1 Department of Nursing and Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre and Ingram School of Nursing and Department of Pediatrics, McGill University, Montreal, QC, Canada.
2 Division of General Pediatrics, Montreal Children's Hospital, McGill University Health Centre and Department of Pediatrics, McGill University, Montreal, QC, Canada.
3 Department of Critical Care, The Hospital for Sick Children (SickKids) and Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
4 School of Nursing, Dalhousie University and Department of Pediatrics, Neonatal-Perinatal Division, IWK Health, Halifax, NS, Canada.
5 Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
6 Department of Psychology and Neuroscience, and Department of Pediatrics, Dalhousie University and the Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada.
7 Department of Psychology and Centre for Research in Human Development, Concordia University, Montreal, QC, Canada.
8 Lawrence Bloomberg Faculty of Nursing, University of Toronto and SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.

Objectives: To report the 3-year follow-up results of the "Caring Intensively" study, which examined children's psychological and behavioral responses after PICU hospitalization.

Design: Prospective mixed methods, concurrent triangulation design. In the quantitative arm, study group (SG) and comparison group (CG) children and their parents were administered a battery of measures assessing psychological and behavioral outcomes, and telephone survey data were collected 6 weeks, 6 months, 1, 2, and 3 years post-discharge. In the qualitative arm, SG interviews were conducted 1 and 3 years post-discharge. Recruitment 2014-2018, with follow-up completed 2021.

Setting: SG recruited from PICUs of three Canadian quaternary care pediatric hospitals; CG from two hospitals' ear, nose, and throat (ENT) day surgery units.

Patients: Age (3-12 yr) and gender-matched PICU children (SG, 158) or day surgery ENT children (CG, 169) and their parents were recruited; 62% of families completed the study (SG, 97; CG, 106). Selected SG families were interviewed at year 1 (17 families, 30 participants) and year 3 (14 families, 27 participants).

Interventions: None.

Measurements and main results: No group differences on primary or secondary outcomes. Both groups reported emotional and behavioral changes in children via telephone survey; however, group findings diverged on their nature and attribution. SG parents attributed changes primarily to PICU hospitalization; CG parents attributed changes to other life events. At year 3, 40.3% of SG parents still reported negative emotional and behavioral changes in children suggesting a chronic trajectory of recovery. Qualitative interview findings converged with SG survey responses, reflecting the adaptive and relational challenges confronting children and families.

Conclusions: This study highlights children's emotional and behavioral responses over the 3 years post-PICU and the need to study child recovery within the family. These findings contribute to our understanding of the nature and duration of trajectories of recovery and emphasize the importance of providing clinical follow-up and prioritizing family-identified outcomes in future research.