Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis

Abstract

Objectives: Journaling is a common non-pharmacological tool in the management of mental illness, however, no clear evidence-based guideline exists informing primary care providers on its use. We seek here to present this synthesis that may begin to inform future research and eventual evidence-based guideline development.

Design: Of the 3797 articles retrieved from MEDLINE, EMBASE, PsycINFO, 20 peer-reviewed randomised control trials (31 outcomes) met inclusion criteria. These studies addressed the impact of a journaling intervention on PTSD, other anxiety disorders, depression or a combination of the aforementioned.

Eligibility criteria: Peer reviewed, randomised control trials on the impact of journaling on mental illness were included.

Information sources: MEDLINE, EMBASE and PsycINFO.

Results: The data are highly heterogeneous (control arm=I² of 71.2%, intervention arm=I² of 83.8%) combined with a B-level Strength of Recommendation Taxonomy recommendation. It was additionally found that there is a significant pre-post psychometric scale difference between control (-0.01, 95% CI -0.03 to 0.00) and intervention arms (-0.06, 95% CI -0.09 to -0.03). This 5% difference between groups indicates that a journaling intervention resulted in a greater reduction in scores on patient health measures. Cohen's d effect size analysis of studies suggests a small to moderate benefit.

Conclusion: Further studies are needed to better define the outcomes. Our review suggests that while there is some randomised control data to support the benefit of journaling, high degrees of heterogeneity and methodological flaws limit our ability to definitively draw conclusions about the benefit and effect size of journaling in a wide array of mental illnesses. Given the low risk of adverse effects, low resource requirement and emphasis on self-efficacy, primary care providers should consider this as an adjunct therapy to complement current evidence-based management.

Keywords: family medicine; health knowledge, attitudes, practice; mental health; physicians, primary care.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram.

Figure 2

Standardised forest plot for control and intervention groups.

Figure 3

Histogram of Cohen’s d effect size of journaling efficacy. n indicates the numbers of participants within each Cohen’s effect size classification.