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SAD person Scale

The SAD person scale was designed as an assessment tool for screening adult patients’ suicide risk, based on an acronym model of the most common risk factors.

SAD person scores range from 0 to 10, where the higher the score, the higher the suicide risk:

0-4: Low risk;
5-6: Medium risk;
7-10: High risk.

Several studies have found that the scale’s sensitivity is low, so its clinical value may be put under serious question. Another found disadvantage of the scale was that the risk factors might not apply to all individuals.

If you have thoughts of suicide or self-harm, you should call 911, go to the nearest emergency room, or call the National Suicide Prevention Hotline at 1-800-273-8255.

The SAD person Scale – Applicability and criticism

The scale was designed by Patterson et al. in 1983 to help medical professionals screen suicide risk in adults. It consists of 10 risk factors, organized under the mnemonic: “SAD PERSONS.” Juhnke published a further adaptation for the use of the scale in children in 1996.

The 10 risk factors from the scale are:

  • S: Male sex
  • A: Age (<19 or >45 years)
  • D: Depression
  • P: Previous attempt
  • E: Excess alcohol or substance use
  • R: Rational thinking loss
  • S: Social supports lacking
  • O: Organized plan
  • N: No spouse
  • S: Sickness

SAD person scores range from 0 to 10, where the higher the score, the higher the suicide risk:

  • 0-4: Low risk;
  • 5-6: Medium risk;
  • 7-10: High risk.

Since then, several studies have found that the scale’s sensitivity is low, so its clinical value may be put under serious question. Another found disadvantage of the scale was that the risk factors might not apply to all individuals, hence why personalized risk screening would be safer than the application of the scale in assessing an individual’s suicide risk.

A study by Bolton et al. compared the SAD PERSONS and Modified SAD PERSONS (MSPs) scale scores following subsequent assessments. The 2 main outcome measures in the study were current suicide attempts (at first presentation) and future suicide attempts (within the next 6 months).

The ability of the scales to predict suicide attempts was evaluated with logistic regression, sensitivity and specificity analyses, and receiver operating characteristic curves.

Both the SAD PERSONS and MSPS scale showed poor predictive ability for future suicide attempts. SAD PERSONS did not predict suicide attempts better than chance (area under the curve =0.572; 95% confidence interval [CI], 0.51-0.64; P-value nonsignificant).

A study by Saunders et al. set out to explore the utility of the SAD person Scale as a screening tool for suicide risk in those presenting to the emergency department following self-harm.

Following assessment, clinical management outcomes were recorded, from psychiatric hospital admission, community psychiatric aftercare, and repetition of self-harm in the next 6 months.

While the specificity of the SAD person scores was greater than 90% for all outcomes, sensitivity was:

  • Only 2.0% for admission;
  • Only 5.8% for community aftercare;
  • Only 6.6% for repetition of self-harm in the following 6 months.

In the context of the Saunders study, SAD PERSONS failed to identify the majority of those either requiring psychiatric admission or community psychiatric aftercare or to predict repetition of self-harm.  And so, the authors advised against using the scale to screen self-harm patients presenting to general hospitals. Instead, the clinical assessment was advised to be centered on the individual risk factors of the subject.

References

Original reference

Patterson, WM; Dohn, HH; Bird, J; Patterson, GA. Evaluation of suicidal patients: the SAD person scale. Psychosomatics. 1983; 24 (4): 343–5, 348–9.

Validation

Bolton JM, Spiwak R, Sareen J. Predicting Suicide Attempts With the SAD person Scale: A Longitudinal Analysis. J Clin Psychiatry. 2012 Jun;73(6):e735-41.

Saunders K et al. The sad truth about the SAD person Scale: An evaluation of its clinical utility in self-harm patients. Emerg Med J. 2014 Oct;31(10):796-8.

Hockberger et al. Assessment of suicide potential by nonpsychiatrists using the SAD person score. J Emerg Med 6 (1988), pp. 99-107.


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SAD Persons Scale