Effect of Diaries on Mental Health Outcomes in Adult ICU Survivors: A Systematic Review and Meta-Analysis.

Post-Intensive Care Syndrome (PICS) is common among intensive care unit (ICU) survivors and is frequently accompanied by post-traumatic stress disorder (PTSD), anxiety and depression. ICU diaries are used to help survivors reconstruct fragmented ICU memories, but their effects on mental health outcomes remain uncertain. To evaluate the efficacy of ICU diaries in mitigating PTSD, anxiety and depression among adult ICU survivors. This systematic review and meta-analysis included randomized and non-randomized controlled studies. PubMed, Embase, Web of Science, the Cochrane Library, VIP, Wanfang Data and CNKI were searched from inception to 1 December 2025. Risk of bias was assessed using RoB 2 and ROBINS-I. Random effects meta-analyses were performed. Publication bias was examined using Egger's test and the trim-and-fill method. Trial sequential analysis (TSA) and GRADE assessment were also conducted. Twenty-one studies (17 RCTs and 4 NRCTs) involving 2180 participants were included. After trim-and-fill correction for publication bias, ICU diaries showed no statistically significant effect on PTSD incidence (adjusted RR 0.73, 95% CI [0.47, 1.12]) or PTSD severity (adjusted SMD -0.23, 95% CI [-1.20, 0.75]). Modest benefits persisted for anxiety and depression symptoms. Substantial heterogeneity was observed across studies (I2 ranging from 0% to 95%). Subgroup analyses suggested that healthcare-professional-led diaries (without family involvement) were superior in reducing PTSD symptom severity. After adjustment for publication bias, ICU diaries did not show statistically significant benefits for PTSD incidence or severity but may provide modest adjunctive benefits in alleviating anxiety and depression symptoms. ICU diaries may serve as a low-cost, humanistic adjunct to post-ICU psychological support for mental health outcomes. They should not be used as a standalone intervention for any single outcome. Standardized protocols and large trials using consistent outcomes of PTSD, anxiety and depression are needed. The protocol for this systematic review and meta-analysis was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD420251239895).