Haematological alterations associated with panic disorder among Sri Lankan university students: a preliminary case-control study

Panic disorder (PD) is a significant mental health concern in Sri Lanka, with a prevalence of 14% exceeding global averages. However, its pathophysiology remains unexplored locally. This preliminary case-control study aimed to assess the hematological alterations and panic severity associated with PD among university students. We evaluated 60 university students (30 PD patients and 30 healthy controls). PD patients scored significantly higher across all panic measures (* p < 0.001). RBC (* p = 0.002) and platelet (* p = 0.003) counts were significantly higher in the PD group and differential WBC profiles also differed between groups. Despite remaining within physiological reference ranges, the neutrophil-lymphocyte ratio (NLR) was significantly elevated in the PD group (* p = 0.002), potentially reflecting stress-induced leukocyte redistribution and neuroendocrine activity associated with HPA-axis dysregulation. However, since NLR does not constitute direct evidence of systemic inflammation, future studies evaluating direct inflammatory biomarkers such as CRP and IL-6 are warranted. These findings remained significant after adjusting for age and sex via Analysis of Covariance (ANCOVA) and controlling for multiple testing via Benjamini-Hochberg False Discovery Rate (FDR) correction ( q < 0.05). These preliminary findings contribute to understanding the complex pathophysiology of PD, highlighting potential stress-mediated physiological alterations within South Asian cohorts, offering a foundation for prospective research. Not applicable.