Baseline Anxiety and Depression and Risk for ICU Delirium: A Prospective Cohort Study

Abstract

OBJECTIVES: Anxiety and depression are common mental disorders in adults admitted to the ICU. Although depression increases postsurgical delirium and anxiety does not, their associations with ICU delirium in critically ill adults remain unclear. We evaluated the association between ICU baseline anxiety and depression and ICU delirium occurrence.DESIGN: Subgroup analysis of a prospective cohort study. SETTING: Single, 36-bed mixed ICU.PATIENTS: Nine-hundred ninety-one ICU patients admitted with or without delirium between July 2016 and February 2020; patients admitted after elective surgery or not assessed for anxiety/depression were excluded. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS:The Hospital Anxiety and Depression Scale questionnaire was administered at ICU admission to determine baseline anxiety and depression. All patients were assessed with the Confusion Assessment Method for the ICU (CAM-ICU) q8h; greater than or equal to 1 +CAM-ICU assessment and/or scheduled antipsychotic use represented a delirium day. Multivariable logistic and Quasi-Poisson regression models, adjusted for ICU days and nine delirium risk variables ("Pre-ICU": age, Charlson Comorbidity Index, cognitive impairment; "ICU baseline": Acute Physiology and Chronic Health Evaluation-IV, admission type; "Daily ICU": opioid and/or benzodiazepine use, Sequential Organ Failure Assessment score, coma), were used to evaluate associations between baseline anxiety and/or depression and ICU delirium. Among the 991 patients, 145 (14.6%) had both anxiety and depression, 78 (7.9%) had anxiety only, 91 (9.2%) had depression only, and 677 (68.3%) had neither. Delirium occurred in 406 of 991 total cohort (41.0%) patients; in the baseline anxiety and depression group, it occurred in 78 of 145 (53.8%), in the anxiety only group, 37 of 78 (47.4%), in the depression only group, 39 of 91 (42.9%), and in the group with neither in 252 of 677 (37.2%). Presence of both baseline anxiety and depression was associated with greater delirium occurrence (adjusted odds ratio, 1.99; 95% CI, 1.10-3.53; p = 0.02) and duration (adjusted risk ratio, 1.62; 95% CI, 1.17-2.23; p < 0.01). CONCLUSIONS:Baseline anxiety and depression are associated with increased ICU delirium occurrence and should be considered when delirium risk reduction strategies are being formulated.

Enhancing hospice care with psychological support and a nomogram to predict delirium in patients with advanced solid tumors

“…Brain metastases, signifying invasion of the central nervous system, directly affect brain function, increasing the likelihood of delirium [36]. Mental and emotional state factors highlight the psychological health of patients, with anxiety and depression assessed by SAS and SDS scores, respectively, marking critical concerns for advanced cancer patients facing end-of-life distress [37]. These psychological aspects not only affect mental health but can also impair cognitive function and increase the risk of delirium [38].…”

Precision‐based approaches to delirium in critical illness: A narrative review

“…Again, the relationship between the underlying disease state (i.e., hypertension, either controlled or uncontrolled), effective medication therapy, and delirium warrants further exploration. While baseline anxiety and depression are known strong risk factors for the development of delirium, a secondary analysis of the BRAIN‐ICU study recently demonstrated that the use of selective serotonin reuptake inhibitors (SSRIs) was associated with a decreased risk of delirium and coma 36,37 . These findings warrant further exploration to determine the association between baseline mental illness, effective chronic treatment (i.e., SSRI therapy) versus new initiation during critical illness, and subsequent impact on delirium.…”

“…for the development of delirium, a secondary analysis of the BRAIN-ICU study recently demonstrated that the use of selective serotonin reuptake inhibitors (SSRIs) was associated with a decreased risk of delirium and coma. 36,37 These findings warrant further exploration to determine the association between baseline mental illness, effective chronic treatment (i.e., SSRI therapy) versus new initiation during critical illness, and subsequent impact on delirium.…”

Risk factors for dementia in older intensive care unit (ICU) survivors

“… 4 , 6 , 7 , 8 , 9 , 10 However, our understanding of potentially modifiable risk factors for dementia after ICU hospitalization is limited. Cardiovascular risk factors and depression 11 , 12 occur commonly in older ICU survivors and are well‐established, potentially modifiable risk factors for dementia. 13 , 14 , 15 , 16 , 17 Whether these risk factors are also associated with post‐ICU dementia have not been clearly established.…”