Prospective Associations of Serum Tumor Necrosis Factor-Alpha and Employment on Suicidal Behaviors Over 1 Year in Depressive Patients Receiving Psychopharmacotherapy

Abstract

Objective This study explored both the individual and combined effects of serum tumor necrosis factor-alpha (sTNF-alpha) levels and employment status on suicidal behavior (SB) in patients with depressive disorders undergoing pharmacologic treatment. Methods Baseline measurements of sTNF-alpha levels were taken, and employment status was determined. Over a 1-year period of stepwise pharmacotherapy, SB was monitored and categorized into increased suicidal severity and fatal/non-fatal suicide attempts. Logistic regression models adjusted for relevant covariates were used to analyze the individual and interactive associations between sTNF-alpha levels, employment status, and these two forms of SB. Results Unemployment was significantly associated with both forms of SB, whereas sTNF-alpha levels alone did not show a significant correlation. However, lower sTNF-alpha levels combined with employment were associated with the lowest incidence rates of both SB categories, demonstrating significant interactive effects after adjustment. Conclusion The study demonstrates that the prospective associations of sTNF-alpha levels for SB is enhanced when combined with employment status in patients receiving pharmacological treatment for depressive disorders. These findings suggest that integrating biological markers with socio-economic factors can improve the assessment and management of suicide risk. Psychiatry Investig 2025;22(7):748-756