The Impact of PICU Diaries on Posttraumatic Stress Disorder and Psychological Distress in Parents of Critically Ill Children Admitted to PICUs: A Randomized Cluster Crossover Trial

Abstract

OBJECTIVES: The study aimed to assess the effect of using diaries during hospitalization in a PICU on the occurrence of posttraumatic stress disorder (PTSD) and psychologic distress among family members of critically ill children. DESIGN: A two-arm, two-period, cluster-randomized, crossover trial. SETTINGS: Four PICUs in Rio de Janeiro, Brazil. PATIENTS: From December 2019 to December 2021, the primary caregiver of each child (age 29 d to 12 yr) admitted to the participant PICUs for more than 36 hours was enrolled in the trial. INTERVENTIONS: The intervention consisted of providing diaries for the healthcare team, parents, and visitors to complete, including photographs of events during hospitalization. The standard practice served as the control group. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were the incidence of PTSD and psychologic distress in the primary caregiver 60 days after PICU discharge. PTSD was screened using the Posttraumatic Stress Disorder Checklist (PCL-5) instrument, and psychologic distress was assessed using the Hospital Anxiety and Depression Score. Of the 431 primary caregivers included, 339 were analyzed for PTSD, and 335 for psychologic distress. The use of diaries resulted in an average decrease of 2.97 points in the total PCL-5 score (p = 0.012) and a 42% reduction in the incidence of PTSD symptoms (incidence rate ratio [IRR], 0.58; p < 0.001). Diaries also reduced the incidence of psychologic distress (anxiety and/or depression symptoms) by 25% among the intervention group (IRR, 0.75; p = 0.009). CONCLUSIONS: This trial reinforces the potential of PICU diaries as a family-centered intervention to reduce the incidence of PTSD symptoms and psychologic distress among caregivers of critically ill children. Given their low-cost, pragmatic nature, PICU diaries may represent a promising strategy for supporting family mental health in the PICU setting.