Hospital Diaries Help Prevent PTSD

According to the American Psychiatric Association, community samples show the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among adults is eight percent. Post-Traumatic Stress Disorder can develop after someone experiences or witnesses a traumatic event, such as a car crash, sexual assault, war, or domestic violence. Some individuals who are admitted to the intensive care unit (ICU) at the hospital also develop PTSD. However, a recent study indicates diaries might be an effective tool for combating PTSD for individuals who have spent time in intensive care units.

The study was conducted by Rich Griffiths, a professor, and Christina Jones from the University of Liverpool, located in the United Kingdom. They worked with an international team of researchers to determine the effectiveness of hospital diaries in preventing PTSD in patients who spent time in the ICU in 12 different hospitals, located in six different European counties.

Three-hundred and fifty-two patients from 12 different hospitals were randomly assigned to either receive a hospital diary after their stay in the intensive care unit or not to receive a diary. Griffiths stated, "On average 1 in 10 patients who stay more than 48 hours in intensive care will develop PTSD. 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. These memories are frequently described as vivid, realistic and frightening."

During the study period, 162 individuals who spent time in intensive care were randomly assigned to receive a diary. The diary was filled out by the patient's relatives and nursing staff at the hospital. Nursing staff and the patient's relatives wrote in the diary everyday utilizing everyday language and took pictures to accompany the journal. After a patient was discharged from the intensive care unit, a nurse sat down and talked the individual through the journal entries.

The researchers discovered that those individuals who received diaries were less than half as likely as those who did not to develop Post-Traumatic Stress Disorder.

According to Griffiths, the diaries have costs; the nursing staff must be willing to write something in the journal daily, to take photographs when a significant change occurs, and an experienced nurse is required to sit down and talk with the patient about the diary once he or she is released from intensive care. However, the cost of the hospital diaries is less costly than the therapy patients need who develop PTSD after being in intensive care. Additionally, Griffiths asserts that the cost of the diaries is not significantly more than providing an unstructured discussion about a patient's stay in the ICU.

PTSD may occur after an individual experiences a traumatic event. The mental illness contains several characteristics. Individuals who suffer from PTSD experience at least one re-experiencing symptom, which include physiological reactions to something that resembles or symbolizes an aspect of the traumatic event, disturbing and intrusive recollections of the trauma, including perceptions, thoughts, and images, psychological distress to something that resembles or symbolizes an aspect of the event, nightmares, and/or flashbacks, feeling as if the event were happening again.

Individuals suffering from Post-Traumatic Stress Disorder also engage in at least three of the following avoidance behaviors: tries to avoid feelings, thoughts, and conversations related to the traumatic event, has a sense of a foreshortened future, experiences decreased participation in or interest in activities, possesses a restricted range of emotions, tries to avoid people, activities, or places that remind him or her of the event, and/or has an inability to remember a significant aspect or detail of the event. Finally, individuals with PTSD experience at least two hyperarousal symptoms, which include an exaggerated startle response, sleeping difficulties, concentration difficulties, outbursts of anger or irritability, and/or hypervigilance. These symptoms must occur for one month or longer in duration in order for a diagnosis of PTSD be made.

While individuals who have spent time in intensive care units at hospitals are at risk for developing PTSD, new research indicates hospital diaries are effective for preventing this mental illness. If you would like to read more about this study, you may check out the BioMed Central's open access journal, Critical Care where this study was published.

Sources:

Psych Central: Hospital Diaries Protect from PTSD:
http://psychcentral.com/news/2010/09/17/hospital-diaries-protect-from-ptsd/18334.html

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders IV-TR. 2000. American Psychiatric Association: Arlington, VA.