The Effect of Mindfulness in Inflammation Markers (MLR, NLR, PLR), Stress, Anxiety, and Depression Rate Among Survivors of Tidal Flooding in Sayung Demak

The Effect of Mindfulness in Inflammation Markers (MLR, NLR, PLR), Stress, Anxiety, and Depression Rate Among Survivors of Tidal Flooding in Sayung Demak

Tidal flood disasters in coastal areas cause chronic psychological stress due to economic, social, and residential disruption. Psychological stress is closely linked to systemic inflammatory responses-marked by elevated Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR)-which are associated with depression and anxiety symptoms. Mindfulness interventions, particularly body scan techniques, have been shown to reduce psychological distress and modulate immune responses, but empirical evidence on coastal flood survivors in Indonesia remains limited.

This study aims to evaluate the effectiveness of a community-based mindfulness body scan intervention on inflammatory biomarkers (MLR, NLR, PLR) and psychological parameters (stress, depression, anxiety, trauma, sleep quality, and resilience) among tidal flood survivors in Sayung, Demak. Participants will undergo baseline blood work and psychometric assessments, receive an 8-day mindfulness body scan intervention, and complete post-intervention evaluations.

Background:

Coastal communities in Sayung District, Demak Regency, face recurrent tidal flooding (rob) that causes continuous environmental and economic pressure. From a psychoneuroimmunological perspective, chronic psychosocial stress triggers systemic low-grade inflammation. Biomarkers such as MLR, NLR, and PLR serve as accessible systemic inflammatory indices that correlate with mood disorders and stress severity. Mindfulness body scan training aims to improve interoceptive awareness, emotional regulation, and parasympathetic activity, thereby reducing stress reactivity and systemic inflammation.

Study Design and Objectives:

This is an interventional pre-post experimental study conducted at the Sayung 1 Public Health Center (Puskesmas Sayung 1), Demak. The study evaluates changes in systemic inflammatory markers and psychological parameters pre- and post-intervention.

Intervention:

Participants will participate in a structured mindfulness body scan program over an 8-day period. The body scan protocol guides participants to direct attention sequentially to various body regions without judgment to enhance somatic awareness and stress mitigation.

Assessments:

1. Laboratory Testing: Complete blood counts to determine monocyte, neutrophil, platelet, and lymphocyte ratios (MLR, NLR, PLR) pre- and post-intervention.

2. Psychometric Evaluations: Assessment of psychological symptoms using validated tools, including:

   • Beck Depression Inventory (BDI) & Patient Health Questionnaire-9 (PHQ-9)
   • Depression, Anxiety, and Stress Scale-21 (DASS-21)
   • Impact of Event Scale - Revised (IES-R) & PTSD Checklist-5 (PCL-5)
   • Pittsburgh Sleep Quality Index (PSQI)
   • Connor-Davidson Resilience Scale (CD-RISC)
   • Spiritual Wellbeing Scale (SWBS)
   • Fatigue Assessment Scale (FAS)
   • WHO Quality of Life (WHOQOL)
   • Perceived Social Performance (PSP)

Data Analysis:

Pre- and post-intervention data will be analyzed using paired statistical tests and multivariate regression to determine changes in inflammatory markers and psychological scores, as well as the correlation between systemic inflammation changes and psychological recovery.

Inclusion Criteria:

• Adults aged 18 to 60 years.
• Survivors of tidal flooding (bencana rob) residing in the Sayung coastal area for at least 6 months.
• Minimum educational attainment of Primary School (Sekolah Dasar / SD).
• Literate in Indonesian (able to read and write).
• Willing to participate in and complete the 8-day mindfulness intervention program.
• Physically independent and capable of completing self-administered questionnaires.

Exclusion Criteria:

• Active psychotic disorders or severe mental illness.
• Cognitive impairment that limits ability to complete assessments.
• History of diagnosed autoimmune disorders, active allergies, or chronic inflammatory diseases.
• Presence of acute infectious disease symptoms within the past 1 month.
• Currently undergoing formal psychotherapy or other structured psychological interventions.