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Schluessel S, Halfter K, Haas C, Kroenke K, Lukaschek K, Gensichen J. Validation of the German Version of the P4 Suicidality Tool. J Clin Med 2023; 12:5047. [PMID: 37568448 PMCID: PMC10420186 DOI: 10.3390/jcm12155047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
For general practitioners (GPs), it may be challenging to assess suicidal ideation (SI) in patients. Although promising instruments exist for the use in primary care, only a few have been validated in German. The objectives of this study were to examine the validity of the brief P4 screener for assessing SI in a cross-sectional study including outpatients. Inclusion criteria were a PHQ-9 score ≥ 10 or an affirmative answer to its SI item. Construct validity of the P4 was examined by comparison with the four-item Suicide Behaviors Questionnaire-Revised (SBQ-R), the PHQ-9 (convergent), and the positive mental health (PMH) scale (divergent). The study sample included 223 patients (mean age 47.61 ± 15 years; 61.9% women) from 20 primary care practices (104 patients) and 10 psychiatric/psychotherapeutic clinics (119 patients). The first three items of the P4 correlate positively with most of the four items of the reference standard SBQ-R (convergent validity); the fourth item of the P4 (preventive factors) correlates significantly with the PMH scale. The most common preventive factor (67%) is family or friends. The German P4 screener can be used to assess SI in outpatient care. It explores preventive or protective factors of suicide, which may support the GP's decision on treatment. We recommend a further clinical interview for patients flagged by P4 assessment in order to more formally assess suicidal risk.
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Affiliation(s)
- Sabine Schluessel
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
| | - Kathrin Halfter
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University, 81377 Munich, Germany;
| | - Carolin Haas
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
- Graduate Program “POKAL—Predictors and Outcomes in Primary Care Depression Care” (DFG-GrK 2621), 80336 Munich, Germany
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
- Graduate Program “POKAL—Predictors and Outcomes in Primary Care Depression Care” (DFG-GrK 2621), 80336 Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
- Graduate Program “POKAL—Predictors and Outcomes in Primary Care Depression Care” (DFG-GrK 2621), 80336 Munich, Germany
- DZPG (German Center for Mental Health), 80336 Munich, Germany
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