[Why do we require clinical guidelines for suicide prevention?]

Validation of the German Version of the P4 Suicidality Tool

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.

Psychotherapists' Knowledge of Guideline Recommendations for the Treatment of Depressed Suicidal Patients

Objective

Clinical practice guidelines present expert consensus on the treatment of mental disorders. Yet, studies have shown that knowledge of and adherence to recommendations are moderate. The aim of the present study was to investigate, whether and to what extent psychotherapists are aware of and follow the German guideline recommendations for the treatment of suicidal depressed patients.

Methods

174 participants (licensed psychotherapists, psychotherapists-in-training) were presented with five groups of guideline recommendations (referring to inpatient admission, psychotherapy, acute pharmacotherapy, pharmacologic relapse prevention, follow-up appointments) and were asked to identify the guideline recommendation and indicate whether they provided treatment according to the guideline.

Results

Knowledge and adherence to the guidelines recommendations on psychotherapy and inpatient admission were well present. However, knowledge about pharmacological treatment recommendations was low; same as the knowledge on the necessity of immediate follow-up appointments after discharge of patients hospitalized due to suicidality.

Discussion

The results highlight the importance of greater dissemination of various facts about the management of suicidal patients.