Clarifying the role of somatic and depressive symptoms in suicide risk: Evidence from a cross-sectional analysis

Somatic symptoms are common in psychiatric and primary care populations, and their relationship with depression and suicidal ideation is complex. This study investigates the association between somatic symptoms and suicidal ideation, accounting for comorbid depressive symptoms.

This cross-sectional study included 521 in- and outpatient with PHQ-9 ≥ 6 or a positive response to item 9, indicative of suicidal thoughts. Somatic and depressive symptoms were assessed using the PHQ-15 and PHQ-2 or PHQ-9, respectively. Suicidal ideation was measured using the risk subscale of the SuPr-10; the protective subscale was included as a covariate. Associations were examined using correlation matrices and regression models.

The sample was 68 % female with a mean age of 41 years; 52 % screened positive for suicidal ideation. PHQ-9 (mean = 14.8, SD = 5.0) and PHQ-15 scores (mean = 12.4, SD = 5.0) were moderately elevated. In a two-part regression model, higher depressive symptoms were associated with a reduced likelihood of reporting no suicidal ideation (OR = 0.50, 95 % CI: 0.41-0.62) and increased severity of suicidal ideation (IRR = 1.17, 95 % CI: 1.09-1.27). Somatic symptoms showed no meaningful direct effects but were indirectly associated with suicidal ideation via depressive symptoms (indirect effect OR = 1.05, 95 % CI: 1.03-1.07).

In individuals with somatic complaints, co-occurring depressive symptoms are strongly associated with suicidal ideation. Systematic depression screening is essential in somatically presenting patients.