Predictors of suicidal ideation in depressive primary care patients

Background: Suicidal ideation is common in patients suffering from depression, but it often remains undetected. General practitioners play an important role in the management of depression and suicidality. The aim of this study was to identify predictors for suicidal ideation in patients with major depression in primary health care. Method: We conducted a cross-sectional study. Patients were recruited from 74 primary care practices in Germany. Data was collected between April 2005 and July 2006. We calculated a binary logistic regression model to evaluate whether depression severity (Patient Health Questionnaire, PHQ-9), physical pain (SF-36 Physical Pain Scale), physical comorbidity, intake of antidepressant medication, sex and age were predictors of suicidal ideation. Results: We enrolled 626 patients, aged 18 to 80 with major depression. Depression severity (OR 1.16 per unit PHQ-9 score, 95% CI 1.09-1.22, p <0.001) and male sex (OR 1.71,95% CI 1.13-2.58, p = 0.012) were associated with suicidal ideation, while absence of pain (OR 0.99 per unit SF-36 Physical Pain Scale, 95% CI 0.98-1.00, p = 0.004) and older age (>60) compared to the reference group aged 40 to 60 (OR 0.55, 95% CI 0.35-0.86, p = 0.009) were protective factors. Limitations: This cross-sectional study allows the generation of hypotheses. Conclusions: Depression severity is a predictor for suicidal ideation in primary care patients with major depression. In addition, physical pain appears to be a predictor. Results should be confirmed using a prospective study design. (C) 2009 Elsevier B.V. All rights reserved.