ICU Diaries Reduce Post Traumatic Stress Disorder after Critical IIllness in Patients and Family Members

Purpose:

Delusional memories from the period of critical illness have been shown to be a major contributor to the later occurrence of post traumatic stress disorder (PTSD). The experience of watching the patient being critically ill is also traumatic to families, making them at risk of PTSD.  It was hypothesised that an ICU diary could help patients and their families come to terms with their differing memories and so reduce the incidence of PTSD.

Methods:

A prospective randomised, controlled study was performed in 12 ICUs across 6 European countries. 1 week after ICU discharge the ICU Memory Tool was used to identify recall for delusional memories. 1 month post ICU discharge PTSD related symptoms was assessed using the PTSS-14 and the patients were randomised to receive their diary at this point or after the next interview 3 months post ICU discharge. At 3 months a diagnosis of PTSD was made using the PDS. After the final interview, the control patients also received their diaries. In 2 of the study ICUs relatives were asked to complete the PTSS-14 at 1 month and 3 months post ICU discharge.  

Results:

352 patients were randomised, 322 (91.5%) completing the 3 month follow-up. 11 patients with undiagnosed, pre-existing PTSD were excluded from the final analysis. The incidence of new PTSD in the intervention group was 5% (8/154), and 13.4% (21/157) in the control group; this was statistically significant (p = 0.013). 30 relatives (15 in the intervention group and 15 in the control group) completed questionnaires at 1 and 3 months. Relatives in the intervention group had reduced PTSD symptom (P = .03).

Conclusion:

This randomised, controlled trial confirms that an ICU Diary helps patients come to terms with critical illness and reduces PTSD incidence. In addition the diary helps reduce symptoms of PTSD in relatives.