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All Journal Scientia Psychiatrica Jurnal Global Ilmiah Sriwijaya Journal of Neurology
Wayan Wiradana
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Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Economics, Econometrics & Finance Environmental Science Health Professions Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Journal : Scientia Psychiatrica

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Peripheral Inflammatory Markers and Suicidal Behavior in Depressive and Anxiety Disorders: A Systematic Review and Meta-Analysis of Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and Monocyte-to-Lymphocyte Ratios Ni Made Citra Riesti Wulan; Wayan Wiradana
Scientia Psychiatrica Vol. 6 No. 4 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.192

Abstract

Introduction: Suicidal behavior is a major public health crisis, intricately linked with depressive and anxiety disorders. A growing body of evidence implicates systemic inflammation in the pathophysiology of these conditions and suicidality. This systematic review and meta-analysis aims to synthesize the evidence on the association between accessible peripheral inflammatory markers—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR)—and suicidal behavior in patients with depressive or anxiety disorders. Methods: A systematic literature search was conducted in PubMed, Cochrane, ScienceDirect, Ebsco, and SpringerLink for observational studies up to March 2024. Studies comparing NLR, PLR, or MLR between patients with depressive or anxiety disorders with suicidal behavior and those without were included. Data were pooled using a random-effects model. The primary outcomes were the standardized mean difference (SMD) for NLR and mean difference (MD) for PLR and MLR. Results: Thirteen studies comprising 2,392 patients (1,192 with suicidal behavior, 1,200 controls) were included. The analysis revealed that patients with suicidal behavior had significantly higher NLR (Standardized Mean Difference [SMD] = 0.55; 95% CI: 0.26–0.84; p < 0.001), PLR (Mean Difference [MD] = 11.31; 95% CI: 7.48–15.14; p < 0.00001), and MLR (MD = 0.02; 95% CI: 0.01–0.03; p < 0.00001) compared to non-suicidal patients. Significant heterogeneity was observed in the NLR analysis (I2 = 90%). Conclusion: This meta-analysis establishes a significant association between elevated peripheral inflammatory markers (NLR, PLR, MLR) and suicidal behavior in patients with depressive and anxiety disorders. These findings support the inflammatory hypothesis of suicidality. However, substantial heterogeneity and methodological limitations across studies necessitate cautious interpretation. These markers represent promising areas for future research but are not yet suitable for clinical risk prediction.
The Screen as a Shield: Internet Addiction as a Maladaptive Defense Against Childhood Emotional Neglect in a Left-Behind Adult Made Citra Riesti Wulan; Wayan Wiradana
Scientia Psychiatrica Vol. 6 No. 2 (2025): Scientia Psychiatrica
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/scipsy.v6i2.202

Abstract

Introduction: Internet addiction (IA) is frequently conceptualized as an impulse control disorder driven by dopaminergic dysregulation. However, in the context of left-behind children—those raised by grandparents due to parental migration—IA may function as a complex psychodynamic defense mechanism. This study aims to elucidate the role of the smartphone as a digital shield against the resurfacing trauma of Childhood Emotional Neglect (CEN) and attachment deficits. Case presentation: We report the case of a 23-year-old female in Eastern Bali presenting with acute dysphoria, elective mutism, and total insomnia following the confiscation of her smartphone. Assessment included the Internet Addiction Test (IAT), clinical interviews utilizing written communication during the mute phase, and family system analysis. The patient scored 58 on the baseline IAT, indicating moderate addiction. Clinical inquiry revealed a history of split-parenting, where the patient was reared by emotionally distant grandparents. The smartphone served a specific function of displacement, seeking safety in online relationships, and dissociation, used to numb loneliness. The device confiscation triggered a traumatic re-enactment of early childhood abandonment, resulting in physiological hyperarousal incompatible with the moderate IAT score. Treatment involved Fluoxetine (20mg), Clobazam (10mg), and psychodynamic psychotherapy focusing on attachment repair. At the 4-week follow-up, the IAT score decreased to 32, and verbal communication was fully restored. Conclusion: IA in young adults with developmental trauma functions as a maladaptive defense mechanism (The Digital Shield). Clinicians must address the underlying attachment wound rather than focusing solely on digital detoxification to achieve sustainable remission.
Co-Authors Made Citra Riesti Wulan Ni Made Citra Riesti Wulan Rahayu, Wayan Saka Wayan Saka Rahayu Wulan, Made Citra Riesti