The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Survivors of Critical Illness and Their Relatives: A Systematic Review and Meta-Analysis

Abstract

Objectives: To evaluate the effect of ICU diaries on posttraumatic stress disorder symptoms in ICU survivors and their relatives. Secondary objectives were to determine the effect on anxiety, depression, and health-related quality of life in patients and their relatives. Data Sources: We searched online databases, trial registries, and references of relevant articles. Study Selection: Studies were included if there was an ICU diary intervention group which was compared with a group without a diary. Data Extraction: Titles, abstracts, and full-text articles were reviewed independently by two authors. Data was abstracted using a structured template. Data Synthesis: Our search identified 1,790 articles and retained eight studies for inclusion in the analysis. Pooled results found no significant reduction in patients’ posttraumatic stress disorder symptoms with ICU diaries (risk ratio, 0.75 [0.3–1.73]; p = 0.5; n = 3 studies); however, there was a significant improvement in patients’ anxiety (risk ratio, 0.32 [0.12, 0.86]; p = 0.02; n = 2 studies) and depression (risk ratio, 0.39 [0.17–0.87]; p = 0.02; n = 2 studies) symptoms. Two studies reported significant improvement in posttraumatic stress disorder symptoms of relatives of ICU survivors; however, these results could not be pooled due to reporting differences. One study reported no significant improvement in either anxiety (risk ratio, 0.94; 95% [0.66–1.33]; p = 0.72) or depression (risk ratio, 0.98; 95% [0.5–1.9]; p = 0.95) in relatives. There was a significant improvement in health-related quality of life of patients with a mean increase in the Short Form-36 general health score by 11.46 (95% CI, 5.87–17.05; p ≤ 0.0001; n = 2 studies). No studies addressed health-related quality of life of relatives. Conclusions: ICU diaries decrease anxiety and depression and improve health-related quality of life, but not posttraumatic stress disorder among ICU survivors and may result in less posttraumatic stress disorder among relatives of ICU patients. Multicenter trials with larger sample sizes are necessary to confirm these findings.

Effect of an ICU diary on psychiatric disorders, quality of life, and sleep quality among adult cardiac surgical ICU survivors: a randomized controlled trial

“…Quality of life is a critical, patient-oriented long-term outcome in ICU survivors. This study found the use of ICU diaries did to preserve the quality of life in ICU survivors, which is not similar to those of other studies [14,17,18]. Compared with the baseline data, both groups increased the SF-36 scores at post-3 months while without a significant difference between groups postintervention.…”

“…These results found that using an ICU diary is not useful for preventing PTSD symptoms, anxiety symptoms, and preserving health-related quality of life in the patients at 3 months post-ICU, while it increases the survivor's factual memories of ICU at 1 month post-ICU, improves the sleep quality, and prevents the hyperarousal symptom at 3 months post-ICU. The results of this study are not entirely consistent with previous trials [14,17,19] and systematic reviews [17,18]. Similar to a trial published on JAMA, ICU diary is not associated with symptoms of PTSD, symptoms of anxiety, and memories of ICU in ICU survivors [19].…”

“…Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of life have been published, the results still seem to be controversial. Several trials indicated that ICU diaries reduced PTSD symptoms [7,8,16], but results by meta-analysis showed that ICU diaries improved quality of life, decreased symptoms of anxiety and depression but not PTSD [17,18]. An assessor-blinded, multicenter RCT in 35 French ICUs did not support ICU diaries for preventing symptoms of PTSD, anxiety, and depression [19].…”

Report on the Third International Intensive Care Unit Diary Conference

“…In contrast, the investigators reported that family members had a significant improvement in PTSD and healthrelated quality of life, although the heterogeneous impact of ICU diaries on patients may be due to factors such as timing, assessment method, and diary-related contents (wording, photographs, etc). 9,30 Regardless of patient effects, however, family members appear to benefit substantially, 9,31 possibly through acquiring a better understanding of the critical illness and intensive care provided, or possibly through their expression and processing of feelings.…”

Intensive care unit (ICU) diaries and the experiences of patients’ families: a grounded theory approach in a lower middle-income country (LMIC)

“…Recent meta-analyses show that ICU diaries can improve psychological outcomes among ICU patients and their relatives [5,6]. Their use began in Denmark in the 1980s; presently many ICUs in Europe implement ICU diaries [7].…”