title: Suicidality in primary care patients who present with sadness and anhedonia: a prospective European study.
abstract: BACKGROUND
  Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia.
  
  
  METHODS
  Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months.
  
  
  RESULTS
  1) In patients with sadness and/or anhedonia who were not depressed at entry to the study, suicide plans (OR = 3.05; 95 % CI = 1.50-6.24; p = 0.0022) and suicide attempts (OR = 9.08; 95 % CI = 2.57-32.03; p = 0.0006) were significant predictors of developing new onset depression at 6 or 12 months. 2) In patients with sadness and/or anhedonia who met CIDI criteria for major depression at entry, suicidal ideation (OR = 2.93; 95 % CI = 1.70-5.07; p = 0.0001), suicide plans (OR = 3.70; 95 % CI = 2.08-6.57; p < 0.0001), and suicide attempts (OR = 3.33; 95 % CI = 1.47-7.54; p = 0.0040) were significant predictors of persistent depression at 6 or 12 months.
  
  
  CONCLUSIONS
  Three questions on suicidality could help primary care professionals to assess such patients more closely without necessarily establishing whether they meet criteria for major depression.
authors.affiliation: Department of Personality, Assessment and Psychological Treatment, University of Malaga (Maristan Network), Malaga, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Moreno-Küstner
authors.affiliation: Division of Psychiatry, UCL, London, UK.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Igor
authors.initials: I
authors.lastname: Švab
authors.affiliation: Faculty of Medicine, University of Tartu, Tartu, Estonia.
authors.forename: Heidi
authors.initials: H
authors.lastname: Maaroos
authors.affiliation: NOVA Medical School - UNLLisbon, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Xavier
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Geerlings
authors.affiliation: CIBERSAM, University of Granada, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-González
authors.affiliation: Department of Primary Care and Population Health, University College London Medical School and Medical, Research Council General Practice Research Framework, London, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: International University Loyola Andalucía, Seville, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Motrico-Martínez
authors.affiliation: Centro de Salud Casablanca. (redIAPP, grupo Aragón) Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Montón-Franco
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria de La Rioja, La Rioja, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Gil-de-Gómez
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria de Madrid, Coordinadora de Coordinadora de Direcciones de Continuidad Asistencial, Servicio Madrileño de Salud, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sánchez-Celaya
authors.affiliation: Centro de Salud de Vecindario, Gerencia de Atención Primaria de Gran Canaria, Las Palmas, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Díaz-Barreiros
authors.affiliation: Centro de Salud Son Serra, Unidad de Investigación de Atención Primaria de Baleares (redIAPP, grupo Baleares), Mallorca, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Vicens-Caldentey
authors.affiliation: Division of Psychiatry, UCL, London, UK. michael.king@ucl.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: King
mesh_terms: D059445:Anhedonia; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*
keywords: Anhedonia; Cohort; Depression; Primary care; Risk; Suicidality