Development and validation of the SuPr-10 questionnaire for suicidality assessment in primary care patients with depressive symptoms

Suicidal ideation affects 10% of primary care patients. Although guidelines recommend screening, few tools are suitable for use in this setting, and protective factors are often overlooked. This study aimed to develop a brief questionnaire to assess suicidality in primary care. The Suicide Prevention for Primary Care Questionnaire (SuPr-10) was validated in 521 participants with a PHQ-9 score ≥ 6 across six subsamples. Its structure was analyzed using exploratory and confirmatory factor analysis, item analysis, and psychometric evaluation. Diagnostic accuracy was assessed via logistic regression and ROC analysis, and patient acceptance was measured in a follow-up survey. A two-factor structure with ten items was identified: I. protective scale (ω = .817) and II. risk scale (ω = .928), showing strong correlations with suicidality (r = –.529, .854) and depression (r = –.736, .626) scales. SuPr-10 showed acceptable discriminatory ability for identifying individuals with a history of suicide attempts (AUC = .765; 83% sensitivity, 56% specificity). It provides a structured assessment of suicidal tendencies and protective factors in primary care patients with depressive symptoms, supporting clinical decision-making and resource-focused communication. These findings are based on a clinically enriched, German-speaking sample, do not imply prospective prediction of suicidal behavior, and require validation in broader primary care populations.