Neutrophil to-lymphocyte (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratios (PLR) as biomarkers for suicidal behavior in children and adolescents with depression or anxiety: A systematic review and meta-analysis
Bibliographic record
Abstract
Introduction: Suicidal behaviour is a global phenomenon that has reached epidemic proportions due to the consistent rise in both completed and attempted suicides year after year, particularly among children and adolescents, who are the fifth leading cause of death in this demographic globally. Every year, over 700,000 individuals die by suicide, which equates to one death every 40 seconds on average. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are blood markers of inflammatory status that are easy to use and reasonably priced. It was discovered that patients with depression or anxiety have higher NLR, MLR, and PLR. Thus far, there have been relatively few studies assessing biomarkers for the prognosis for suicidal behavior in children and adolescents with depression or anxiety and shown varying results. The aim of this meta-analysis is to assess NLR, MLR, PLR as predictive biomarkers for suicidal behavior in children and adolescents with depression or anxiety. Methods: A literature search was conducted through databases, such as PubMed, Cochrane, ScienceDirect, Ebsco, Springerlink to identify relevant topics up to March 2025. The inclusion criteria for this meta-analysis study were (1) studied patients with suicidal behavior in children and adolescents with depression or anxiety, (2) the study had to be a type of observational study that was reported the relationship between suicidal behavior in children and adolescents with depression or anxiety and NLR, MLR, PLR, (3) providing sufficient information about mean and standard deviation, (4) the publication language of studies is limited to English. The quality of research methods was assessed using a modified form of the Newcastle Ottawa Scale (NOS). The statistical analysis in this study was conducted using RevMan 5.4 software. Results: A total of 13 studies including 1192 depressed or anxiety patients with suicidal behavior and 1200 controls were included, with the majority of studies coming from Turkey. Our analysis revealed that depressed or anxiety patients with suicidal behavior had significantly higher NLR (SMD = 0.43, 95% CI: 0.15–0.72, p = 0.003), PLR (SMD = 11.31, 95% CI: 7.48-15.14, p < 0.00001), MLR (SMD = 0.02, 95% CI: 0.01-0.03, p < 0.00001) compared with controls. Risk bias assessment utilizing the NOS scale indicated that all studies showed good quality with minimal bias. Conclusion: Higher NLR, PLR, MLR were significantly associated with an increased risk of depressed or anxiety patients with suicidal behavior. Therefore further research is needed to develop this topic.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.032 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".