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

August 27, 2026 updated by: Natalia Dewi Wardani, MD

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Estimated)

70

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Natalia Dewi Wardani Dr. dr. Sp.KJ(K)
  • Phone Number: +6281325683134
  • Email: anatdew@gmail.com

Study Locations

  • Indonesia
    • Central Java
      • Demak, Central Java, Indonesia
        • Puskesmas Sayung 1

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Mindfulness Body Scan Group
Participants in this single arm receive an 8-day community-based mindfulness body scan training designed to evaluate its effects on systemic inflammatory markers (MLR, NLR, PLR) and psychological parameters.
Behavioral: Mindfulness Body Scan
A structured 8-day behavioral intervention consisting of guided mindfulness body scan practices. Participants are instructed to direct non-judgmental attention sequentially across different regions of the body to enhance somatic awareness, promote relaxation, and reduce psychological stress reactivity.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Monocyte-to-Lymphocyte Ratio (MLR)
Time Frame: Baseline and Day 8 (post-intervention)
Changes in MLR derived from routine complete blood count to evaluate systemic inflammation.
Baseline and Day 8 (post-intervention)
Change in Neutrophil-to-Lymphocyte Ratio (NLR)
Time Frame: Baseline and Day 8 (post-intervention)
Changes in NLR derived from routine complete blood count to evaluate systemic inflammation
Baseline and Day 8 (post-intervention)
Change in Platelet-to-Lymphocyte Ratio (PLR)
Time Frame: Baseline and Day 8 (post-intervention)
Changes in PLR derived from routine complete blood count to evaluate systemic inflammation.
Baseline and Day 8 (post-intervention)
Change in DASS-21 Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of changes in psychological distress using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Total score ranges from 0 to 63, where higher scores indicate higher levels of psychological distress.
Baseline and Day 8 (post-intervention)
Change in Beck Depression Inventory (BDI) Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of changes in depressive symptoms using the BDI questionnaire. Total score ranges from 0 to 63, where higher scores indicate more severe depression.
Baseline and Day 8 (post-intervention)
Change in Patient Health Questionnaire-9 (PHQ-9) Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of depression severity using the PHQ-9 scale. Total score ranges from 0 to 27, where higher scores indicate more severe depressive symptoms.
Baseline and Day 8 (post-intervention)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Pittsburgh Sleep Quality Index (PSQI) Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of sleep quality using the PSQI questionnaire. Total score ranges from 0 to 21, where higher scores indicate poorer sleep quality.
Baseline and Day 8 (post-intervention)
Change in Connor-Davidson Resilience Scale (CD-RISC) Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of psychological resilience levels using the CD-RISC questionnaire. Total score ranges from 0 to 100, where higher scores indicate greater resilience.
Baseline and Day 8 (post-intervention)
Change in Impact of Event Scale-Revised (IES-R) Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of post-traumatic stress distress related to the tidal flood disaster using the IES-R. Total score ranges from 0 to 88, where higher scores indicate greater post-traumatic distress.
Baseline and Day 8 (post-intervention)
Change in WHOQOL-BREF Score
Time Frame: Baseline and Day 8 (post-intervention)
Evaluation of quality of life across physical, psychological, social, and environmental domains using the WHOQOL-BREF scale. Domain scores are transformed to a scale of 0 to 100, where higher scores indicate higher quality of life.
Baseline and Day 8 (post-intervention)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Natalia Dewi Wardani, MD

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing; 2013.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2026

Primary Completion (Estimated)

February 1, 2027

Study Completion (Estimated)

April 1, 2027

Study Registration Dates

First Submitted

August 27, 2026

First Submitted That Met QC Criteria

August 27, 2026

First Posted (Actual)

September 1, 2026

Study Record Updates

Last Update Posted (Actual)

September 1, 2026

Last Update Submitted That Met QC Criteria

August 27, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • FK-UNDIP-MIND-02

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The data are not publicly available due to privacy or ethical restrictions. The dataset involves sensitive information about mental health, and sharing it publicly would compromise participant confidentiality as per the ethical approval obtained.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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