Suicidal ideation after acute traumatic brain injury: A longitudinal actor-partner interdependence model of patients and caregivers in Latin America

Brain and blood transcriptome profiles delineate common genetic pathways across suicidal ideation and suicide

Human genetic studies indicate that suicidal ideation and behavior are both heritable. Most studies have examined associations between aberrant gene expression and suicide behavior, but behavior risk is linked to the severity of suicidal ideation. Through a gene network approach, this study investigates how gene co-expression patterns are associated with suicidal ideation and severity using RNA-seq data in peripheral blood from 46 live participants with elevated suicidal ideation and 46 with no ideation. Associations with the presence of suicidal ideation were found within 18 co-expressed modules (p < 0.05), as well as in 3 co-expressed modules associated with suicidal ideation severity (p < 0.05, not explained by severity of depression). Suicidal ideation presence and severity-related gene modules with enrichment of genes involved in defense against microbial infection, inflammation, and adaptive immune response were identified and investigated using RNA-seq data from postmortem brain that revealed gene expression differences with moderate effect sizes in suicide decedents vs. non-suicides in white matter, but not gray matter. Findings support a role of brain and peripheral blood inflammation in suicide risk, showing that suicidal ideation presence and severity are associated with an inflammatory signature detectable in blood and brain, indicating a biological continuity between ideation and suicidal behavior that may underlie a common heritability.

Wishing for an end? Longitudinal analysis of suicidal ideation among informal caregivers inside and outside their household in different welfare systems of Europe

OBJECTIVE

This study examines whether transition to caregiving within or outside the household is associated with changes in suicidal ideation and whether this depends on the type of caregiver relationship, the age or gender of the caregiver, or the welfare system.

DESIGN

Longitudinal study.

SETTING

Ten European countries.

PARTICIPANTS

Data from the Survey of Health, Ageing, and Retirement in Europe were used (waves 1, 2, 4, 5, and 6) including participants aged ≥40 years (pooled Observations = 171,848).

MEASUREMENTS

Suicidal ideation was measured using the Euro-D scale. Caregiving was measured as care inside and outside the household, and for different recipients. Fixed effects logistic regression analyses, adjusted for health and sociodemographic factors, were used.

RESULTS

Transitioning into caregiving inside the household was associated with higher odds of suicidal ideation, in particular if they transitioned into care for partners or parents and within Southern and Bismarckian welfare systems. Transitioning into caregiving outside the household was not associated with suicidal ideation, except among those transitioning into caregiving for non-relatives (higher odds of suicidal ideation), and among male and older caregivers (lower odds of suicidal ideation). Suicide ideation was higher among caregivers in Southern compared to Bismarckian or Scandinavian welfare systems.

CONCLUSION

Informal caregiving is associated with suicidal ideation among caregivers inside but not among all caregivers outside the household. The caregiver's characteristics, the care relationship, and the welfare system play an important role. Preventing suicidal ideation requires interventions that focus on informal caregivers and consider their individual and contextual factors.

Setting a research agenda for caregiving after neurotrauma and neurological disability

Research on caregiving after neurotrauma and neurological disability critically extends the focus beyond individuals with neurological conditions to family, friends, and significant others who also are greatly impacted. This article introduces a thematic issue of NeuroRehabilitation on the topic with 10 articles that coalesce around the three approaches of (a) literature reviews, (b) empirical studies, and (c) caregiver intervention studies. This introductory article introduces each of these articles and synthesizes them to chart important future directions for research on caregiving after neurotrauma and neurological disability including: (a) a focus on evidence-based common factors caregiver interventions, (b) dissemination and implementation science approaches to imbedding caregiver interventions into health care systems, and (c) cultural considerations in the context of caregiving. This thematic issue helps rehabilitation clinicians incorporate more of a systems perspective to improve the functioning not only of individuals with neurological conditions but also their caregivers.