Evaluation of the effect of prospective patient diaries on emotional well-being in intensive care unit survivors: A randomized controlled trial

Objective: To evaluate the effect of a prospective diary intervention on levels of anxiety and depression in a group of intensive care unit survivors. Design: Pragmatic randomized controlled trial. Setting: Adult intensive care unit, medical/surgical wards of a district general hospital and community bases. Patients: A total of 36 patients who were admitted to the intensive care unit between March 2006 and March 2007 for a minimum of 48 hrs. Interventions: Prospective diary kept by nursing staff for the duration of the patient's stay on intensive care unit, containing daily information about their physical condition, procedures and treatments, events occurring on the unit, and significant events from outside the unit. Measurement and Main Results: At initial assessment, almost half of patients fell into the disorder likely category on the Hospital Anxiety and Depression Scale (44% for anxiety and 47.2% for depression). Paired-samples Student's t tests to compare the Hospital Anxiety and Depression Scale scores at time I and time 2 in the two participant groups revealed that the experimental group displayed statistically significant decreases in both anxiety (t (1,17) = 2.65, p < 0.05) and depression (t (1,17) = 3.33, p < 0.005) scores, while the control group did not, a difference attributed to the diary intervention. Conclusions: Survivors of critical illnesses are likely to experience clinically significant symptoms of anxiety and depression following their discharge from hospital. The prospective diary intervention designed to help patients understand what happened to them in intensive care and it has a significant positive impact on anxiety and depression scores almost 2 months after patients' discharge from intensive care unit. Attempts to replicate these results using larger samples are therefore encouraged, with the aim Of informing best practice guidelines. (Crit Care Med 2009; 37: 184-191)