Relationship Between ICU Delirium and Change in Quality of Life, Mood, and Cognition Over 12 Months in Survivors of Acute Respiratory Failure

Severe symptomatic aortic stenosis is associated with increased morbidity and mortality. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established treatment options. Neurological complications such as subclinical cerebral ischemia, delirium, and postoperative cognitive decline can occur during either treatment; however, precise data on neurological impairment remain scarce. The aim of this study was to compare neurological outcomes of patients undergoing TAVI or SAVR. COSTA (Cognitive Outcome after Surgical and Transcatheter Aortic valve replacement) is a single-center sub-study of the randomized DEDICATE trial (clinicaltrials.gov ID: NCT04535076). Neurocognitive tests (memory, attention, language, executive functions), questionnaires on neuropsychology (cognitive failures questionnaire [CFQ], hospital anxiety, and depression scale [HADS]), and health-related quality of life (SF-36) were used before intervention and 3months thereafter. Cranial magnetic resonance imaging (MRI) was carried out post-intervention. In addition, there was a systematic assessment of delirium during the hospital stay. The study cohort (mean age 71.8years, 32% female) consisted of SAVR (n = 13) and TAVI (n = 18) patients. In the SAVR group, subsyndromal delirium was more common (54 vs. 11%, p = 0.017; OR = 8.58), visual recognition ability was worse (mean difference (MD) = - 0.6 vs. + 0.3, p = 0.036, η2 = 0.14), and emotional impairment was numerically more declined (MD = - 36.8 vs. - 4.7, p = 0.058, η2 = 0.12) when compared to the TAVI group. In this small, exploratory sample, SAVR showed a trend toward less favorable neuropsychological outcomes compared with TAVI in patients with low-to-intermediate surgical risk. ClinicalTrials.gov Identifier: NCT04535076. 27 August 2020 (retrospectively registered).

Construction of a predictive model for postoperative subsyndromal delirium in patients undergoing brain tumor surgery.

The underlying mechanisms of the neuropsychiatric syndrome delirium are still unknown, but neuroinflammation is a central hypothesis. Chitinase-3-like-protein-1 (YKL-40/CHI3L1) is considered a marker of neuroinflammation when measured in cerebrospinal fluid (CSF). The aim of this study was to examine concentrations of CSF YKL-40 in patients with and without delirium, to enhance the understanding of delirium pathophysiology. A total of 545 hip fracture patients were included from two similar cohorts. CSF samples were collected in conjunction with spinal anaesthesia for hip fracture surgery. The patients were screened for delirium both pre- and postoperatively. Those with delirium were further divided into subgroups based on whether they developed it before surgery (prevalent delirium) or after surgery (incident delirium). Among patients without delirium, those who met some, but not all diagnostic criteria, were classified as having subsyndromal delirium. Prefracture cognitive function was assessed, and American Society of Anaesthesiologists physical status score was included as a marker of comorbidity. In total, 257 (47%) of the patients developed delirium. These patients were older and had a higher prevalence of dementia and severe systemic diseases. Among the patients without dementia, those with delirium had higher median concentration of CSF YKL-40 compared with those without delirium (first cohort: 175 versus 132 ng/mL, P = 0.01, second cohort: 243 versus 174 ng/mL, P < 0.001). No association was found among the patients with dementia. The results remained consistent when adjusting for age and comorbidity. No difference in median CSF YKL-40 concentration was found between patients who had delirium at the time of surgery (prevalent delirium) and those who developed it afterwards (incident delirium). Our findings support the hypothesis of neuroinflammation as a mechanism for delirium in patients without dementia.

Subsyndromal delirium is common in intensive care unit (ICU) patients and can prolong hospital stay, increase costs, and worsen prognosis. Advance intervention to prevent subsyndromal delirium would be valuable. To construct a machine learning-based model to predict the risk of subsyndromal delirium in ICU patients. This prospective cohort study included data from 447 patients hospitalized in the ICU between September 2023 and August 2024. Eight independent predictors of subsyndromal delirium were identified by least absolute shrinkage and selection operator and multivariate logistic regression analyses. Four machine learning models and a logistic regression model were constructed and validated to obtain the optimal algorithmic model. Subsyndromal delirium occurred in 90 ICU patients (20.1%). Richards-Campbell Sleep Questionnaire score, sedative use, restraint tape use, receipt of continuous renal replacement therapy or extracorporeal membrane oxygenation, intra-abdominal pressure, prealbumin level, history of alcohol consumption, and stroke were independent predictors of subsyndromal delirium. Of the 4 machine learning models constructed, the random forest model had the best comprehensive performance (area under the receiver operating characteristic curve, 0.885; F1 score, 0.629). Four machine learning-based risk prediction models and 1 traditional logistic regression model were developed to predict risk of subsyndromal delirium in ICU patients. Choosing a suitable model for early screening of ICU patients at high risk of subsyndromal delirium would allow medical staff to formulate individualized early intervention plans, which could improve patients' prognosis and save medical costs.

Subsyndromal delirium after cardiac surgery: a clinically relevant but overlooked condition.

BackgroundThis study aimed to assess the prevalence of preoperative hypoalbuminemia in patients with hip fractures at Honghui Hospital, Xi’an Jiaotong University, and to examine its associations with postoperative subsyndromal delirium (SSD) and postoperative discharge-status.MethodsA prospective study was conducted at Honghui Hospital, Xi’an Jiaotong University, involving patients who underwent hip fracture surgery between October 2023 and March 2024. Data on demographics, comorbidities, preoperative serum albumin levels, SSD occurrence, and postoperative discharge status were also collected. Hypoalbuminemia was defined as serum albumin levels below 35 g/L.ResultsIn total, 279 patients were included in the analysis. Hypoalbuminemia was observed in 60 patients (21.51%) and 114 patients (40.86%) exhibited postoperative SSD. Multivariate logistic regression analysis revealed that diabetes mellitus (OR = 2.93, p = 0.007), smoking (OR = 4.30, p = 0.033), and hypoalbuminemia (OR = 6.13, p < 0.001) were independently associated with an elevated risk of SSD. Furthermore, each one-point increase in MMSE score was independently associated with a 1.74 reduction in SSD risk (p < 0.001). A threshold effect on the association between albumin levels and SSD was observed when serum albumin level was treated as a continuous variable (p for likelihood test = 0.034). Among the 279 patients, 22 were admitted to the ICU; however, further statistical analysis was not conducted for the five patients with hypoalbuminemia who were admitted to the ICU due to low ICU occupancy.ConclusionOur study identified a 21.51% prevalence of preoperative hypoalbuminemia in elderly patients undergoing hip fracture surgery, which independently contributed to an increased risk of postoperative SSD. We recommend implementing preoperative interventions to correct hypoalbuminemia.

Delirium is common in intensive care unit (ICU) patients and is associated with adverse outcomes. Subsyndromal delirium (SSD) represents a milder form of this spectrum, which frequently goes unnoticed. It is important to clarify its incidence and risk factors to guide early detection and prevention. To determine the incidence and risk factors of delirium and SSD in ICU patients. This prospective observational study was conducted in a medical-surgical ICU in Izmir/Turkiye. Adult patients ≥ 18 years and admitted for ≥ 24 h were assessed twice daily using the Intensive Care Delirium Screening Checklist (ICDSC) and the Richmond Agitation-Sedation Scale (RASS) to identify delirium and SSD. Demographic and clinical data were recorded for potential risk factors, and associations with delirium and SSD were analysed using univariate tests and multinomial logistic regression. Among 233 patients, delirium occurred in 37.8% and SSD in 33.0%. Significant risk factors for both conditions were higher pain score (delirium: OR = 2.35, 95% CI: 1.59-3.46; SSD: OR = 2.83, 95% CI: 1.80-4.46), midazolam use (delirium: OR = 7.93, 95% CI: 1.97-17.64; SSD: OR = 4.12, 95% CI: 1.82-8.55) and physical restraint (delirium: OR = 1.60, 95% CI: 1.22-3.83; SSD: OR = 2.02, 95% CI: 1.86-4.72). Mechanical ventilation (OR = 1.67, 95% CI: 1.13-3.69) and vasopressor use (OR = 0.83, 95% CI: 1.06-2.14) were associated only with delirium, while longer ICU stay (OR = 1.55, 95% CI: 1.12-3.17) was associated only with SSD. SSD is a frequent and early-occurring condition in ICU patients, with both shared and unique risk factors compared to fully manifest delirium, underscoring the need for vigilant monitoring and timely intervention. Implementing routine screening and addressing modifiable risk factors may prevent SSD progression to delirium and enhance ICU patient outcomes.

Sepsis often causes cognitive changes like delirium and subsyndromal delirium (SSD). Delirium involves acute cognitive dysfunction, while SSD presents partial symptoms. Both conditions impact prognosis and are linked to neuroinflammation, altered cerebral perfusion and neurotransmitter dysfunction. This study explores the embodied cognitive experience in sepsis, integrating enactivist perspectives on the dynamic interplay of body, environment and neural activity. To analyse the lived bodily and cognitive experiences of patients with sepsis who experienced delirium or SSD. A qualitative grounded theory study was conducted in a university hospital in Santiago of Chile. Adults with sepsis meeting SEPSIS-3 criteria and meeting at least one criterion on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) positivity were included. Data were analysed using Corbin and Strauss's approach, applying open and axial coding to identify cognitive and bodily experience patterns. Ten semi-structured interviews (nine patients) were conducted before discharge. The study identified 20 subcategories of patients' bodily and cognitive experiences with delirium or SSD. In terms of bodily experiences, patients reported somatic depersonalization and loss of bodily control; pain and discomfort led to postural adjustments and eye closure as coping mechanisms. In the case of cognitive experiences, participants experienced visual hallucinations, distorted reality, disorientation and difficulty verbalising thoughts or understanding healthcare providers. Patients opened their eyes to confront visual stimuli and gradually recognized hallucinations as unreal, helping them reconnect with reality. Reported consequences following delirium or SSD included fragmented memories, fear of recurrence and perceived cognitive and physical decline. Patients with sepsis and delirium or SSD experience disruptions in the lived body, including bodily and cognitive aspects such as pain, depersonalization, hallucinations, disorientation and communication difficulties, affecting emotional and cognitive functioning. This study points to the need for non-pharmacological interventions that address cognitive, bodily and environmental aspects. Patient-centred care should ensure accessible environments and adequately trained personnel to support individuals experiencing delirium and SSD.

Sleep disturbances and delirium are prevalent problems in the intensive care unit. Evidence suggests that these conditions negatively impact patient outcomes by increasing the length of hospital stays, delaying recovery, and raising healthcare costs. This study aimed to investigate the effect of implementing a sleep care bundle on sleep quality and delirium among critically ill patients. A quasi-experimental research design was used. A purposive sample of 66 patients was divided equally into two groups: a bundle group that received a sleep care bundle and a control group that received routine unit care in the chest intensive care units at Mansoura University in Egypt. Data were collected using the critically ill patients' outcome evaluation tool based on the Richards-Campbell Sleep Questionnaire Scale and the Intensive Care Delirium Screening Checklist. Compared to the control group, the bundle group demonstrated statistically significant improvements across all sleep quality domains measured by the Richards-Campbell Sleep Questionnaire by Day 3. Specifically, sleep depth improved from 1.24 ± 0.44 to 1.82 ± 0.39 (effect size = 0.600), ability to fall asleep from 1.21 ± 0.42 to 1.91 ± 0.29 (effect size = 0.703), number of awakenings from 1.27 ± 0.45 to 1.79 ± 0.42 (effect size = 0.483), sleep efficiency from 1.24 ± 0.44 to 1.76 ± 0.44 (effect size = 0.600), and overall sleep quality from 1.24 ± 0.44 to 1.85 ± 0.36 (effect size = 0.600). In addition, the occurrence of delirium on Day 3 was significantly lower in the bundle group (0.0%) compared with the control group (15.2%) (χ2 = 7.471, p = 0.023). Subsyndromal delirium was observed in 6.1% of the bundle group and 15.2% of the control group. The overall percentage of patients without delirium was significantly higher in the bundle group (93.9%) compared to the control group (69.7%). Implementing a sleep care bundle enhances sleep quality and reduces the occurrence of delirium in critically ill patients. Therefore, it can be integrated as an adjunctive intervention alongside routine care for these patients. To strengthen future applications, incorporating fidelity monitoring is recommended to ensure consistent implementation of the sleep care bundle and to optimize its effectiveness in clinical practice.

Postoperative delirium (POD) is a common and serious complication, especially among older adults. The economic burden of POD, particularly in patients undergoing highly invasive cancer resection who are at high risk of delirium, remains unclear. We aimed to clarify the economic burden of subsyndromal delirium (SSD) and severe delirium in this population. We prospectively enrolled 281 adults undergoing highly invasive cancer resection and evaluated the impact of severe delirium and SSD diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Delirium Rating Scale-Revised-98 severity scale. The primary outcome was diagnosis procedure combination (DPC) costs. Propensity score matching was performed to estimate the effect of delirium within a background-matched cohort, and generalized estimating equations with two-way cluster-robust standard errors were applied at both matched-set and patient levels. Sensitivity analyses were performed using direct medical costs (fee-for-service [FFS]). Fifty-five patients (19.6%) developed severe delirium. DPC costs showed no significant mean difference, whereas total FFS costs were significantly higher in severe delirium (mean difference: US$2364, 95%CI: US$122~US$4606). Component analyses indicated higher costs for prescriptions, infusions, wound-related procedures, and laboratory tests. SSD had no significant economic impact. Severe postoperative delirium after highly invasive cancer resection was associated with increased FFS expenditures, particularly for prescriptions, infusions, wound care, and laboratory tests, whereas no significant differences were observed in DPC costs. Findings underscore the importance of preventing severe delirium.

A nomogram and risk stratification for predicting subsyndromal delirium in elderly patients in a post-anaesthesia care unit: A prospective cohort study

Risk factors for transitions and outcomes of subsyndromal delirium in the ICU: Post-hoc analysis of a prospective multicenter cohort study.

This study aimed to evaluate the ability of the Confusion Assessment Method for Intensive Care Units 7-Item Scale (CAM-ICU-7) compared with the Intensive Care Delirium Screening Checklist (ICDSC) in assessing post-operative delirium (POD) and predicting adverse outcomes. Patients >20 years undergoing elective cardiovascular surgery were recruited in this prospective cohort study in Taiwan. Emergence delirium was evaluated following discontinuing sedation, followed by POD assessments, conducted twice-daily until the patient was transferred to ward. All datasets were obtained from 84 patients and encompassed 833 assessments. The POD incidence was 48% and 45%, as detected using the ICDSC and CAM-ICU-7, respectively, whereas the incidence of concurrent POD and subsyndromal delirium (SSD) was 35% and 21%, respectively. It revealed high agreement for POD in the two tools (kappa = 0.84, P < 0.001) but moderate-to-poor for SSD (kappa = 0.21, P < 0.001). The ICDSC detected SSD better than the CAM-ICU-7. POD detected using both tools and concurrent POD and SSD detected using ICDSC predicted the intensive care unit (ICU) stay duration and the number of adverse events (P < 0.001). Concurrent POD and SSD detected using ICDSC predicted the hospital length of stay (P < 0.001), whereas POD detected using both tools predicted adverse event occurrence. POD and concurrent POD and SSD are associated with adverse outcomes. The CAM-ICU-7 and ICDSC can both diagnose POD. The ICDSC outperforms CAM-ICU-7 in detecting SSD and predicting adverse outcomes, suggesting that it is a better tool for cardiovascular-surgical patients.

Shortcomings of intensive care units (ICU) delirium screening tools include not measuring its core features, not excluding stupor/coma and not being continuous measurement instruments. We validated the Delirium Diagnostic Tool-Provisional (DDT-Pro) that assesses all 3 core symptom domains for delirium and subsyndromal delirium (SSD) in the ICU. This is a multicenter validation following STARD guideline. Delirium reference standards were DSM-5 criteria, cluster analysis (CA) of the DDT-Pro scores and clinical validators for preestablished DDT-Pro ≤ 6 and ≤ 7 cutoffs (0–9 range) for delirium and SSD. DDT-Pro dimensionality and internal consistency reliability are reported. Of 127 patients, 29 (22.8%) had DSM-5 delirium. The area under the receiver-operator DDT-Pro curve was 90% with the ≤ 7 and ≤ 6 DDT-Pro cutoffs which had 82.7% and 80.3% accuracy at the most balanced sensitivity-specificity. The ≤ 6 cutoff specificity (85.7%) was higher, while ≤ 7 cutoff sensitivity (89.7%) was higher with NPV = 96.2%. According to CA, ≤7 cutoff differentiated 100% of nondelirium patients from SSD and delirium, whereas DSM-5 misattributed SSD. Validation of an SSD group was supported by delirium severity gradients and various clinical validators. Cases in this CA also coincided exactly with nondelirium, SSD and delirium groups prespecified by DDT-Pro cutoffs from non-ICU samples. One factor explained 69.9% of the DDT-Pro variance, Cronbach α = 0.79 (cohesive delirium dimension). Our findings indicate that the DDT-Pro has very good construct validity and discriminates ICU delirium against DSM-5, performing even more cleanly using agnostic CA for SSD and delirium diagnosis. Its continuous score structure discernment of SSD was supported by clinical validators. ICU cutoffs were the same as in previous inpatient samples.

Association between delirium severity and prognosis following Transcatheter aortic valve implantation.

Background &amp; Objective: Intensive care unit (ICU) delirium occurs in up to 70% of patients with 20-40% later developing dementia post-discharge. Plasma amyloid-beta (Aβ) levels have been associated with Alzheimer’s Disease. Whether ICU delirium compared to subsyndromal delirium (SSD) is associated with higher plasma Aβ levels at hospital discharge is not well described. Methods: This is a secondary analysis of the IMPROVE randomized controlled trial. Subjects were ICU delirium survivors aged 50 years or older who provided venous blood samples at discharge. Delirium was assessed twice daily until discharge using Confusion Assessment Measurement in the ICU (CAM-ICU). SSD is a less severe form of delirium with one abnormal CAM-ICU feature. Samples were analyzed using a Multiplex Luminex Assay (Thermofisher), values were reported in pg/mL, and compared using the Wilcoxon Rank Sum Test using SAS. The detection range is 451 – 1846900pg/mL for Aβ1-40 vs. 0.68 – 2800pg/mL for Aβ1-42. Results: In total, 68 subjects were included, 45% experienced SSD, and 54% had delirium. The mean age in the SSD group was 63.7 years [SD 7.3] vs. 64.4 years [SD 7.1] in the delirium group (p=0.667). The SSD group had a mean education of 13.6 years [SD 2.6] vs. 13.1 years [SD 2.3] (p=0.441) in the delirium group. Median plasma Aβ1-40 levels were 200.55 pg/mL (IQR 137.76, 286.57) in the SSD group, and 189.35 (IQR 150.38, 283.00) in the delirium group. The median plasma values of Aβ1-42 were 0.02 (IQR 0.02, 0.72) for the SSD group and 0.67 (IQR 0.02, 1.85) for the delirium group. There were no significant differences in plasma levels between the two groups (Aβ1-40: p=0.936; Aβ1-42: p=0.178). Conclusion &amp; Impact: There were no significant differences in plasma Aβ levels between ICU delirium and SSD. Further studies are needed to explore the relationship between delirium and plasma Aβ levels.

To investigate the effects of a 12-week, web-based, combined cognitive and physical training intervention on cognitive performance among ICU delirium survivors. Prospective, four-arm randomized controlled trial. Four sites (academic, county, community ICUs). ICU adults 50 years old or older with at least one instance of ICU delirium or subsyndromal delirium. Patients were randomized to one of four groups: physical exercise-cognitive training (PE-CT), physical exercise-cognitive control (PE-CC), stretching control-cognitive training (SC-CT), or stretching control-cognitive control (SC-CC). The primary outcome was cognitive function at 3 and 6 months after start of intervention, as assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). One hundred fifty-three patients were randomized to either: PE-CT, n = 41; PE-CC, n = 41; SC-CT, n = 36; or SC-CC, n = 35. There was a significant difference on changes in RBANS z scores among the four arms (interaction term p = 0.012). The mean RBANS z scores ranged from -2.66 to +1.43 (change in RBANS z score of ± 0.5-0.6 may be clinically significant). The SC-CT group had statistically significant worsening in cognitive scores compared with the SC-CC group at 3 (mean estimated difference in change from baseline, -0.28; 95% CI, -0.53 to -0.02; p = 0.035) and 6 months (mean estimated difference in change from baseline, -0.29; 95% CI, -0.53 to -0.04; p = 0.021). Compared with the SC-CC group, the PE-CC group had statistically significant worsening in cognitive scores at 6 month (mean estimated difference in change from baseline, -0.26; 95% CI, -0.49 to -0.02; p = 0.035). There were no significant differences between groups in physical or mental quality of life, depression, or anxiety outcomes at any of the timepoints. The Improving Recovery and Outcomes Every Day After the ICU (IMPROVE) trial did not result in improved cognitive, physical, mental health, or quality of life measures at 3 or 6 months. We found a drop in cognitive performance among patients receiving cognitive training from baseline to 3 months postintervention.

Aims/Background Subsyndromal delirium (SSD) in elderly patients can lead to prolonged hospital stays, reduced quality of life, and cognitive decline. Evidence suggests that nursing interventions play a key role in mitigating SSD risk by facilitating early identification as well as timely and effective interventions. This study aimed to assess the knowledge, attitude, and practice (KAP) levels of nurses in primary hospitals regarding elderly SSD, identify factors influencing these levels, and construct a network-based tiered training program. Methods A literature review and Delphi expert consultation method, based on the KAP theory, were utilized to develop a questionnaire to assess the KAP levels of nurses regarding elderly SSD in primary hospitals. A pilot study was conducted to determine the reliability and validity of the questionnaire. From January 2024 to June 2024, a stratified cluster sampling method was employed to survey nurses from six secondary or higher-level primary hospitals in Shaoxing, China. The self-developed questionnaire was used to evaluate the KAP levels of primary hospital nurses regarding elderly SSD assessment and analyze factors influencing their scores. Based on the findings, a network-based tiered training program was constructed. Results A total of 615 questionnaires were distributed, of which 600 were valid, with an effective response rate of 97.56%. The mean total KAP score for nurses in primary hospitals regarding elderly SSD assessment was 98.11 ± 12.23, with an overall scoring rate of 61.32%. The mean scoring rates for KAP were 48.35%, 81.29%, and 68.84% respectively. Significant differences in KAP scores regarding elderly SSD for nurses in primary hospitals with different characteristics were observed based on age, educational level, years of experience, and professional title (p < 0.001). Multiple linear regression analysis showed that years of experience and professional title (nurse in charge or deputy senior nurse practitioner and above) were significant predictors of total KAP scores (p < 0.05). Conclusion The overall KAP level of primary hospital nurses regarding elderly SSD assessment was suboptimal. While attitudes towards SSD were generally positive, knowledge and practice levels required considerable improvement. A network-based tiered training program was developed to enhance the capacity of primary hospital nurses for timely and accurate identification of SSD risks in elderly patients.

Abstract Rationale: Delirium occurs in up to 80% of intensive care unit (ICU) patients with acute respiratory failure (ARF) and is associated with Post-Intensive Care Syndrome. How delirium and subsyndromal delirium (SSD) are associated with depression at 12 months after ICU discharge is less well described. Methods: This is a secondary analysis of the Mobile Critical Care Recovery Program Trial, which enrolled patients ≥ 18 years with ARF requiring mechanical ventilation. Delirium was assessed using the Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU)/CAM-ICU-7 twice daily until discharge. SSD was defined as any one feature of CAM-ICU abnormal. Severity of illness was assessed by Acute Physiology and Chronic Health Evaluation Score (APACHE-II). Depression was assessed by Patient Health Questionnaire-9 (PHQ-9 scores range from 0-21) at discharge and 12-months post-ICU discharge. Mixed-effects models (using SAS) were used with longitudinal PHQ-9 at baseline, 3, 6, and 12 months as the outcome measures. The models included variables for delirium, time, and an interaction term for delirium[asterisk]time as independent variables, and a random effect for patient was included. Results: A total of n=466 were included in the analysis. Patients with delirium or SSD had higher mean APACHE-II scores at ICU admission compared to those without delirium (delirium: 26.3 SD 8.4, SSD: 24 SD 8.4, no delirium: 23.3 SD 9.1, p=0.004), and greater median ICU length of stay in days (delirium: 10 IQR 6.0, 17.0, SSD: 7 IQR 5.0, 13.0, no delirium: 6 IQR 4.0, 10.0, p&amp;lt;0.001). At discharge, PHQ-9 scores were significantly higher in delirium survivors (delirium: 9.37 SD 6.61, SSD: 8.16 SD 5.45, no delirium: 7.97 SD 6.00). At all timepoints, delirium was associated with higher PHQ-9 scores compared to those with SSD and no delirium (p=0.037). By 12 months, mean PHQ-9 scores remained higher in delirium survivors (delirium: 6.37 SD 5.70, SSD: 5.29 SD 5.84, no delirium: 5.36 SD 5.78). In all three groups, PHQ-9 scores improved over time (p&amp;lt;0.001). Conclusion: Patients with ICU delirium and SSD had mild depressive symptoms up to 12 months after discharge. Further research is needed to explore interventions targeting early mental health recovery in ARF survivors with delirium and SSD.