Diary helps ICU patients with PTSD

A diary can help reduce intensive care patients' risk of post-traumatic stress disorder (PTSD) after a difficult stay in the hospital, according to a new study.

The randomized controlled study included 352 intensive care unit (ICU) patients at 12 hospitals in six European countries. Of those patients, 162 were randomly selected to receive diaries about their time in the ICU. The diaries, completed by nursing staff and relatives, used plain language and included photographs.

After the patients were discharged from the ICU, a nurse reviewed the diary entries with them.

The patients who received a diary were less than half as likely to develop PTSD as the control group that didn't receive a diary, according to the report published in journal Critical Care.

The findings

"On average, one in 10 patients who stay more than 48 hours in intensive care will develop PTSD," said study author Richard Griffiths, a professor at the University of Liverpool in the United Kingdom.

"It is likely that the fragmentary nature of their memories and the high proportion of delusional memories, such as nightmares and hallucinations, make it difficult for patients to make sense of what has happened to them," he explained.

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

"Diaries are not without cost; there has to be a commitment from the staff to write something in the diary every day and take photographs when important changes happen," Griffiths added. "In addition, an experienced nurse is needed to go through the diary with the patient to ensure that they understand its contents, but this is not significantly more than might have been provided by an unstructured discussion in the past.

Compared with providing formal therapy to all patients struggling to cope with their experiences, diaries are likely to be highly cost-effective."

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