Development and validation of a post-ICU syndrome in family caregivers scale (PICS-F Scale)

Abstract

Abstract Background Recent studies indicate that rapid advances in medical technology have led to a steady increase in intensive care unit (ICU) survivors. The stressful experience of admission can lead to a series of symptoms in family caregivers of ICU patients, which is referred as Post-Intensive Care Syndrome‑Family (PICS‑F). However, existing tools are single-domain assessments and can only cover a portion of the four main domains of PICS-F. A comprehensive evaluation requires the combined use of multiple scales, which may make the process complex and time-consuming. Therefore, this study aims to develop and validate the PICS‑F Scale as an early screening tool for the risk of PICS‑F that covers physical, mental, cognitive, and social domains in family caregivers of adult ICU survivors. Methods The initial item pool was generated through a literature review. Two rounds of the modified Delphi survey were conducted by a multidisciplinary panel of experts. Psychometric evaluation was conducted using data from 468 family caregivers of ICU survivors who were recruited from two general hospitals in Shandong Province, China, from March to May 2025. Validity was assessed via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Cronbach’s α was used to assess the internal consistency. Criterion validity was assessed by calculating the correlation coefficient with the 36-Item Short Form Health Survey questionnaire (SF-36) used as the criterion measure. Results The final PICS-F Scale contains 22 items. EFA revealed a four-factor structure, corresponding to physical, mental, cognitive, and social dimensions, which explained 76.33% of the total variance. CFA showed satisfactory fit indices (SRMR = 0.075, RMSEA = 0.090, TLI = 0.917, and CFI = 0.927). The scale showed great internal consistency (Cronbach’s α = 0.934; subscales: 0.891–0.958). With respect to criterion validity, the correlation between the PICS-F Scale and SF-36 was r = -0.723 ( p < 0.001). Conclusions The scale is a valid and reliable early screening tool for rapidly identifying family members at high risk of PICS‑F in Chinese language settings. It can be used in the early phase after ICU survivors are transferred out of the ICU.