Page 90 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics HDL markers and suicidal ideation

various blood components, such as blood cells, immune we categorized inflammatory marker values into both
cells, CRP, and PLT. 8,30-32 HDL-related inflammatory continuous and quantile-based groups, fitting regression
biomarkers, which are novel indicators derived by models for each. In addition, we used RCS and subgroup
combining HDL-C with other inflammatory or immune analyses to enhance the robustness and consistency of
markers, provide a comprehensive reflection of the body’s our key findings. Finally, we applied weighted strategies
inflammatory and immune status. However, research to all statistical analyses, significantly improving the
8,33
on the relationship between HDL-related inflammatory representativeness of our sample and allowing our findings
biomarkers and SI remains limited. Using data from to more accurately reflect the health status of the U.S.
this large cross-sectional NHANES study, we found that population.
among six HDL-related inflammatory biomarkers, CHR However, this study also has some limitations. First,
demonstrated the strongest association with SI, exhibiting although we accounted for various confounding factors,
a linear relationship. To further assess CHR’s role within such as demographic, lifestyle, and health conditions,
the context of co-exposure to other inflammatory we cannot entirely rule out the influence of unmeasured
markers, we included all markers in a WQS regression confounders on our findings. Nonetheless, the use of
model. The results confirmed that even after accounting multiple statistical models likely reduced the probability
for interactions among inflammatory markers, CHR of false-positive results to some extent. Second, the
remained the primary factor influencing SI prevalence. As cross-sectional design limits our ability to infer a causal
an easily accessible clinical marker, CHR demonstrates a relationship between CHR and SI. However, conducting
linear and stable influence on SI, remaining unaffected by this analysis based on a large cross-sectional study is
other biochemical indicators. This highlights its potential still valuable, as the findings provide important insights
for broad clinical application in the future. and directions for future prospective research. Third, the
Previous studies have demonstrated a significant findings are based on data from the U.S. population, which
association between lower HDL-C levels, higher CRP necessitates further validation in other regions to confirm
levels, and increased SI prevalence. 34-37 However, to our their generalizability.
knowledge, no prior research has specifically examined 5. Conclusion
the relationship between CHR and SI. We hypothesize
that CHR may influence SI prevalence for the following This study is the first to simultaneously evaluate the
reasons: (1) HDL can exert anti-inflammatory effects relationship between multiple HDL-related inflammatory
through the transcriptional regulator ATF3. 13,38 Individuals indicators and the prevalence of SI among adults in the
with higher HDL levels tend to have lower inflammation U.S. Notably, CHR exhibited the strongest association with
(which decreases CHR), thereby reducing the likelihood SI in both individual and mixed exposure models. Further
of SI; (2) Under conditions of inflammatory stimuli, HDL prospective studies are needed to confirm this causal
may undergo oxidative or enzymatic modifications. relationship.
32
In individuals with higher levels of inflammation, HDL
function may become impaired or exacerbate inflammation Acknowledgments
(resulting in elevated CHR), ultimately promoting the The authors express heartfelt thanks to the team at the
occurrence of SI; (3) Compared to other inflammatory National Center for Health Statistics for their commitment
markers, hs-CRP is sensitive to lower levels of chronic to designing, collecting, and compiling NHANES data.
inflammation and serves as a distinctive indicator of
susceptibility to suicide. 5,37,39 Funding
This study has several notable strengths. First, This study was supported by the Natural Science
compared to traditional inflammatory markers, the Foundation of Jiangsu Province (Grant No. BK20242002).
novel inflammatory markers used in this research offer
higher sensitivity and account for the combined effects of Conflict of interest
metabolic and immune factors. Despite limited research Chen Qu is an Editorial Board Member of this journal
on the association between these novel markers and but was not in any way involved in the editorial and
SI, this study is the first to simultaneously evaluate the peer-review process conducted for this paper, directly or
relationship between multiple HDL-related inflammatory indirectly. Separately, other authors declared that they
indicators and SI prevalence. Advanced mixture machine have no known competing financial interests or personal
learning methods were employed to assess the stability relationships that could have influenced the work reported
of CHR under complex co-exposure conditions. Second, in this paper.

Volume 3 Issue 1 (2025) 84 doi: 10.36922/jcbp.5084