Exploring sleep quality, obesity, eating jetlag, chronotype, and Internet Gaming Disorder in early adolescents: a mixed-methods study.

Approximately 33% of individuals experience post-stroke depression (PSD) within three months following acute ischemic stroke (AIS), making PSD a prevalent neuropsychiatric complication []. Accumulating evidence has confirmed that PSD not only severely impedes neurological recovery and quality of life in affected patients [, ], but correlates strongly with adverse outcomes such as stroke recurrence and increased mortality []. Therefore, identifying early accessible risk markers for PSD in AIS patients holds crucial clinical significance for implementing precise interventions and improving prognostic outcomes []. However, the availability of clinically applicable early prediction tools remains limited. In recent years, the lipid profile, a widely acknowledged determinant of cerebrovascular disease risk, has garnered growing attention for its potential association with post-stroke neuropsychiatric complications—particularly post-stroke depression (PSD) [–]. Against this backdrop, the search for objective biomarkers capable of enabling early prediction of PSD has gained increasing research attention. Although the pathophysiology of PSD is thought to involve multiple processes, including neuroinflammation, cerebrovascular dysfunction, and impaired neuroplasticity [, ], an ideal predictive marker in clinical practice should be able to reflect overall cerebrovascular and metabolic status rather than individual pathways alone. In this context, the systemic ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL)—termed the TC/HDL ratio—has attracted interest due to its potential value as an integrated assessment tool. Previous studies have suggested abnormal TC levels may be linked to depressive symptoms through effects on neurotransmitter-related processes []; whereas HDL is generally considered to exert neuroprotective effects after stroke owing to its anti-inflammatory and antioxidant properties []. Thus, the TC/HDL ratio is regarded as a composite indicator that simultaneously evaluates atherogenic burden and the body’s protective physiological reserve. It should be noted, however, that these mechanistic explanations are derived primarily from prior studies and are not directly examined in the present analysis. Beyond the mechanistic support from the aforementioned pathophysiological pathways, evidence-based medical data on the TC/HDL ratio in cardiovascular and cerebrovascular diseases provide more direct validation of its predictive value. TC/HDL has been established as an important marker of atherosclerotic severity and cardiovascular event risk [–]. In the field of cardiology, it is widely recognized as a superior risk assessment tool compared to individual lipid components, as it more effectively quantifies the degree of dyslipidemia. Notably, in cerebrovascular disease research, an abnormally high TC/HDL is positively linked to the onset, severity, and long-term prognosis of stroke [, ]. Given that cerebrovascular injury constitutes a critical biological substrate for PSD, and that the TC/HDL ratio can sensitively quantify cerebrovascular-related risk and overall health status, extending its application to PSD risk assessment appears clinically reasonable. However, while its value in prognostic assessment for ischemic stroke has been confirmed, the specific relationship between TC/HDL and PSD risk within 90 days of AIS onset remains unclear. Its independent predictive performance has yet to be systematically evaluated.