Head and neck cancer (HNC) represents a major global health burden and is frequently associated with psychological distress, particularly depressive symptoms. Alcohol consumption is a major risk factor for HNC development due to the production of carcinogenic metabolites such as acetaldehyde, which increase oxidative stress and DNA damage. Inflammation plays a central role in tumor progression and has also been implicated in the pathophysiology of depression. Pro-inflammatory cytokines can cross the blood-brain barrier, disrupt neurotransmitter metabolism, and impair neuroplasticity, contributing to depressive symptoms. Inflammatory markers derived from routine blood counts, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), are accessible indicators of systemic inflammation. However, their relationship with depressive symptoms in HNC patients remains poorly explored.

To investigate the association between depressive symptoms and sociodemographic characteristics, lifestyle factors, and systemic inflammatory markers in HNC patients.

A total of 110 patients with locally advanced HNC (TNM stage III or IV) were evaluated (mean age 60 years, 91 men and 19 women, 89 White and 21 Black, 21 active smokers and 10 current alcohol users). Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Sociodemographic data, lifestyle factors, tumor characteristics, and inflammatory markers obtained from complete blood counts (NLR, PLR, LMR, SII, and SIRI) were collected from medical records. Data distribution was assessed using the Shapiro-Wilk test. Associations were evaluated using Spearman’s correlation and the Mann-Whitney test. Variables with p < 0.05 were included in multivariate linear regression analysis.

Non-drinkers presented higher BDI-II scores compared with current alcohol users (19.7 vs 9.5, p = 0.01). NLR (? = 0.23, p = 0.02), PLR (? = 0.30, p = 0.002), and SII (? = 0.31, p = 0.002) showed significant positive correlations with depression symptoms scores. In multivariate analysis, non-drinking status was associated with an increase of approximately 10 points in BDI-II scores (p = 0.02), while SII remained independently associated with depressive symptoms (ß = 0.30, p = 0.002).

Non-drinking status and higher SII levels were associated with increased depressive symptoms in patients with locally advanced HNC. These findings highlight the role of systemic inflammation in the emotional burden of HNC patients. Larger studies are needed to confirm these associations and clarify underlying biological mechanisms.