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The intensive care unit (ICU) has been portrayed as psychologically stressful, with a growing body of research substantiating elevated rates of depression, posttraumatic stress disorder (PTSD), and other psychological disruptions in populations of critical care survivors. To explain these psychopathology elevations, some have proposed a direct effect of ICU admission upon the later development of psychopathology, whereas others highlight the complex interaction between the trauma of a life-threatening illness or injury and the stressful life-saving interventions often administered in the ICU. However, the conclusion that the ICU is an independent causal factor in trauma-related psychological outcomes may be premature. Current ICU research suffers from important methodological problems including lack of true prospective data, failure to employ appropriate comparison groups, sampling bias, measurement issues, and problems with statistical methodology. In addition, the ICU literature has yet to investigate important risk and resilience factors that have been empirically validated in the broader stress-response literature. The authors propose the application of these important constructs to the unique setting of the ICU. This review focuses on multiple aspects of the important but complex research question of whether the ICU confers risk for psychological distress above and beyond the traumatic impact of the serious health events that necessitate ICU treatment.