Employment Status Shapes the Link between Serum Tumor Necrosis Factor and Suicidal Ideation in Patients with Acute Coronary Syndrome: Evidence from an Independent Clinical Cohort.

Objective: Building on our prior observation in a depression cohort that employment status may modify the association between serum tumor necrosis factor-alpha (TNF-α) and suicidal ideation (SI), we examined whether a similar context-dependent association is present in an independent cohort of patients with acute coronary syndrome (ACS). Methods: Methods: We analyzed 969 consecutively enrolled ACS patients assessed 2 weeks after diagnosis (baseline). Serum TNF-α was quantified at baseline and dichotomized at the cohort median (48.14 pg/ml) into lower vs. higher groups. Employment status was classified as employed vs. unemployed. SI was evaluated at baseline and again at 1-year follow-up among 711 participants. Binary logistic regression examined independent and interactive associations of TNF-α (binary and ln-transformed continuous) and employment with SI, adjusting for sociodemographic, psychiatric, and cardiac covariates. Results: Contrastingly to the depression cohort, higher TNF-α independently predicted SI, while employment status showed no independent association. However, a significant TNF-α × employment interaction at both timepoint was confirmed, with the highest risk found in unemployed patients with elevated TNF-α. Conclusion: This study in patients with ACS supports employment status as an important contextual modifier of the association between serum TNF-α and SI across clinical populations. The independent contribution of inflammation may be more evident in medically ill populations with acute inflammatory activation. Combining a routinely available cytokine measure with employment information may help identify high-risk subgroups after ACS.