence on the epidemiology, pathophysiology, risk factors, and consequences of emotional distress among ICU physicians. Second, it critically appraises the efficacy of existing care packages and interventions. Third, it identifies emerging strategies and future directions for fostering emotional resilience in critical care practice.

Summary of Findings

Burnout affects over 40% of ICU physicians globally, with emotional exhaustion and depersonalisation (a Maslach Burnout Inventory dimension that, in trauma-exposed clinicians, may overlap clinically with dissociative or trauma-related disengagement) being the most prevalent dimensions. The neurobiological underpinnings of chronic stress—including hypothalamic–pituitary–adrenal (HPA) axis dysregulation, prefrontal cortex dysfunction, and neuroinflammation—are well characterised. Moral distress, moral injury, second victim syndrome, and compassion fatigue represent distinct but overlapping psychological constructs that compound the emotional burden. Evidence from landmark trials, including the Hello trial (2025), systematic reviews, and meta-analyses supports multimodal interventions encompassing positive communication strategies, schedule restructuring, mindfulness-based therapeutic strategies, emotional intelligence training, Schwartz Rounds, death cafés, and structured reflection. Organisational-level changes—including leadership engagement, workflow optimisation, and cultures of psychological safety—are increasingly recognised as essential. However, significant gaps persist in high-quality evidence, particularly from low- and middle-income countries (LMICs), including India. This review underscores the imperative to shift from reactive, individual-focused approaches to proactive, systemic strategies that nurture compassion, resilience, and wellbeing in ICU doctors.