Indian Journal of Private Psychiatry

Register      Login

VOLUME 18 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Association between Severity of Depression and CRP Level: A Cross-sectional Study

Julia Keisham, Vidya Sanapala, Niveditha Vasireddy, Ramya Spandana Tata, Srikrishna Nukala, Srinivas Singisetti, Abhilash Garapati

Keywords : C-reactive protein, CRP, Cross-sectional observational, Depression, Inflammatory markers, Severity of depression, Suicidal ideation

Citation Information : Keisham J, Sanapala V, Vasireddy N, Tata RS, Nukala S, Singisetti S, Garapati A. Association between Severity of Depression and CRP Level: A Cross-sectional Study. Ind J Priv Psychiatry 2024; 18 (1):4-8.

DOI: 10.5005/jp-journals-10067-0167

License: CC BY-NC 4.0

Published Online: 03-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim and background: Depression is a worldwide mental health issue. Depression is believed to result from multifaceted social, psychological, and biological interactions. Many recent studies have found elevated levels of pro-inflammatory cytokines in patients with depression and speculated on their involvement in the pathophysiology of depression. The autonomic nervous system (ANS) activity and hypothalamic (HPA) axis are linked to depression symptoms and C-reactive protein (CRP) production. So, this study aimed to study the severity of depression (SOD) and its correlation to serum CRP levels and identify the relationship between suicidal ideations and CRP levels. Materials and methods: This is a cross-sectional study, hospital-based on patients diagnosed with depression who attended the outpatient department, fulfilled the inclusion criteria, and gave consent. A semi-structured proforma for sociodemographic details and the Montgomery-Asberg Depression Rating Scale to assess the SOD were applied to the patients, after which serum C-reactive protein levels (CRP) were tested based on the particle-enhanced turbidimetric immunoassay (PETIA) technique. Results and conclusion: In our study, we found a statistically significant (p-value of 0.001) positive correlation between the SOD and serum CRP levels. A statistically significant (p-value = 0.001) association is found between the presence of suicidal ideations and an increase in CRP levels. In conclusion, with the SOD and the presence of suicidal ideations, higher CRP levels were observed. Clinical significance: These results indicate that CRP levels can be an essential marker for understanding the disease pathophysiology and may contribute to therapeutic management in the future.

  1. World Health Organization. Depressive Disorder (Depression) [Internet]. World Health Organization. 2023. Available from:
  2. Murthy RS. National Mental Health Survey of India 2015–2016. Indian J Psychiatry 2017;59(1):21–26. DOI: 10.4103/psychiatry.IndianJPsychiatry_102_17.
  3. GBD 2017. Disease and Injury Incidence and prevalence collaborators. global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1789–858. DOI: 10.1016/S0140-6736(18)32279-7.
  4. Raison CL, Cowles MK, Miller AH. Immune system and central nervous system interactions. Kaplan and Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia: Wolters Kluwer; 2015.
  5. Maes M, Smith R, Scharpe S. The monocyte-T-lymphocyte hypothesis of major depression. Psychoneuroendocrinology 1995;20(2):111–116. DOI: 10.1016/0306-4530(94)00066-j.
  6. Maes M. Depression is an inflammatory disease, but cell-mediated immune activation is the key component of depression. Prog Neuropsychopharmacol Biol Psychiatry 2011;35(3):664–675. DOI: 10.1016/j.pnpbp.2010.06.014.
  7. Kubzansky LD, Cole SR, Kawachi I, et al. Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the normative aging study. Ann Behav Med 2006;31(1):21–29. DOI: 10.1207/s15324796abm3101_5.
  8. Janszky I, Lekander M, Blom M, et al. Self-rated health and vital exhaustion, but not depression, is related to inflammation in women with coronary heart disease. Brain Behav Immun 2005;19(6):555–563. DOI: 10.1016/j.bbi.2005.01.001.
  9. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 2006;27(1):24–31. DOI: 10.1016/
  10. Dantzer R, O'Connor JC, Freund GG, et al. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008;9(1):46–56. DOI: 10.1038/nrn2297.
  11. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003;111(12):1805–1812. DOI: 10.1172/JCI18921.
  12. Osimo EF, Baxter LJ, Lewis G, et al. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med 2019;49(12):1958–1970. DOI: 10.1017/S0033291719001454.
  13. Orsolini L, Pompili S, Tempia Valenta S, et al. C-Reactive Protein as a Biomarker for Major Depressive Disorder. Int J Mol Sci 2022;23(3):1616. DOI: 10.3390/ijms23031616.
  14. Wium-Andersen MK, Ørsted DD, Nielsen SF, et al. Elevated C-reactive protein levels, psychological distress, and depression in 73, 131 individuals. JAMA Psychiatry 2013;70(2):176–184. DOI: 10.1001/2013.jamapsychiatry.102.
  15. Dowlati Y, Herrmann N, Swardfager W, et al. A meta-analysis of cytokines in major depression. Biol Psychiatry 2010;67(5):446–457. DOI: 10.1016/j.biopsych.2009.09.033.
  16. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 2009;71(2):171–186. DOI: 10.1097/PSY.0b013e3181907c1b.
  17. Chen X, Pu J, Liu Y, et al. Increased C-reactive protein concentrations were associated with suicidal behavior in patients with depressive disorders: a meta-analysis. Psychiatry Res 2020;292:113320. DOI: 10.1016/j.psychres.2020.113320.
  18. Quilty LC, Robinson JJ, Rolland JP, et al. The structure of the Montgomery-Åsberg depression rating scale over the course of treatment for depression. Int J Methods Psychiatr Res 2013;22(3):175–184. DOI: 10.1002/mpr.1388.
  19. Nehring SM, Goyal A, Patel BC. C Reactive Protein. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  20. Singh S, Tiwari S, Ali W, et al. Association of C reactive protein with mild and severe depression. Journal of Clinical and diagnostic research 2021;15(6):01–04. DOI: 10.7860/JCDR/2021/48611.14955.
  21. Devita M, De Salvo R, Ravelli A, et al. Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management. Neuropsychiatr Dis Treat 2022;18:2867–2880. DOI: 10.2147/NDT.S347356.
  22. Jeenger J, Sharma M, Mathur DM, et al. Associations of number and severity of depressive episodes with C-reactive protein and Interleukin-6. Asian J Psychiatr 2017;27:71–75. DOI: 10.1016/j.ajp.2017.02.016.
  23. O'Donovan A, Rush G, Hoatam G, et al. Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depress Anxiety 2013;30(4):307–314. DOI: 10.1002/da.22087.
  24. Ekinci O, Ekinci A. The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio. Nord J Psychiatry 2017;71(8):574–580. DOI: 10.1080/08039488.2017.1363285.
  25. Park RJ, Kim YH. Association between high sensitivity CRP and suicidal ideation in the Korean general population. Eur Neuropsychopharmacol 2017;27(9):885–891. DOI: 10.1016/j.euroneuro.2017.06.010.
  26. Köhler-Forsberg O, Buttenschøn HN, Tansey KE, et al. Association between C-reactive protein (CRP) with depression symptom severity and specific depressive symptoms in major depression. Brain Behav Immun 2017;62:344–350. DOI: 10.1016/j.bbi.2017.02.020.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.