Global cross-cultural validation of a brief measure for identifying potential suicide risk in 42 countries

A. Gewirtz-Meydan, M. Koós, L. Nagy, S.W. Kraus, Z. Demetrovics, M.N. Potenza, R. Ballester-Arnal, D. Batthyány, S. Bergeron, J. Billieux, J. Burkauskas, G. Cárdenas-López, J. Carvalho, J. Castro-Calvo, L. Chen, G. Ciocca, O. Corazza, R. Csako, D.P. Fernandez, H. FujiwaraE.F. Fernandez, J. Fuss, R. Gabrhelík, B. Gjoneska, M. Gola, J.B. Grubbs, H.T. Hashim, M.S. Islam, M. Ismail, M.C. Jiménez-Martínez, T. Jurin, O. Kalina, V. Klein, A. Költő, S.-K. Lee, K. Lewczuk, C.-Y. Lin, C. Lochner, S. López-Alvarado, K. Lukavská, P. Mayta-Tristán, D.J. Miller, O. Orosová, G. Orosz, F.P. Ponce, G.R. Quintana, G.C. Quintero Garzola, J. Ramos-Diaz, K. Rigaud, A. Rousseau, M. De Tubino Scanavino, M.K. Schulmeyer, P. Sharan, M. Shibata, S. Shoib, V. Sigre-Leirós, L. Sniewski, O. Spasovski, V. Steibliene, D.J. Stein, C. Strong, B.C. Ünsal, M.-P. Vaillancourt-Morel, M.C. Van Hout, B. Bőthe

Research output: Contribution to journalArticlepeer-review


Objectives This study aimed to examine the psychometric properties of the P4 suicide screener in a multinational sample. The primary goal was to evaluate the reliability and validity of the scale and investigate its convergent validity by analyzing its correlation with depression, anxiety, and substance use. Study design The study design is a cross-sectional self-report study conducted across 42 countries. Methods A cross-sectional, self-report study was conducted in 42 countries, with a total of 82,243 participants included in the final data set. Results The study provides an overview of suicide ideation rates across 42 countries and confirms the structural validity of the P4 screener. The findings indicated that sexual and gender minority individuals exhibited higher rates of suicidal ideation. The P4 screener showed adequate reliability, convergence, and discriminant validity, and a cutoff score of 1 is recommended to identify individuals at risk of suicidal behavior. Conclusions The study supports the reliability and validity of the P4 suicide screener across 42 diverse countries, highlighting the importance of using a cross-cultural suicide risk assessment to standardize the identification of high-risk individuals and tailoring culturally sensitive suicide prevention strategies.
Original languageEnglish
Pages (from-to)13-23
Number of pages11
JournalPublic Health
Early online date20 Feb 2024
Publication statusE-pub ahead of print - 20 Feb 2024


  • Assessment
  • Cross-cultural
  • Suicide
  • Validation


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