Schluessel Sabine, Halfter Kathrin, Haas Carolin, Kroenke Kurt, Lukaschek Karoline, Gensichen Jochen
Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany.
Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University, 81377 Munich, Germany.
J Clin Med. 2023 Jul 31;12(15):5047. doi: 10.3390/jcm12155047.
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.
对于全科医生（GP）而言，评估患者的自杀意念（SI）可能具有挑战性。尽管有一些适用于初级保健的有前景的工具，但只有少数在德语环境中得到验证。本研究的目的是在一项包括门诊患者的横断面研究中检验简短的P4筛查工具评估自杀意念的有效性。纳入标准为PHQ-9评分≥10或对其自杀意念项目的肯定回答。通过与四项自杀行为问卷修订版（SBQ-R）、PHQ-9（收敛效度）和积极心理健康（PMH）量表（区分效度）进行比较，检验P4的结构效度。研究样本包括来自20家初级保健机构（104名患者）和10家精神科/心理治疗诊所（119名患者）的223名患者（平均年龄47.61±15岁；61.9%为女性）。P4的前三项与参考标准SBQ-R的大多数四项呈正相关（收敛效度）；P4的第四项（预防因素）与PMH量表显著相关。最常见的预防因素（67%）是家人或朋友。德语版P4筛查工具可用于门诊护理中评估自杀意念。它探究自杀的预防或保护因素，这可能有助于全科医生做出治疗决策。我们建议对P4评估标记出的患者进行进一步的临床访谈，以便更正式地评估自杀风险。
