Keeping a diary in intensive care halves the risk of post traumatic stress disorder

BMJ 2010; 341 doi: (Published 16 September 2010) Cite this as: BMJ 2010;341:c5102
  1. Zosia Kmietowicz
  1. 1London

    Patients who have spent more than three days in intensive care are less likely to develop post traumatic stress disorder (PTSD) if staff and relatives make a diary of their stay and go through it with them afterwards, a study has found.

    Out of 162 patients randomised to review their diaries with a health professional one month after discharge from intensive care, just eight (5%) developed PTSD compared with 21 of 160 (13%) patients who did not review their stays with the help of a diary, shows the study published in the open access journal Critical Care (Crit Care 2010;14:R168; doi: 10.1186/cc9260).

    Richard Griffiths, professor of medicine (intensive care) at the University of Liverpool and one of the study’s authors, said that although there are costs associated with keeping diaries, “Compared with providing formal therapy to all patients struggling to cope with their experiences, diaries are likely to be highly cost-effective.”

    Previous research indicates that about 1 in 10 patients who stay in intensive care for more than 48 hours to develop PTSD. Professor Griffiths explained that the fragmentary nature of patients’ memories and the high proportion of delusional memories, such as nightmares and hallucinations, make it difficult for patients to make sense of what happened to them.

    “These memories are frequently described as vivid, realistic, and frightening and may even involve patients thinking that nurses or doctors tried to kill them,” he said. “Hard evidence of what really happened, in the form of a diary filled out by the treatment staff, may help to allay these fears.”

    To test the effect of diaries on the risk of PTSD, staff at 12 hospitals in six European countries kept diaries for 1164 patients who spent at least 72 hours in intensive care and were ventilated for at least 24 hours. Family members could contribute to the diaries of daily events, which were written in everyday language, included photographs, and were drawn up according to guidelines.

    Patients were recruited to the study one week after they were discharged from intensive care. Of the 1164 for whom diaries were made, 309 died and 522 refused to take part, were excluded for other reasons, withdrew from the study, or did not complete follow-up questionnaires. Staff from the hospitals went through the diaries of those patients randomised to receive them one month after their discharge from intensive care.

    As well as reducing the incidence of PTSD, going through the diary with a nurse seems to help recovery from this condition. Overall there was no difference in symptom scores between patients who were given their diaries and those who were not at one and three months after discharge from intensive care. But when researchers included only the patients diagnosed with PTSD in the analysis, they found that symptoms were significantly reduced among patients who went through their diaries compared with those who did not.


    Cite this as: BMJ 2010;341:c5102

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