Suicide, the second reason for death between the ages of 15 and 29, is an important problem of community health. While all of them are important, it is known that some factors increase the risk of death at the end of the attempt. There are a variety of suicide‐related studies based on laboratory data, handling genetic features, obtained by imaging methods or using scales. Various data obtained from peripheral blood, cerebrospinal fluid, and brain tissue form the basis of laboratory studies. In some of these studies, suicide cases were divided into subgroups according to whether they had been performed violently or not, and significant differences were noted. However, we did not find a study in our literature search on lymphocyte‐related ratios and neutrophil‐related parameters about suicide severity. In this study, we aimed to examine the white blood cell values in the violent suicide attempt (VSA) and nonviolent suicide attempt (NVSA).
In this first retrospective cohort study, the records of 61 VSA (hanging, jumping, using firearms, using pesticides, and corrosive substances) and 55 NVSA subjects (self‐poisoning) were examined. We compared complete blood count (CBC) values of 43 VSA, 43 NVSA, and 43 healthy subjects in terms of immune cells. Patients and controls with insufficient data were excluded and the persons with organic disease or those with the potential to affect the measured parameters are excluded. As major depression or anxiety statements cannot be considered apart from suicidal thoughts, they are not an exclusionary criterion. However, patients with other psychiatric disorders are excluded. This study was approved by the ethics committee of our hospital. The centrifugation was followed in the CELL‐DYN 3700 SL analyser (Abbott Diagnostics, Chicago, Illinois) device. SPSS for Windows statistical package version 22 (SPSS Inc., Chicago, Illinois) was used for all statistical analyses. One‐way anova test was used for three independent groups. A post‐hoc Tukey test was used when a significant difference was found between the three independent groups. A value of less than 0.05 was considered statistically significant.
The mean age was 29.98 ± 11.83 in the VSA, 30.02 ± 12.87 in the NVSA, and 29.47 ± 9.11 in the control group and there was no significant difference between them (P = 0.955). Gender distribution was similar among the groups (P = 0.572). According to the comparison of CBC values, White blood cell (P = 0.016, Cohen's d 0.64) and neutrophil (P = 0.003, Cohen's d 0.78) were significantly higher in the VSA group than in the control group. Percentage of neutrophil (NEU %) (P = 0.001, Cohen's d 0.85) and neutrophil to lymphocyte ratio (NLR) (P = 0.015, Cohen's d 0.59) were significantly higher in the VSA group compared to the other two groups. Monocyte (P = 0.039, Cohen's d 0.63) was significantly higher in the NVSA group than in the control group. Other variables showed no significant differences. A comparison of sociodemographic variables and CBC values of the three groups are given in Table . The area under the ROC curve of NEU % and NLR for VSA was 0.68 and 0.62.
Comparison of sociodemographic variables and complete blood count values of violent suicide attempt group, nonviolent suicide attempt group, and control groupVSA (N = 43) | NVSA (N = 43) | Control (N = 43) | P value | ||
Age (years) | 29.98 ± 11.83 | 30.02 ± 12.87 | 29.47 ± 9.11 | 0.955 | |
Gender | |||||
Male (87) | 30 (69.76%) | 28 (65.11%) | 29 (67.44%) | 0.572 | |
Female (42) | 13 (30.24%) | 15 (34.89%) | 14 (32.56%) | ||
WBC (103/μL) | 10.93 ± 3.99 | 10.36 ± 3.55 | 8.75 ± 1.84 | 0.016 | |
NEU (106/μL) | 7.48 ± 4.11 | 6.33 ± 2.43 | 5.09 ± 1.66 | 0.003 | |
LYM (103/μL) | 2.46 ± 1.16 | 2.93 ± 1.17 | 2.62 ± 0.90 | 0.030 | |
MONO (103/μL) | 0.63 ± 0.23 | 0.71 ± 0.26 | 0.57 ± 0.15 | 0.039 | |
BASO (103/μL) | 0.10 ± 0.06 | 0.08 ± 0.04 | 0.09 ± 0.05 | 0.453 | |
EOS (103/μL) | 0.17 ± 0.20 | 0.17 ± 0.17 | 0.19 ± 0.17 | 0.831 | |
NEU% | 65.79 ± 14.64 | 58.59 ± 9.34 | 55.24 ± 10.17 | 0.001 | |
LYM% | 25.24 ± 12.27 | 29.16 ± 9.16 | 30.99 ± 8.78 | 0.055 | |
MONO% | 6.07 ± 1.75 | 6.80 ± 1.86 | 6.86 ± 1.55 | 0.103 | |
BASO% | 1.09 ± 0.66 | 0.93 ± 0.44 | 1.12 ± 0.55 | 0.321 | |
EOS% | 1.86 ± 1.85 | 1.63 ± 1.41 | 2.39 ± 2.12 | 0.197 | |
NLR | 4.48 ± 5.07 | 2.44 ± 1.24 | 2.47 ± 2.49 | 0.015 | |
MLR | 0.31 ± 0.19 | 0.25 ± 0.10 | 0.25 ± 0.16 | 0.272 | |
BLR | 0.04 ± 0.03 | 0.03 ± 0.01 | 0.04 ± 0.05 | 0.136 | |
ELR | 0.06 ± 0.05 | 0.05 ± 0.04 | 0.07 ± 0.07 | 0.369 |
Prevention of suicide attempts and reduction of the risk of death due to intervention methods has long been of interest to researchers. It was reported that NLR values of depression patients with the suicide attempt were found to be significantly higher than without suicide attempt and the control group. However, our study is the first study to examine the association of suicide attempt with NEU %, monocyte to lymphocyte ratio, basophil to lymphocyte ratio, and eosinophil to lymphocyte ratio in relation to the risk of death and achieve meaningful results. To understand whether immune cells especially neutrophils can be used as a diagnostic and evaluation parameter foreseeing violent suicidal ideation, studies with fewer limitations are needed.
All authors declare no conflict of interest.
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Abstract
Various data obtained from peripheral blood, cerebrospinal fluid, and brain tissue form the basis of laboratory studies. According to the comparison of CBC values, White blood cell (P = 0.016, Cohen's d 0.64) and neutrophil (P = 0.003, Cohen's d 0.78) were significantly higher in the VSA group than in the control group. Comparison of sociodemographic variables and complete blood count values of violent suicide attempt group, nonviolent suicide attempt group, and control group VSA (N = 43) NVSA (N = 43) Control (N = 43) P value Age (years) 29.98 ± 11.83 30.02 ± 12.87 29.47 ± 9.11 0.955 Gender Male (87) 30 (69.76%) 28 (65.11%) 29 (67.44%) 0.572 Female (42) 13 (30.24%) 15 (34.89%) 14 (32.56%) WBC (103/μL) 10.93 ± 3.99 10.36 ± 3.55 8.75 ± 1.84 0.016 NEU (106/μL) 7.48 ± 4.11 6.33 ± 2.43 5.09 ± 1.66 0.003 LYM (103/μL) 2.46 ± 1.16 2.93 ± 1.17 2.62 ± 0.90 0.030 MONO (103/μL) 0.63 ± 0.23 0.71 ± 0.26 0.57 ± 0.15 0.039 BASO (103/μL) 0.10 ± 0.06 0.08 ± 0.04 0.09 ± 0.05 0.453 EOS (103/μL) 0.17 ± 0.20 0.17 ± 0.17 0.19 ± 0.17 0.831 NEU% 65.79 ± 14.64 58.59 ± 9.34 55.24 ± 10.17 0.001 LYM% 25.24 ± 12.27 29.16 ± 9.16 30.99 ± 8.78 0.055 MONO% 6.07 ± 1.75 6.80 ± 1.86 6.86 ± 1.55 0.103 BASO% 1.09 ± 0.66 0.93 ± 0.44 1.12 ± 0.55 0.321 EOS% 1.86 ± 1.85 1.63 ± 1.41 2.39 ± 2.12 0.197 NLR 4.48 ± 5.07 2.44 ± 1.24 2.47 ± 2.49 0.015 MLR 0.31 ± 0.19 0.25 ± 0.10 0.25 ± 0.16 0.272 BLR 0.04 ± 0.03 0.03 ± 0.01 0.04 ± 0.05 0.136 ELR 0.06 ± 0.05 0.05 ± 0.04 0.07 ± 0.07 0.369 Abbreviations: BASO%, percentage of basophil; BASO, basophil; BLR, basophil to lymphocyte ratio; ELR, eosinophil to lymphocyte ratio; EOS%, percentage of eosinophil; EOS, eosinophil; LYM%, percentage of lymphocyte; LYM, lymphocyte; MLR, Monocyte to lymphocyte ratio; MONO%, percentage of monocyte; MONO, monocyte; NEU%, percentage of neutrophil; NEU, neutrophil; NLR, neutrophil to lymphocyte ratio; NVSA, nonviolent suicide attempt; VSA, violent suicide attempt; WBC, white blood cell.
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1 Adiyaman University Training and Research Hospital, Child and Adolescent Psychiatry, Adiyaman, Turkey
2 Adiyaman University, Faculty of Medicine, Department of Psychiatry, Adiyaman, Turkey