Gülay TAŞCI, Filiz ÖZSOY

Inflammation in Major Depressive Disorder Patients with and without Attempted Suicide

Objective: This study aimed to examine Major Depressive Disorder (MDD) patients with or without attempted suicide history for inflammation parameters. Methods: The study included 287 participants, 187 had MDD diagnosis (87 patients with a suicide attempt, 100 patients without suicide history) and 100 healthy. All participants were subjected to Beck Depression Inventory (BDI). Results: Mean BDI score of MDD patients with suicide attempts was higher than the other two groups (p<0.01). Compared to the healthy controls, MDD patients with suicide attempts had significantly higher white blood cell and neutrophil levels (p= .007, .001; retrospectively). Hematocrit, erythrocyte and PCT value, which represents the percentage of platelet in blood, was significantly lower in MDD patient group withsuicide history than in the control (p= .036, .016, .002; respectively). Neutrophil/lymphocyte ratios and monocyte/lymphocyte ratio values were significantly higher in MDD patients with suicide attempts compared to the ones without suicide history (p= .003, .022; respectively). On the other hand, no difference was found among the study groups for the platelet/lymphocyte ratio (p= .590). Conclusion: The present study indicated that certain inflammatory parameters could be used to predict suicide risk in MDD. More detailed studies are needed to better elucidate the associations of inflammatory processes with MDD and different stages of suicide behavior.

Keywords:

Major depressive disorder, suicide, inflammation neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio.,

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Dávila-Cervantes CA, Luna-Contreras M. Suicide attempt in teenagers: associated factors. Rev Chil Pediatr. 2019; 90: 606-616. doi: 10.32641/rchped.v90i6.1012.
World Health Organization. Preventing suicide: a Global Imperative. Geneva: World Health Organization (WHO), 2014.
Turecki G, Ernst C, Jollant F, Labonte B, Mechawar N. The neurodevelopmental origins of suicidal behavior. Trends Neurosci. 2012; 35: 14-23. doi: 10.1016/j.tins.2011.11.008.
Serafini G, Parisi VM, Aguglia A, Amerio A, Sampogna G, Fiorillo A, Pompilli M, Amore M. A specific inflammatory profile underlying suicide risk? Systematic review of the main literature findings. Int J Environ Res Public Health. 2020; 17: 2393. doi: 10.3390/ijerph17072393.
Ucuz İ, Tetik BK. Can suicide behavior and seasonality of suicide be predicted from inflammatory parameters in adolescents?. Medical Hypotheses. 2020; 143: 110061. doi: 10.1016/j.mehy.2020.110061.
Pandey GN, Rizavi HS, Zhang H, Bhaumik R, Ren X. Abnormal protein and mRNA expression of inflammatory cytokines in the prefrontal cortex of depressed individuals who died by suicide. J. Psychiatry Neurosci. 2018; 43: 376-385. doi: 10.1503/jpn.170192.
Courtet P, Giner L, Seneque M, Guillaume S, Olie E, Ducasse D. Neuroinflammation in suicide: Toward a comprehensive model. World J Biol Psychiatry. 2016; 17: 564-586. doi: 10.3109/15622975.2015.1054879.
Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, Cincin A. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. 2014; 36:217-221. doi: 10.3109/10641963.2013.804547.
Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, Gobunsuy R, Jadonath S, Baldari D, McCord D, Lafferty J. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST elevation myocardial infarction. Am J Cardiol. 2010; 106:470-476. doi: 10.1016/j.amjcard.2010.03.062.
Giynas Ayhan M, Cicek IE, Inanli I, Caliskan AM, Kirci Ercan S, Eren I. Neutrophil/lymphocyte and platelet/lymphocyte ratios in all mood states of bipolar disorder. Psychiatry and Clinical Psycho-pharmacology. 2017; 27(3):284-288. doi.org/10.1080/24750573.2017.1338822.
Sunbul EA, Sunbul M, Yanartas O, Cengiz F, Bozbay M, Increased neutrophil/lymphocyte ratio in patients with depression is correlated with the severity of depression and cardiovascular risc factors. Psychiatry Investig. 2016; 13(1):121-126. doi: 10.4306/pi.2016.13.1.121.
Moody G, Miller BJ. Total and differential white blood cell counts and hemodynamic parameters in first-episode psychosis. Psychiatry Res. 2018; 260: 307-312. doi: 10.1016/j.psychres.2017.11.086.
Demir B, Şahin SK, Özsoy F, Altındağ A, Elboğa G. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in methamphetamine use disorder. Psychiatr Clin Psychopharmacol. 2021;31(1):34-39.
Kulu M, Özsoy F, Demir B. Alkol ve madde kullanım bozukluğu tanılı hastalarda inflamasyon düzeyleri. J Cukurova Med. 2021;46(4):1558-1565. (Turkish)
Ayhan MG, Dagıstan AA, Tanrikulu CŞ, Bozdogan ŞY, Eren I. Increased neutrophil/lymphocyte ratio in suicide attempters. Anatolian J Psychiatr. 2019; 20(3):305-312. [in Turkish]. DOI: 10.5455/apd.8099
Ivković M, Pantović Stefanović M, Dunjić Kostić B, Jurišić V, Lačković M, Totić-Poznanović S, Jovanovic A, Damjanovic D. Neutrophil to lymphocyte ratio predicting sui-cide risk in euthymic patients with bipolar disorder: Moderatory effect of family history. Compr Psychiatry. 2016; 66: 87-95. doi: 10.1016/j.comppsych.2016.01.005.
Meydaneri GG, Meydaneri S. Can neutrophil lymphocyte ratio predict the likelihood of suicide in patients with major depression? Cureus. 2018; 10(4):e2510. doi: 10.7759/cureus.2510.
Mazza MG, Lucchi S, Rossetti A, Clerici M. Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio in non-affective psychosis: A meta-analysis and systematic review. World J Biol Psychiatry. 2019;21: 1-13. doi: 10.1080/15622975.2019.1583371.
Özdin S, Böke Ö. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in different stages of schizophrenia. Psychiatry Res. 2019; 271: 131-135. doi: 10.1016/j.psychres.2018.11.043.
Mazza MG, Capellazzi M, Lucchi S, Tagliabue I, Rossetti A, Clerici M. Monocyte count in schizophrenia and related disorders: a systematic review and meta-analysis. Acta Neuropsychiatr. 2020; 32(5): 229-236. doi: 10.1017/neu.2020.12.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-571.
Mazza MG, Lucchi S, Tringali AGM, Rossetti A, Botti ER, Clerici M. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: A meta-analysis. Prog Neuro-Psychopharmacol Biol Psychiatry. 2018; 84: 229-236. doi: 10.1016/j.pnpbp.2018.03.012.
Adhikari A, Dikshit R, Karia S, Sonavane S, Shah N, De Sousa A. Neutrophil-lymphocyte ratio and C-reactive protein level in patients with major depressive disorder before and after pharmacotherapy. East Asian Arch Psychiatry. 2018; 28: 53-58. DOI: 10.12809/eaap181746
Miná VAL, Lacerda-Pinheiro SF, Maia LC, Pinheiro RFF Jr, Meireles CB, de Souza SIR, Reis AOA, Bianco B, Rolim MLN. The influence of inflammatory cytokines in physio-pathology of suicidal behavior. J Affect Disord. 2015; 172:219-230. doi: 10.1016/j.jad.2014.09.057.
Inanli I, Aydin M, Çaliskan AM, Eren I. Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder. Nord J Psychiatry. 2017; 73: 372-379. doi: 10.1080/08039488.2019.1640789.
Özdin S, Sarisoy G, Böke Ö. A comparison of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in schizophrenia and bipolar disorder patients–a retrospective file review. Nord J Psychiatry. 2017; 71: 509-512. doi: 10.1080/08039488.2017.1340517.
Cai L, Xu L, Wei L, Chen W. Relationship of mean platelet volume to MDD: a retrospective study. Shanghai Arch Psychiatry. 2017; 29: 21-29. doi: 10.11919/j.issn.1002-0829.216082.
Kayhan F, Gündüz Ş, Ersoy SA, Kandeğer A, Annagür BB. Relationships of neutrophil–lymphocyte and platelet–lymphocyte ratios with the severity of major depression. Psychiatry Res. 2017; 247: 332-335. doi: 10.1016/j.psychres.2016.11.016.
Pan J, Borné Y, Engström G. The relationship between red cell distribution width and all-cause and cause-specific mortality in a general population. Sci Rep. 2019; 9(1): 16208. doi: 10.1038/s41598-019-52708-2.
Zalawadiya SK, Veeranna V, Panaich SS, Afonso L, Ghali JK. Gender and ethnic differences in red cell distribution width and its association with mortality among low risk healthy United State adults. American J Cardiol. 2012; 109: 1664-1670. doi: 10.1016/j.amjcard.2012.01.396.
Demircan F, Gözel N, Kılınç F, Ulu R, Atmaca M. The impact of red blood cell distribution width and neutrophil/lymphocyte ratio on the diagnosis of major depressive disorder. Neurol Ther. 2016; 5: 27-33. doi: 10.1007/s40120-015-0039-8.
Wysokinski A, Szczepocka E. Red blood cells parameters in patients with acute schizophrenia, unipolar depression and bipolar disorder. Psychiatr Danub 2018; 30(3): 323-330. doi: 10.24869/psyd.2018.323.
Sublette ME, Galfalvy HC, Fuchs D, Lapidus M, Grunebaum MF, Oquendo MA, Mann JJ, Postolache TT. Plasma kynurenine levels are elevated in suicide attempters with major depressive disorder. Brain Behav Immun. 2011;25(6):1272-1278.
Grassi-Oliveira R, Brieztke E, Teixeira A, Pezzi JC, Zanini M, Lopes RP, Bauer ME. Peripheral chemokine levels in women with recurrent major depression with suicidal ideation. Braz J Psychiatry. 2012;34(1):71-75.