Effect of religiosity and spirituality on the incidence of delirium: the neglected effect

The incidence and prevalence of delirium in the intensive care unit (ICU) are extremely high. Generally, the incidence and prevalence of delirium in the hospitalized patients in ICU are 2931% (1, 2) and 1125% (3, 4), respectively. Each additional day with delirium increases a patient’s risk of dying by 10%. The incidence of delirium among mechanically ventilated patients compared to nonintubated patients is reported 45 to 87% more (58).  Due to the high prevalence of delirium in hospitalized patients in the ICU, the many effects of delirium on the short and long term outcomes of patients, and the imposition of high costs on the health system; several studies have assessed the impacts of delirium to outcomes of patients and healthcare systems (8,9). Recently, a study looking at costs over 1 year following an episode of delirium, estimated that delirium is responsible for between $60,000 and $64,000 of additional healthcare costs per patient with delirium per year; at national level, total direct 1year healthcare costs attributable to delirium might range from $38 billion to up to $152 billion nationally (9). The cost associated with delirium in mechanically ventilated patients in the United States of America is around 4–16 billion dollars per year (10) which is impacts of the delirium on the health system.The shortterm implications of delirium for hospitalized patients in ICU include prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospitalacquired complication, and increased admission to longterm care (11, 12).Chronic cognitive impairment and different physical and psychological functional disability are among the longterm impacts for hospitalized patients in ICU (13).In overall, it can be concluded that there are differences between the complications of Delirium incidence, both short and long term, in admitted patients to the ICU by sex, socioeconomic status, race, ethnicity, and even the degree to which one practices an organized religion (religiosity) (14).  According to the definition, religiosity and spirituality are broadly defined as feelings, thoughts, experiences and behaviors that arise from searching for the “sacred,” with former implying group or social practices and doctrines, and the latter referring to personal experiences and beliefs (15, 16).   It’s been reported that approximately 90% of Iranians (USA 84%) report religious affiliation, and 96% of Iranians (USA 82%) report religion as at least somewhat or very important in their lives (17, 18).Several systematic reviews of the literature support a relationship between religiosity promoting improved health behaviors (19, 20) and lower allcause mortality (21, 22).Emerging evidence suggests that religiosity and spirituality are correlated with improved mental and physical health outcomes, including decreased rates of depression (23), anxiety, posttraumatic stress disorder, suicide, and coronary heart disease (24).Despite the recognition of the impacts of the delirium occurrence and its high cost on the health system from one side, and the relationship between religiosity and the delirium event, which significantly improves the consequences of it, from other side (1922), to the best knowledge of the researchers, Still, the study does not investigate the effect of religiosity and spirituality on the severity of delirium to determine whether different levels of religiosity and spirituality cause different levels of delirium in admitted patients to the ICU or the effects of medications, the environment of the ICU and so on …. without affecting the different levels of religiosity, there are different degrees of delirium? which brings up a chickenortheegg conundrum.