Assessing the relationship between suicidality and inflammatory biomarkers: C-reactive protein/albumin and neutrophil/albumin ratios in an inpatient setting

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Emerging evidence suggests a strong association between inflammatory processes and suicidality. This study aims to investigate the relationship between suicidality and inflammatory biomarkers in psychiatric inpatients. Methods This retrospective cross-sectional study included female psychiatric inpatients aged 18–65 years admitted to the Psychiatry Department of Göztepe Prof. Dr. Süleyman Yalçın City Hospital between 2022 and 2024. Inflammatory biomarkers, including C-reactive protein (CRP), albumin, neutrophils, lymphocytes, monocytes, platelets, and red cell distribution width (RDW), mean platelet volume (MPV) were analyzed. Additionally, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), CRP-to-albumin ratio (CAR), and neutrophil-to-albumin ratio (NAR) were calculated. Results The analysis revealed no statistically significant differences between patients with suicidality (including both suicide ideation and history of suicide attempts) and the non-suicidality group in terms of MPV, RDW, NLR, MLR, PLR, CAR or NAR values, with all parameters showing p > 0.05. Conclusions The absence of statistically significant differences in inflammatory markers suggests that these biomarkers may not be robust indicators of suicidality in this sample. Further research with larger, more diverse populations is warranted to clarify the potential role of inflammation in suicidality. CAR inflammatory biomarkers NAR suicidality Introduction Suicide is the voluntary and intentional act of ending one's own life. According to the World Health Organization (WHO), suicide is the fourth leading cause of death among individuals aged 15–29 years, with approximately 700,000 people dying by suicide annually. Suicide rates vary both within and between countries, with differences of up to tenfold across regions, which are partially attributed to economic status and cultural differences ( 1 ). Suicidality is a comprehensive term encompassing an individual’s thoughts, intentions, plans, and behaviors related to ending their own life. This term not only refers to actual suicide attempts but also includes suicidal ideation, suicide planning, suicidal intent, and suicide attempts, representing a multidimensional construct ( 2 ). A suicide attempt is characterized as an intentional act aimed at self-inflicted death that does not result in fatality ( 3 ). Despite increasing knowledge regarding the mechanisms underlying suicidality, its burden continues to affect various sectors of society, including healthcare, education, labor, justice, politics, and the media ( 4 ). Suicidality is a multifaceted phenomenon shaped by the interplay of various factors. Environmental risk factors, including socioeconomic disparities, unemployment, social exclusion, natural disasters, and traumatic life events, can undermine an individual’s coping mechanisms, thereby heightening the risk of suicide ( 3 ). Beyond mental health disorders such as depression, anxiety disorders, substance abuse, and personality disorders, certain psychological traits, including elevated neuroticism, low self-esteem, hopelessness, poor problem-solving abilities, and difficulties with emotional regulation, further contribute to the susceptibility to suicidality ( 5 ) ( 6 ). Neurobiologically, imbalances in the serotonergic system, neurotransmitter dysfunctions, and hereditary/genetic predispositions are crucial elements influencing suicidality ( 7 ). In addition to the factors mentioned above, recent research has increasingly highlighted the role of inflammatory alterations in the biological mechanisms of suicide. Focusing on peripheral biological markers, researchers have proposed that alterations in the inflammatory profile may involve an imbalance between proinflammatory and anti-inflammatory cytokines ( 8 ). Several studies have proposed that elevated levels of proinflammatory cytokines—such as IL-6, TNF-α, and CRP—may lead to neuroinflammatory changes affecting neurotransmission, neuroendocrine regulation, and neuroplasticity, which are all implicated in mood dysregulation and impulsivity ( 9 , 10 ). However, the inflammatory markers (cytokines) identified in these studies are heterogeneous, indicating the need for more comprehensive investigations ( 11 , 12 ). A meta-analysis examining the association between suicidal behavior and inflammatory biomarkers found that individuals exhibiting suicidal behavior had significantly higher blood levels of C-reactive protein (CRP) compared to healthy controls, patients with depression without suicidality, and individuals with other psychiatric disorders. These findings suggest that the immune system and inflammatory response play a role in suicidal behavior, independent of major psychiatric disorders, and that these biological markers are predominantly state-dependent indicators ( 13 ). Postmortem studies have further demonstrated that, regardless of primary psychiatric diagnoses, individuals who die by suicide exhibit increased microgliosis levels and elevated cytokine mRNA expression, indicative of neuroinflammation ( 14 , 15 ). In light of these findings, researchers have suggested that anti-inflammatory treatments may be effective in reducing suicidality ( 16 ). Neutrophils, granulocytes, monocytes, platelets, lymphocytes, and white blood cell (WBC) counts, along with various hemogram-derived parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), mean platelet volume (MPV), and red cell distribution width (RDW), are recognized as inflammation-related markers ( 17 , 18 ). Studies investigating the associations between hemogram-derived inflammatory parameters and suicide attempts are increasingly prevalent. Elevated NLR levels have been consistently observed in individuals who have attempted suicide ( 19 – 23 ). One study conducted on adolescents with a history of suicide attempts reported significantly higher MLR and NLR values than did the control group. Similarly, another study reported that individuals who attempted suicide had significantly higher MLR and NLR values, whereas the MPV and RDW levels were significantly lower ( 20 , 21 ). In addition to these parameters, the C-reactive protein-to-albumin ratio (CAR) has been recognized as a marker of increased inflammation, with elevated levels indicating poor prognosis in patients with systemic diseases ( 24 , 25 ). Research focusing on the CAR in psychiatry has been expanding, with findings suggesting that the CAR may serve as a reliable biomarker of inflammation and could reflect increased inflammatory status in schizophrenia patients, potentially serving as a predictive parameter in this disorder ( 26 , 27 ). Furthermore, recent studies have highlighted the neutrophil-to-albumin ratio (NAR), suggesting that it is a novel parameter for assessing ischemic inflammation and mortality in conditions such as cancer, sepsis, and stroke ( 28 – 30 ). One study demonstrated that NAR levels were significantly higher in individuals who attempted suicide than in healthy controls ( 20 ). To our knowledge, this is the first study to exclusively investigate the inflammatory biomarkers CAR and NAR in a female-only cohort of hospitalized psychiatric patients with and without suicidality. No prior studies have specifically examined the CAR and NAR in the context of suicidality among psychiatric inpatients using a female-only sample. By addressing this gap, our study provides novel insights into the potential role of inflammation-based biomarkers in suicidality assessment within a clinically relevant and demographically consistent population. Future research may establish these hemogram-derived parameters as objective, accessible, reproducible, and cost-effective laboratory markers that can be routinely assessed to better understand their association with suicidality. In this study, we examined the associations between suicidality and inflammatory markers, including the MPV, RDW, NLR, MLR, PLR, CAR or NAR in psychiatric inpatients. Methods Our study was designed as a retrospective cross-sectional study and was conducted by reviewing the medical records of patients hospitalized in the Psychiatry Department of Göztepe Prof. Dr. Süleyman Yalçın City Hospital between 2022 and 2024. The study included female inpatients aged 18–65 years who were admitted to the Psychiatry Department between January 1, 2022, and December 31, 2024. Patients with intellectual disability or dementia-related conditions were excluded. The diagnosis of psychiatric disorders was established by the attending specialist psychiatrist responsible for inpatient care, based on the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). All laboratory tests were conducted in the morning after an overnight fast and prior to the administration of any medication. Body Mass Index (BMI) was measured at the time of admission under fasting conditions and calculated by dividing body weight (kg) by the square of height in meters (m²). Patients with elevated white blood cell (WBC) counts secondary to bacterial infection, as well as those diagnosed with systemic conditions that could affect inflammatory status—such as diabetes, liver or kidney failure, hypertension, acute infection, acute or chronic immune-inflammatory diseases, or pregnancy—were excluded. Additionally, patients who used anti-inflammatory or immunosuppressive medications or had documented laboratory findings related to liver or kidney pathology were not included in the study. Data collection Sociodemographic data: Sociodemographic variables, including age, marital status, employment status, education level, mode of admission, and the presence of additional medical conditions, were obtained from hospital records. Clinical data: Clinical information, suicidality (including suicide ideation and history of suicide attempts), and psychiatric diagnoses (e.g., depression, bipolar disorder, anxiety disorders), was collected retrospectively from medical records. Laboratory data: In line with the primary aim of the study, inflammatory biomarkers—including C-reactive protein (CRP), albumin, neutrophils, lymphocytes, monocytes, and platelets—and red cell distribution width (RDW) were retrospectively extracted from patient records. On the basis of these parameters, the neutrophil‒lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet‒lymphocyte ratio (PLR), C-reactive protein‒albumin ratio (CAR), neutrophil‒albumin ratio (NAR), and mean platelet volume (MPV) were calculated and analysed. Statistical analysis Statistical analyses were conducted via SPSS version XX (IBM Corp., Armonk, NY, USA). The descriptive statistics summarized the demographic data as frequencies, percentages, means, and standard deviations. Independent samples t tests or Mann‒Whitney U tests were used to compare laboratory and clinical parameters on the basis of normality assessed by the Shapiro‒Wilk test. All tests were two-tailed with a significance threshold of p < 0.05. Effect sizes were calculated where applicable, and missing data were handled via pairwise deletion. Results Sample characteristics The study included a total of 221 participants. The demographic characteristics of the sample are presented in Table 1 . The majority of the participants were single (39.4%) or married (38.5%), and most participants were unemployed (81.4%). With respect to educational status, 38.0% had completed primary education, 34.4% had a high school degree, 22.2% had a university degree, and 5.4% were illiterate. In terms of admission type, 42.5% of the participants were referred from another healthcare facility, 30.8% sought emergency services, and 26.7% presented to an outpatient clinic. Additionally, 56.1% of the sample reported no comorbidities, whereas 43.9% reported at least one medical condition. Table 1 Sample characteristics Variable Mean SD Age 38.81 13.43 BMI 27.00 6.17 Frequency (n) Percentage (%) Marital Status Single 87 39.4 Married 85 38.5 Divorced 40 18.1 Widowed 9 4.1 Employment Status Unemployed 180 81.4 Employed 41 18.6 Education Illiterate 12 5.4 Primary Education 84 38.0 High School 76 34.4 University 49 22.2 Admission Type Emergency 68 30.8 Outpatient 59 26.7 Referral 94 42.5 Psychiatric disorder Anxiety Disorder 8 3.6 Anorexia Nervosa 3 1.4 Bipolar Disorder 35 15.8 Borderline 1 0.5 Mood Disorder 70 31.7 Mixed Anxiety and Depressive Disorder 30 13.6 Obsessive Compulsive Disorder 4 1.8 Psychotic Disorder 70 31.7 Medical Comorbidities None 124 56.1 Present 97 43.9 -Table 1- Comparison of laboratory parameters The laboratory parameters of participants with and without suicidality are compared in Table 2 . The comparison between patients with suicidality (including suicide ideation and history of suicide attempts) and those without revealed no statistically significant differences across any of the examined parameters. Specifically, CRP (p = 0 .248), lymphocyte counts (p = 0.321), monocyte counts (p = 0.363), MPV (p = 0.098), RDW (p = 0.112), PLR (p = 0.236), NLR (p = 0.778), MLR?? CAR (p = 0.216) and NAR (p = 0.830) did not differ significantly between the two groups. Table 2 Comparison of Laboratory Parameters Between Groups Parameter Suicidality (-) Mean ± SD Suicidality (+) Mean ± SD p CRP 4.55 ± 6.47 3.66 ± 4.77 0.248 Albumin 42.49 ± 4.08 42.24 ± 3.63 0.626 Neutrophil 4.27 ± 1.38 4.76 ± 3.64 0.208 Platelet 271.24 ± 73.84 270.28 ± 73.79 0.923 Monocyte 0.44 ± 0.23 0.46 ± 0.17 0.363 Lymphocyte 2.06 ± 0.64 2.15 ± 0.60 0.321 RDW 14.24 ± 1.53 14.67 ± 2.35 0.097 MPV 10.57 ± 1.55 10.70 ± 1.36 0.508 CAR 0.11 ± 0.16 0.09 ± 1.26 0.264 NAR 0.11 ± 0.10 0.11 ± 0.09 0.830 NLR 2.30 ± 1.20 2.35 ± 1.51 0.778 MLR 0.23 ± 0.13 0.22 ± 0.10 0.728 PLR 144.14 ± 59.76 135.08 ± 5.34 0.236 CRP: C-Reactive Protein, RDW: Red Cell Distribution Width, MPV: Mean Platelet Volume, CAR: C-Reactive Protein to Albumin Ratio, NAR: Neutrophil to Albumin Ratio, NLR: Neutrophil to Lymphocyte Ratio, PLR: Platelet to Lymphocyte Ratio -Table 2- Discussion This study aimed to investigate inflammatory biomarkers in psychiatric inpatients with and without suicidality. The analysis revealed no statistically significant differences in the evaluated inflammatory markers between the two groups. The literature has demonstrated that NLR and MLR are significantly elevated in individuals with suicidality across various populations ( 19 – 21 ). However, in contrast to these findings, our study did not observe significant differences in NLR or MLR values between patients with and without suicidality. This discrepancy may be attributed to differences in sample characteristics, psychiatric diagnoses, or methodological variations between studies. Studies examining the MPV and RDW have reported heterogeneous results. Ucuz et al. reported significantly elevated MPV levels in individuals with suicidality, whereas Kara et al. and Petho et al. found no significant differences in RDW or MPV between suicidal and non-suicidal groups ( 19 , 21 , 31 ) Similarly, Aguglia et al. suggested that higher MPV and PLR were associated with high-lethality suicide attempts in psychiatric inpatients. Despite these findings, our results did not support a significant association between MPV or RDW values and suicidality ( 32 ). The relationship between PLR and suicidality has also shown inconsistent patterns in the literature. While some studies, including those by Aguglia et al. and Ucuz et al., found elevated PLR values in individuals exhibiting suicidal behavior, others reported no significant differences ( 19 , 20 , 23 , 32 ). Our findings align with the latter, as no significant difference in PLR was observed between the groups. These inconsistencies across studies suggest that inflammatory markers such as PLR may not consistently reflect suicidality-related biological changes. The CRP-to-albumin ratio (CAR) is a newly recognized parameter associated with inflammation severity. It has been suggested that the CAR is a superior indicator of the inflammatory response compared with CRP or albumin alone ( 24 ). İn our study, no statistically significant differences in CAR levels were observed between patients with and without suicidality. This finding suggests that, despite its recognized value in reflecting systemic inflammation, CAR may not be a reliable standalone marker for distinguishing suicidality in psychiatric inpatients. It is possible that the inflammatory processes associated with suicidality are more subtle or involve different pathways not adequately captured by CAR. Further research with larger sample sizes and a broader range of inflammatory markers may be necessary to clarify these relationships. While Kılıç et al. demonstrated a significant association between the neutrophil-to-albumin ratio (NAR) and suicidal tendency, and Yeşilkaya et al. reported that NAR plays a role in both suicidal behavior and ideation ( 20 , 26 ), our study did not reveal any statistically significant differences in NAR values between patients with and without suicidality. This discrepancy may be attributed to differences in sample characteristics, methodological variations, or the complexity of the biological mechanisms underlying suicidality. Further studies are warranted to clarify the potential role of NAR in the pathophysiology of suicidal behavior across diverse psychiatric populations. One of the strengths of our study is that, to the best of our knowledge, it is the first to specifically examine the inflammatory biomarkers CAR and NAR in hospitalized psychiatric patients in relation to suicidality. However, our study also has several limitations that should be noted. First, it included only inpatients, which limits the generalizability of the findings; including outpatients could have provided a broader perspective. Second, the study was conducted with a female-only sample and had a relatively small sample size, which reduced the statistical power, especially for comparisons across different diagnoses. Third, we did not control for the effects of pharmacological treatments, which may have influenced the biomarker levels. Lastly, potential psychosocial stressors that could affect inflammation were not assessed, introducing the possibility of unmeasured confounding factors. Conclusion In this study, no significant associations were identified between the examined inflammatory biomarkers and suicidality as defined by our criteria. Future studies with larger sample sizes and the inclusion of a broader range of biological markers are warranted to elucidate the potential pathophysiological mechanisms underlying suicidality. Declerations: Declarations Ethics approval and consent to participate Ethical approval for the study was obtained in accordance with the Declaration of Helsinki from the İstanbul Medipol University Ethics Committee (12.09.2024/871). Consent for publication Not applicable Funding None Author Contribution RYE, SSE, and AHİ contributed to the development of the study hypothesis. SSE and AHİ were responsible for data collection. RYE performed the data analysis and drafted the manuscript. All authors reviewed and approved the final version of the manuscript. Acknowledgements Not applicable Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Pacific W. World Health Organization WHO Regional websites. World Health; 2023. Silverman MM, Berman AL, Sanddal ND, O’Carroll PW, Joiner TE. Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7288386","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501795484,"identity":"23e6d905-f726-43df-91a6-dcaad2631923","order_by":0,"name":"Rumeysa Yeni Elbay","email":"data:image/png;base64,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","orcid":"","institution":"Istanbul Medeniyet University","correspondingAuthor":true,"prefix":"","firstName":"Rumeysa","middleName":"Yeni","lastName":"Elbay","suffix":""},{"id":501795485,"identity":"cc67eb46-c3f4-4557-8e4e-e2359cbc1702","order_by":1,"name":"Seda Sarıkaya Erdil","email":"","orcid":"","institution":"Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Seda","middleName":"Sarıkaya","lastName":"Erdil","suffix":""},{"id":501795486,"identity":"c3c9334f-c020-4a42-8749-a104c7db4c7d","order_by":2,"name":"Aysegul Hopur İlhan","email":"","orcid":"","institution":"Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Aysegul","middleName":"Hopur","lastName":"İlhan","suffix":""}],"badges":[],"createdAt":"2025-08-04 07:53:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7288386/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7288386/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-07416-9","type":"published","date":"2025-10-08T15:57:41+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93419711,"identity":"43b5490d-0bf3-44b3-8e3e-d28a790f37fe","added_by":"auto","created_at":"2025-10-13 16:06:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":606232,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7288386/v1/907ff275-1ba8-4c5e-b3c6-e575bbb5306e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the relationship between suicidality and inflammatory biomarkers: C-reactive protein/albumin and neutrophil/albumin ratios in an inpatient setting","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuicide is the voluntary and intentional act of ending one's own life. According to the World Health Organization (WHO), suicide is the fourth leading cause of death among individuals aged 15–29 years, with approximately 700,000 people dying by suicide annually. Suicide rates vary both within and between countries, with differences of up to tenfold across regions, which are partially attributed to economic status and cultural differences (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Suicidality is a comprehensive term encompassing an individual’s thoughts, intentions, plans, and behaviors related to ending their own life. This term not only refers to actual suicide attempts but also includes suicidal ideation, suicide planning, suicidal intent, and suicide attempts, representing a multidimensional construct (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A suicide attempt is characterized as an intentional act aimed at self-inflicted death that does not result in fatality (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Despite increasing knowledge regarding the mechanisms underlying suicidality, its burden continues to affect various sectors of society, including healthcare, education, labor, justice, politics, and the media (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSuicidality is a multifaceted phenomenon shaped by the interplay of various factors. Environmental risk factors, including socioeconomic disparities, unemployment, social exclusion, natural disasters, and traumatic life events, can undermine an individual’s coping mechanisms, thereby heightening the risk of suicide (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Beyond mental health disorders such as depression, anxiety disorders, substance abuse, and personality disorders, certain psychological traits, including elevated neuroticism, low self-esteem, hopelessness, poor problem-solving abilities, and difficulties with emotional regulation, further contribute to the susceptibility to suicidality (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Neurobiologically, imbalances in the serotonergic system, neurotransmitter dysfunctions, and hereditary/genetic predispositions are crucial elements influencing suicidality (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to the factors mentioned above, recent research has increasingly highlighted the role of inflammatory alterations in the biological mechanisms of suicide. Focusing on peripheral biological markers, researchers have proposed that alterations in the inflammatory profile may involve an imbalance between proinflammatory and anti-inflammatory cytokines (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Several studies have proposed that elevated levels of proinflammatory cytokines—such as IL-6, TNF-α, and CRP—may lead to neuroinflammatory changes affecting neurotransmission, neuroendocrine regulation, and neuroplasticity, which are all implicated in mood dysregulation and impulsivity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, the inflammatory markers (cytokines) identified in these studies are heterogeneous, indicating the need for more comprehensive investigations (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA meta-analysis examining the association between suicidal behavior and inflammatory biomarkers found that individuals exhibiting suicidal behavior had significantly higher blood levels of C-reactive protein (CRP) compared to healthy controls, patients with depression without suicidality, and individuals with other psychiatric disorders. These findings suggest that the immune system and inflammatory response play a role in suicidal behavior, independent of major psychiatric disorders, and that these biological markers are predominantly state-dependent indicators (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Postmortem studies have further demonstrated that, regardless of primary psychiatric diagnoses, individuals who die by suicide exhibit increased microgliosis levels and elevated cytokine mRNA expression, indicative of neuroinflammation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In light of these findings, researchers have suggested that anti-inflammatory treatments may be effective in reducing suicidality (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNeutrophils, granulocytes, monocytes, platelets, lymphocytes, and white blood cell (WBC) counts, along with various hemogram-derived parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), mean platelet volume (MPV), and red cell distribution width (RDW), are recognized as inflammation-related markers (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies investigating the associations between hemogram-derived inflammatory parameters and suicide attempts are increasingly prevalent. Elevated NLR levels have been consistently observed in individuals who have attempted suicide (\u003cspan additionalcitationids=\"CR20 CR21 CR22\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). One study conducted on adolescents with a history of suicide attempts reported significantly higher MLR and NLR values than did the control group. Similarly, another study reported that individuals who attempted suicide had significantly higher MLR and NLR values, whereas the MPV and RDW levels were significantly lower (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to these parameters, the C-reactive protein-to-albumin ratio (CAR) has been recognized as a marker of increased inflammation, with elevated levels indicating poor prognosis in patients with systemic diseases (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Research focusing on the CAR in psychiatry has been expanding, with findings suggesting that the CAR may serve as a reliable biomarker of inflammation and could reflect increased inflammatory status in schizophrenia patients, potentially serving as a predictive parameter in this disorder (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, recent studies have highlighted the neutrophil-to-albumin ratio (NAR), suggesting that it is a novel parameter for assessing ischemic inflammation and mortality in conditions such as cancer, sepsis, and stroke (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e–\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). One study demonstrated that NAR levels were significantly higher in individuals who attempted suicide than in healthy controls (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo our knowledge, this is the first study to exclusively investigate the inflammatory biomarkers CAR and NAR in a female-only cohort of hospitalized psychiatric patients with and without suicidality. No prior studies have specifically examined the CAR and NAR in the context of suicidality among psychiatric inpatients using a female-only sample. By addressing this gap, our study provides novel insights into the potential role of inflammation-based biomarkers in suicidality assessment within a clinically relevant and demographically consistent population. Future research may establish these hemogram-derived parameters as objective, accessible, reproducible, and cost-effective laboratory markers that can be routinely assessed to better understand their association with suicidality. In this study, we examined the associations between suicidality and inflammatory markers, including the MPV, RDW, NLR, MLR, PLR, CAR or NAR in psychiatric inpatients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e Our study was designed as a retrospective cross-sectional study and was conducted by reviewing the medical records of patients hospitalized in the Psychiatry Department of Göztepe Prof. Dr. Süleyman Yalçın City Hospital between 2022 and 2024. The study included female inpatients aged 18–65 years who were admitted to the Psychiatry Department between January 1, 2022, and December 31, 2024. Patients with intellectual disability or dementia-related conditions were excluded. The diagnosis of psychiatric disorders was established by the attending specialist psychiatrist responsible for inpatient care, based on the diagnostic criteria outlined in the \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders Fifth Edition\u003c/em\u003e (DSM-5). All laboratory tests were conducted in the morning after an overnight fast and prior to the administration of any medication. Body Mass Index (BMI) was measured at the time of admission under fasting conditions and calculated by dividing body weight (kg) by the square of height in meters (m²). Patients with elevated white blood cell (WBC) counts secondary to bacterial infection, as well as those diagnosed with systemic conditions that could affect inflammatory status—such as diabetes, liver or kidney failure, hypertension, acute infection, acute or chronic immune-inflammatory diseases, or pregnancy—were excluded. Additionally, patients who used anti-inflammatory or immunosuppressive medications or had documented laboratory findings related to liver or kidney pathology were not included in the study.\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003eSociodemographic data: Sociodemographic variables, including age, marital status, employment status, education level, mode of admission, and the presence of additional medical conditions, were obtained from hospital records.\u003c/p\u003e\u003cp\u003eClinical data: Clinical information, suicidality (including suicide ideation and history of suicide attempts), and psychiatric diagnoses (e.g., depression, bipolar disorder, anxiety disorders), was collected retrospectively from medical records.\u003c/p\u003e\u003cp\u003eLaboratory data: In line with the primary aim of the study, inflammatory biomarkers—including C-reactive protein (CRP), albumin, neutrophils, lymphocytes, monocytes, and platelets—and red cell distribution width (RDW) were retrospectively extracted from patient records. On the basis of these parameters, the neutrophil‒lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet‒lymphocyte ratio (PLR), C-reactive protein‒albumin ratio (CAR), neutrophil‒albumin ratio (NAR), and mean platelet volume (MPV) were calculated and analysed.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted via SPSS version XX (IBM Corp., Armonk, NY, USA). The descriptive statistics summarized the demographic data as frequencies, percentages, means, and standard deviations.\u003c/p\u003e\u003cp\u003eIndependent samples t tests or Mann‒Whitney U tests were used to compare laboratory and clinical parameters on the basis of normality assessed by the Shapiro‒Wilk test. All tests were two-tailed with a significance threshold of p \u0026lt; 0.05. Effect sizes were calculated where applicable, and missing data were handled via pairwise deletion.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSample characteristics\u003c/p\u003e\u003cp\u003eThe study included a total of 221 participants. The demographic characteristics of the sample are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of the participants were single (39.4%) or married (38.5%), and most participants were unemployed (81.4%). With respect to educational status, 38.0% had completed primary education, 34.4% had a high school degree, 22.2% had a university degree, and 5.4% were illiterate. In terms of admission type, 42.5% of the participants were referred from another healthcare facility, 30.8% sought emergency services, and 26.7% presented to an outpatient clinic. Additionally, 56.1% of the sample reported no comorbidities, whereas 43.9% reported at least one medical condition.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSample characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFrequency (n)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ePercentage (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdmission Type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutpatient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReferral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePsychiatric disorder\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnorexia Nervosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBipolar Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBorderline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMood Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMixed Anxiety and Depressive Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObsessive Compulsive Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychotic Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedical Comorbidities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e-Table\u0026nbsp;1-\u003c/p\u003e\u003cp\u003eComparison of laboratory parameters\u003c/p\u003e\u003cp\u003eThe laboratory parameters of participants with and without suicidality are compared in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The comparison between patients with suicidality (including suicide ideation and history of suicide attempts) and those without revealed no statistically significant differences across any of the examined parameters. Specifically, CRP (p\u0026thinsp;=\u0026thinsp;0 .248), lymphocyte counts (p\u0026thinsp;=\u0026thinsp;0.321), monocyte counts (p\u0026thinsp;=\u0026thinsp;0.363), MPV (p\u0026thinsp;=\u0026thinsp;0.098), RDW (p\u0026thinsp;=\u0026thinsp;0.112), PLR (p\u0026thinsp;=\u0026thinsp;0.236), NLR (p\u0026thinsp;=\u0026thinsp;0.778), MLR?? CAR (p\u0026thinsp;=\u0026thinsp;0.216) and NAR (p\u0026thinsp;=\u0026thinsp;0.830) did not differ significantly between the two groups.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Laboratory Parameters Between Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuicidality (-) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSuicidality (+) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.248\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.49\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.626\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e271.24\u0026thinsp;\u0026plusmn;\u0026thinsp;73.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e270.28\u0026thinsp;\u0026plusmn;\u0026thinsp;73.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonocyte\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocyte\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRDW\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.264\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.830\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.778\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.728\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144.14\u0026thinsp;\u0026plusmn;\u0026thinsp;59.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.236\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eCRP: C-Reactive Protein, RDW: Red Cell Distribution Width, MPV: Mean Platelet Volume, CAR: C-Reactive Protein to Albumin Ratio, NAR: Neutrophil to Albumin Ratio, NLR: Neutrophil to Lymphocyte Ratio, PLR: Platelet to Lymphocyte Ratio\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e-Table\u0026nbsp;2-\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate inflammatory biomarkers in psychiatric inpatients with and without suicidality. The analysis revealed no statistically significant differences in the evaluated inflammatory markers between the two groups.\u003c/p\u003e\u003cp\u003eThe literature has demonstrated that NLR and MLR are significantly elevated in individuals with suicidality across various populations (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, in contrast to these findings, our study did not observe significant differences in NLR or MLR values between patients with and without suicidality. This discrepancy may be attributed to differences in sample characteristics, psychiatric diagnoses, or methodological variations between studies. Studies examining the MPV and RDW have reported heterogeneous results. Ucuz et al. reported significantly elevated MPV levels in individuals with suicidality, whereas Kara et al. and Petho et al. found no significant differences in RDW or MPV between suicidal and non-suicidal groups (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) Similarly, Aguglia et al. suggested that higher MPV and PLR were associated with high-lethality suicide attempts in psychiatric inpatients. Despite these findings, our results did not support a significant association between MPV or RDW values and suicidality (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The relationship between PLR and suicidality has also shown inconsistent patterns in the literature. While some studies, including those by Aguglia et al. and Ucuz et al., found elevated PLR values in individuals exhibiting suicidal behavior, others reported no significant differences (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Our findings align with the latter, as no significant difference in PLR was observed between the groups. These inconsistencies across studies suggest that inflammatory markers such as PLR may not consistently reflect suicidality-related biological changes.\u003c/p\u003e\u003cp\u003eThe CRP-to-albumin ratio (CAR) is a newly recognized parameter associated with inflammation severity. It has been suggested that the CAR is a superior indicator of the inflammatory response compared with CRP or albumin alone (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). İn our study, no statistically significant differences in CAR levels were observed between patients with and without suicidality. This finding suggests that, despite its recognized value in reflecting systemic inflammation, CAR may not be a reliable standalone marker for distinguishing suicidality in psychiatric inpatients. It is possible that the inflammatory processes associated with suicidality are more subtle or involve different pathways not adequately captured by CAR. Further research with larger sample sizes and a broader range of inflammatory markers may be necessary to clarify these relationships.\u003c/p\u003e\u003cp\u003eWhile Kılı\u0026ccedil; et al. demonstrated a significant association between the neutrophil-to-albumin ratio (NAR) and suicidal tendency, and Yeşilkaya et al. reported that NAR plays a role in both suicidal behavior and ideation (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), our study did not reveal any statistically significant differences in NAR values between patients with and without suicidality. This discrepancy may be attributed to differences in sample characteristics, methodological variations, or the complexity of the biological mechanisms underlying suicidality. Further studies are warranted to clarify the potential role of NAR in the pathophysiology of suicidal behavior across diverse psychiatric populations.\u003c/p\u003e\u003cp\u003eOne of the strengths of our study is that, to the best of our knowledge, it is the first to specifically examine the inflammatory biomarkers CAR and NAR in hospitalized psychiatric patients in relation to suicidality. However, our study also has several limitations that should be noted. First, it included only inpatients, which limits the generalizability of the findings; including outpatients could have provided a broader perspective. Second, the study was conducted with a female-only sample and had a relatively small sample size, which reduced the statistical power, especially for comparisons across different diagnoses. Third, we did not control for the effects of pharmacological treatments, which may have influenced the biomarker levels. Lastly, potential psychosocial stressors that could affect inflammation were not assessed, introducing the possibility of unmeasured confounding factors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, no significant associations were identified between the examined inflammatory biomarkers and suicidality as defined by our criteria. Future studies with larger sample sizes and the inclusion of a broader range of biological markers are warranted to elucidate the potential pathophysiological mechanisms underlying suicidality.\u003c/p\u003e\u003cp\u003eDeclerations:\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003e Ethical approval for the study was obtained in accordance with the Declaration of Helsinki from the İstanbul Medipol University Ethics Committee (12.09.2024/871).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRYE, SSE, and AHİ contributed to the development of the study hypothesis. SSE and AHİ were responsible for data collection. RYE performed the data analysis and drafted the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePacific W. World Health Organization WHO Regional websites. World Health; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilverman MM, Berman AL, Sanddal ND, O\u0026rsquo;Carroll PW, Joiner TE. Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Suicide Life-Threatening Behav. 2007;37(3):248\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Discov Med. 2019;28(154):205\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNg WW-S, Lam S-M, Yan W\u0026ndash;W, Shum H-P, NLR. MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep. 2022;12(1):15974.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong GG, Lee YH. Red cell distribution width, platelet-to-lymphocyte ratio, and mean platelet volume in ankylosing spondylitis and their correlations with inflammation: a meta-analysis. Mod Rheumatol. 2020;30(5):894\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUcuz İ, Tetik BK. Can suicide behavior and seasonality of suicide be predicted from inflammatory parameters in adolescents? Med Hypotheses. 2020;143:110061.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKılı\u0026ccedil; N, Taşcı G, Kaya Ş, \u0026Ouml;zsoy F. 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C-reactive protein/albumin and neutrophil/albumin ratios as novel inflammatory markers in patients with schizophrenia. Psychiatry Invest. 2020;17(9):902.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTingle SJ, Severs GR, Goodfellow M, Moir JA, White SA. NARCA: a novel prognostic scoring system using neutrophil-albumin ratio and Ca19‐9 to predict overall survival in palliative pancreatic cancer. J Surg Oncol. 2018;118(4):680\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen Z, Xie D, Li Y et al. Neutrophil albumin ratio is associated with all-cause mortality in stroke patients: a retrospective database study. Int J Gen Med 2022:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGong Y, Li D, Cheng B, Ying B, Wang B. Increased neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with severe sepsis or septic shock. Epidemiol Infect. 2020;148:e87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePethő B, Kov\u0026aacute;cs M\u0026Aacute;, Simon D, et al. Investigation of peripheral inflammatory biomarkers in association with suicide risk in major depressive disorder. Front Psychiatry. 2024;15:1321354.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAguglia A, Amerio A, Asaro P, Caprino M, Conigliaro C, Giacomini G, Parisi VM, Trabucco A, Amore M, Serafini G. High-lethality of suicide attempts associated with platelet to lymphocyte ratio and mean platelet volume in psychiatric inpatient setting. World J Biol Psychiatry. 2021;22(2):119\u0026ndash;27. Epub 2020 May 28. PMID: 32338121.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CAR, inflammatory biomarkers, NAR, suicidality","lastPublishedDoi":"10.21203/rs.3.rs-7288386/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7288386/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSuicidality is a significant public health concern with multifactorial etiologies, including psychological, environmental, and biological factors. Emerging evidence suggests a strong association between inflammatory processes and suicidality. This study aims to investigate the relationship between suicidality and inflammatory biomarkers in psychiatric inpatients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective cross-sectional study included female psychiatric inpatients aged 18\u0026ndash;65 years admitted to the Psychiatry Department of G\u0026ouml;ztepe Prof. Dr. S\u0026uuml;leyman Yal\u0026ccedil;ın City Hospital between 2022 and 2024. Inflammatory biomarkers, including C-reactive protein (CRP), albumin, neutrophils, lymphocytes, monocytes, platelets, and red cell distribution width (RDW), mean platelet volume (MPV) were analyzed. Additionally, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), CRP-to-albumin ratio (CAR), and neutrophil-to-albumin ratio (NAR) were calculated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe analysis revealed no statistically significant differences between patients with suicidality (including both suicide ideation and history of suicide attempts) and the non-suicidality group in terms of MPV, RDW, NLR, MLR, PLR, CAR or NAR values, with all parameters showing p\u0026thinsp;\u0026gt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe absence of statistically significant differences in inflammatory markers suggests that these biomarkers may not be robust indicators of suicidality in this sample. Further research with larger, more diverse populations is warranted to clarify the potential role of inflammation in suicidality.\u003c/p\u003e","manuscriptTitle":"Assessing the relationship between suicidality and inflammatory biomarkers: C-reactive protein/albumin and neutrophil/albumin ratios in an inpatient setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 05:58:41","doi":"10.21203/rs.3.rs-7288386/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-18T08:14:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T12:03:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T11:40:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108501201400082047426214490479888133108","date":"2025-08-16T11:05:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16340381354431932147750120729734129598","date":"2025-08-15T12:21:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-15T12:07:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-07T10:25:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T14:34:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-05T14:32:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-08-04T07:42:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c584f2d-12f6-4a6c-856b-0e8b4c3ca651","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:01:09+00:00","versionOfRecord":{"articleIdentity":"rs-7288386","link":"https://doi.org/10.1186/s12888-025-07416-9","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-10-08 15:57:41","publishedOnDateReadable":"October 8th, 2025"},"versionCreatedAt":"2025-08-22 05:58:41","video":"","vorDoi":"10.1186/s12888-025-07416-9","vorDoiUrl":"https://doi.org/10.1186/s12888-025-07416-9","workflowStages":[]},"version":"v1","identity":"rs-7288386","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7288386","identity":"rs-7288386","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}