Page 83 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics HDL markers and suicidal ideation

between the pathogenesis of SI and various biomarkers,
including high-sensitivity C-reactive protein (hs-CRP),
5
monocytes, and high-density lipoprotein cholesterol
6
(HDL-C). Recent research has further underscored the
7
complex interplay among inflammatory, immune, and
lipid biomarkers. 8-12
High-density lipoprotein (HDL), among lipid
biomarkers, has attracted significant attention due to
its multifunctional roles, including anti-inflammatory,
antioxidant, immune-regulating, and reverse cholesterol
transport functions. 13,14 In recent years, novel HDL-
related inflammatory indicators have been developed by
combining HDL-C levels with other blood components,
such as white blood cell (WBC), lymphocyte (LYM),
monocyte (MONO), and neutrophil (NEU) counts as
well as hs-CRP and platelet (PLT) levels. 15-17 These HDL-
associated markers simultaneously reflect inflammation,
immune responses, and metabolic states, allowing for a
more comprehensive evaluation of how these risk factors
collectively influence health. However, research on the
relationship between HDL-associated markers and SI
remains extremely limited.
The Centers for Disease Control and Prevention
(CDC) administers the National Health and Nutrition Figure 1. Flowchart depicting the participant selection process
Abbreviation: NHANES: National Health and Nutrition Examination
Examination Survey (NHANES), which provides Survey.
comprehensive data on biochemical markers. This study
aimed to analyze NHANES data to explore the association comprehensive analysis of the association between HDL-
between HDL-related inflammatory markers and SI in U.S. related inflammatory indicators and SI.
adults. We hypothesize that elevated levels of these HDL-
related inflammatory markers are significantly associated 2.2. Exposure variable
with an increased prevalence of SI among adults.
Seven biochemical parameters from the NHANES database
2. Methods were used to calculate HDL-related inflammatory indicators:
HDL-C, WBC, NEU, LYM, MONO, hs-CRP, and PLT. The
2.1. Study population following formulas were applied to derive the HDL-related
Data were collected from three NHANES cycles: 2015 – inflammatory indicators: WBC-to-HDL-C ratio (WHR):
2016, 2017 – March 2020, and August 2021 – August 2023. WBC/HDL-C; NEU-to-HDL-C ratio (NHR): NEU/HDL-
During these cycles, data on both HDL-related inflammatory C; LYM-to-HDL-C ratio (LHR): LYM/HDL-C; MONO-to-
indicators and SI were collected simultaneously. As HDL-C ratio (MHR): MONO/HDL-C; hs-CRP-to-HDL-C
illustrated in Figure 1, the study initially included 37,464 ratio (CHR): hs-CRP/HDL-C; and PLT-to-HDL-C ratio
individuals from the NHANES dataset. Through a stepwise (PHR): PLT/HDL-C. Due to the non-normal distribution of
exclusion process, 18,510 individuals missing SI data, these indicators, a natural log transformation was performed
1,464 individuals missing biochemical parameter data to achieve a normal distribution. 18,19
(HDL-C, WBC, NEU, LYM, MONO, hs-CRP, and PLT),
and 2,729 individuals missing demographic data (gender, 2.3. Definition of SI
age, race/ethnicity, marital status, education level, and SI was assessed using the ninth item of the Patient Health
poverty income ratio [PIR]) were removed. In addition, Questionnaire-9 (PHQ-9), which inquires about thoughts
35 individuals missing lifestyle factor data (smoking status of self-harm or death over the past 2 weeks. Responses
and alcohol consumption) and 172 individuals missing were scored on a scale where 0 indicated “not at all” and 3
health condition data (hypertension, diabetes, stroke, and represented “nearly every day.” Participants with a score of
kidney disease) were excluded. Ultimately, 14,554 adult 1 – 3 were classified as having SI, whereas those scoring 0
individuals with complete data were included, enabling a were considered not to have SI. 20

Volume 3 Issue 1 (2025) 77 doi: 10.36922/jcbp.5084