P4 Suicidality Tool Calculator
For health professionals — screening support only (not a replacement for clinical judgment or emergency protocols).
If a patient appears to be at immediate risk, follow emergency procedures and local institutional protocols immediately.
This calculator first asks the trigger question (current thoughts of self-harm). If positive, it applies the P4 “4 Ps” and displays:
risk category (Minimal / Lower / Higher) and a risk-point count (count of concerning responses).
The P4 Suicidality Tool is a clinical screening brief designed to help primary care providers and mental health professionals rapidly assess the risk of suicide in patients who have expressed suicidal ideation. Developed by Dube et al. (2010), it is specifically designed to move beyond the simple “yes/no” question of ideation and categorize risk into actionable levels.
The Four “P”s of Assessment
The tool derives its name from the four critical dimensions it evaluates:
- Past History: Has the patient attempted suicide previously?
- Plan: Does the patient have a specific plan for how they would do it?
- Probability: How likely does the patient think they are to act on these thoughts in the near future?
- Preventative Factors: What keeps the patient from acting on these thoughts (e.g., family, faith, pets)?
Clinical Interpretation
Unlike a simple numerical scale where every point is equal, the P4 uses a logical “gate” system.
- Minimal Risk: No past attempts, no plan, low probability, and strong preventative factors.
- Lower Risk: May have a past attempt or a vague plan, but expresses low probability and strong deterrents.
- Higher Risk: Multiple “yes” answers in the first three categories and/or a lack of preventative factors. This level typically requires immediate psychiatric consultation or emergency intervention.
