Most suicide victims contact a primary care physician within a month before their death. Over 90% of suicide victims have a diagnosable psychiatric illness, most commonly a mood disorder.

To compare demographic and clinical characteristics of depressed patients with and without a comorbid psychiatric disorder, and subjects without depressive disorders (DD). We hypothesized that depressed patients with a comorbid disorder would be the most impaired group and would have the greatest suicidality.

195 patients were evaluated in three primary care centers in Madrid (Spain) using systematic sampling. Patients were assessed using the Spanish version of Prime-PHQ and a Recent Life Changes Checklist. Demographic data and previous psychiatric history were also collected.

22.1% of all patients had a DD according to PHQ. 46.5% were not previously diagnosed as having a DD. 81.4% of depressed patients had a comorbid psychiatric disorder. Comorbid patients contacted more frequently their primary care physicians and spent more days absent from work compared to the other two groups (p<0.001; p=0.005, respectively). Comorbid subjects had more depressive symptoms and experienced more recent life events compared to the other two groups (p<0.001; p=0.001, respectively). Suicidal ideation was reported by 48.6% of comorbid subjects (p<0.001). Severe suicidal ideation was reported only by the comorbid patients.

Patients with DD are frequently seen in primary care practice. All patients with depression should be screened for suicidal ideation. Primary care physicians should concentrate their prevention efforts for suicidal behavior on depressed patients with comorbid psychiatric disorders.