{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:06:56Z","timestamp":1789578416298,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Non-invasive respiratory supports (High-Flow Nasal Oxygen, HFNO; Continuous Positive Airway Pressure, CPAP; Non-Invasive Ventilation, NIV) are frequently used in Acute Hypoxemic Respiratory Failure (AHRF). However, the experience of assisted breathing may profoundly affect patients\u2019 psychological balance, particularly during acute critical illness and subsequent rehabilitation. Aims and objectives: This longitudinal study investigated the psychological burden associated with non-invasive respiratory support use in patients with COVID-19-related AHRF, exploring changes in psychological functioning from acute hospitalization (RICU\/ICU) (T0) to follow-up, conducted at a mean of 6.0 \u00b1 3.1 months after respiratory rehabilitation (T1). Methods: Fifty-two patients (mean age = 66.9 \u00b1 9.17 years) were assessed at T0 and T1. Standardized measures evaluated anxiety, psychological distress, post-traumatic stress symptoms, depression, and resilience, in relation to perceived illness severity and subjective experience of non-invasive respiratory support. Results: During acute care, patients reported high levels of fear and anxiety related to illness severity and uncertainty. The experience of non-invasive respiratory support, often perceived as a marker of critical condition, was associated with increased fear and anxiety (t(14) = 2.79, p = 0.014) compared to the recovery phase, leading to feelings of loss of control and diminished psychological well-being (t(17) = 2.35, p = 0.031). However, resilience significantly improved over time (t(16) = \u22124.78, p &lt; 0.001). Conclusions: Non-invasive respiratory support may represent a psychologically demanding experience, often perceived as challenging to patients\u2019 sense of safety and control. Encouragingly, psychological adaptation and resilience can improve during rehabilitation. Integrating structured psychological support within respiratory rehabilitation pathways may promote recovery and restore psychological balance in patients requiring assisted ventilation.<\/jats:p>","DOI":"10.3390\/medsci14020270","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T13:53:24Z","timestamp":1779371604000},"page":"270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Breathing Under Pressure: Psychological Burden and Recovery Trajectories in Patients Receiving Non-Invasive Respiratory Support from Acute COVID-19 to Respiratory Rehabilitation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0266-6386","authenticated-orcid":false,"given":"Eleonora","family":"Volpato","sequence":"first","affiliation":[{"name":"Department of Psychology, Universit\u00e0 Cattolica del Sacro Cuore, CAP. 20123 Milan, Italy"},{"name":"IRCCS Fondazione Don Carlo Gnocchi, CAP. 20148 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7458-7498","authenticated-orcid":false,"given":"Valentina","family":"Poletti","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e0 Cattolica del Sacro Cuore, CAP. 20123 Milan, Italy"},{"name":"IRCCS Fondazione Don Carlo Gnocchi, CAP. 20148 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"de Candia","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Piazza Giulio Cesare 12, CAP. 70100 Bari, Italy"},{"name":"Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari \u2018Aldo Moro\u2019, CAP. 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Palma","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Piazza Giulio Cesare 12, CAP. 70100 Bari, Italy"},{"name":"Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari \u2018Aldo Moro\u2019, CAP. 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Pilon","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Piazza Giulio Cesare 12, CAP. 70100 Bari, Italy"},{"name":"Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari \u2018Aldo Moro\u2019, CAP. 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Elisiana","family":"Carpagnano","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Piazza Giulio Cesare 12, CAP. 70100 Bari, Italy"},{"name":"Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari \u2018Aldo Moro\u2019, CAP. 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-0751","authenticated-orcid":false,"given":"Paolo","family":"Banfi","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi, CAP. 20148 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0201-0486","authenticated-orcid":false,"given":"Paola","family":"Pierucci","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical School, Libera Universit\u00e0 Mediterranea LUM Casamassima Bari 2, Strada Statale 100 Km18, CAP. 70010 Bari, Italy"},{"name":"Respiratory and Bronchoscopy Unit EE Miulli Hospital Acquaviva delle Fonti, Strada Provinciale Acquaviva-Santeramo km 4,100, 70021 Acquaviva delle Fonti, CAP. 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/10408363.2020.1783198","article-title":"The COVID-19 pandemic","volume":"57","author":"Ciotti","year":"2020","journal-title":"Crit. 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