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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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: Identifier: NCT00118430 (SCAMP) and NCT00313573 (INCPAD)

Prim Care Companion J Clin Psychiatry 2010;12(6):e1–e8

Submitted: March 6, 2010; accepted May 27, 2010.

Published online: December 23, 2010 (doi:10.4088/PCC.10m00978blu).

Corresponding author: Kurt Kroenke, MD, Regenstrief Institute, 6th Fl, 1050 Wishard Blvd, Indianapolis, IN 46202 (

Prim Care Companion J Clin Psychiatry 2010;12(6):e1-e8