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Cited by 131Suicide and Self-Harm StudiesMental Health Treatment and AccessPsychiatric care and mental health services

The P4 Screener: Evaluation of a Brief Measure for Assessing Potential Suicide Risk in 2 Randomized Effectiveness Trials of Primary Care and Oncology Patients

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Dube, Priyanka, Kroenke, Kurt, Bair, Matthew J., Theobald, Dale, Williams, Linda S.·2010·The Primary Care Companion to The Journal of Clinical Psychiatry
DOI 10.4088/pcc.10m00978bluPMC PMC3067996
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Abstract

BACKGROUND: Depression is the most common mental disorder, and suicide is its most serious consequence. The primary objective of this study was to evaluate preliminary evidence for the P4 screener as a brief measure to assess potential suicide risk. METHOD: The P4 screener was prospectively evaluated in 2 randomized effectiveness trials of primary care (January 2005-June 2008; N = 250) and oncology patients (March 2006-August 2009; N = 309). Potential suicide ideation was assessed at 5 time points in both trials: baseline and 1, 3, 6, and 12 months. The P4 screener asks about the "4 P's": past suicide attempts, suicide plan, probability of completing suicide, and preventive factors. Patients were classified as minimal, lower, and higher risk based upon responses to these 4 items. RESULTS: A suicide assessment was triggered 1 or more times by 17.6% (44 of 250) of Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) participants and 16.5% (51 of 309) of Indiana Cancer Pain and Depression (INCPAD) participants at some point in the trial. Of the patients who triggered a suicide assessment, the majority (29 of 44 in SCAMP and 27 of 51 in INCPAD) were classified as minimal risk by the algorithm. Only 1 (0.4%) of the SCAMP participants and 5 (1.6%) of the INCPAD participants were classified as higher risk. Among the latter, the most common factors preventing patients from attempting suicide were the "4 F's": faith, family, future hope, and fear of failing in their attempt. CONCLUSIONS: Preliminary findings suggest that the P4 screener may be useful in assessing potential suicide risk in the clinical care of depressed patients as well as in clinical research. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00118430 (SCAMP) and NCT00313573 (INCPAD).

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  • Screening for suicide risk coupled with effective referral for evaluation and treatment was found by some studies to prevent suicidal behavior.

    “Screening for suicide risk to identify otherwise undetected at-risk individuals,(30, 37) if coupled with effective referral for evaluation and treatment, was found by some studies to prevent suicidal behavior.(15–17, 37, 38)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [37]

    The Discussion (page unavailable) recommends asking about suicidal ideation and describes assessment that can guide treatment, follow-up, or referral. But it says the degree to which suicide is preventable remains uncertain; it does not report that studies found screening coupled with referral prevented suicidal behavior. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Brief screening tools like the P4 or C-SSRS may improve triage.

    “Brief screening tools like the P4, that assesses the 4P’s (past suicide attempt, suicide plan, probability of completing suicide and preventive factors), or the Columbia Suicide Severity Rating Scale (C-SSRS), that assesses severity of previous suicidal behavior and current suicidal ideation, may improve triage.(37, 39)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [37]

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Research works printed but not linked: 45

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Authors
Dube, P., Kroenke, K., Bair, M. J., Theobald, D., & Williams, L. S.
Affiliations
Indiana University Bloomington (US)
Corresponding author
Kroenke, Kurt
ORCID
Venue
The Primary Care Companion to The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2010-12-23
Volume
12
Issue
6
ISSN
  • 1523-5998 (ISSN-L)
  • 1555-211X
DOI
10.4088/pcc.10m00978blu
PMC
PMC3067996
OpenAlex
W2091468236
Cited by
131
References
53
Citations by year
2026: 4 · 2025: 5 · 2024: 13 · 2023: 11 · 2022: 10 · 2021: 18 · 2020: 5 · 2019: 11 · 2018: 19 · 2017: 6 · 2016: 3 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 7
FWCI
5.99
Type
journal article
Language
en
Open access
Locations
  • The Primary Care Companion to The Journal of Clinical Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
  • National Institute of Mental Health
  • National Cancer Institute (R01CA115369)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
suicide risk assessment, suicidal ideation, depression, suicide prevention, primary care, cancer patients, suicide attempts, suicide planning, preventive factors, brief screening instrument

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