Predicting suicide with the SAD PERSONS scale

Abstract

Background Suicide is a major public health issue, and a priority requirement is accurately identifying high‐risk individuals. The SAD PERSONS suicide risk assessment scale is widely implemented in clinical settings despite limited supporting evidence. This article aims to determine the ability of the SAD PERSONS scale (SPS) to predict future suicide in the emergency department. Methods Five thousand four hundred sixty‐two consecutive adults were seen by psychiatry consultation teams in two tertiary emergency departments with linkage to population‐based administrative data to determine suicide deaths within 6 months, 1, and 5 years. Results Seventy‐seven (1.4%) individuals died by suicide during the study period. When predicting suicide at 12 months, medium‐ and high‐risk scores on SPS had a sensitivity of 49% and a specificity of 60%; the positive and negative predictive values were 0.9 and 99%, respectively. Half of the suicides at both 6‐ and 12‐month intervals were classified as low risk by SPS at index visit. The area under the curve at 12 months for the Modified SPS was 0.59 (95% confidence interval [CI] range 0.51–0.67). High‐risk scores (compared to low risk) were significantly associated with death by suicide over the 5‐year study period using the SPS (hazard ratio 2.49; 95% CI 1.34–4.61) and modified version (hazard ratio 2.29; 95% CI 1.24–2.29). Conclusions Although widely used in educational and clinical settings, these findings do not support the use of the SPS and Modified SPS to predict suicide in adults seen by psychiatric services in the emergency department.

Determinants and Predictive Value of Clinician Assessment of Short‐Term Suicide Risk

“…Further, the standard risk scale did not predict outcomes beyond clinician judgment, adding to the reports of its poor predictive value and limited utility as an independent predictive tool (Bolton et al., ; Katz et al., ). This is consistent with a recent systematic review and meta‐analysis of clinical instruments finding that no individual predictive instrument or pooled subgroup of instruments was able to classify patients as being at high risk for suicidal behavior with a level of accuracy suitable to be used to inform allocation of treatment (Carter et al., ).…”

Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data

“…The results suggested high-risk classification approaches were unlikely to be clinically useful but also reported high between-study heterogeneity. Another study measured the accuracy of the SAD PERSONS Scale (SPS) for predicting suicide following an emergency department presentation, using administrative data to identify suicide deaths [ 11 ]. The study found that the predictive accuracy of the SPS was inadequate to support the use of this risk scale.…”

Investigating Suicide Rate and Poisoning Severity and Their Relationship With Birth Month

“…This scale was then developed by Juhnke for use in children in 1996 [24]. Recent studies indicated that this scale has high specificity and very low sensitivity [4]. SPS consists of 10 yes/no questions; each positive answer is assigned a score.…”

“…On average, the suicide rate is around 11.4 per 100000 people worldwide [1]. Suicide is also a growing phenomenon in Iran, with a rate of 5.3 per 100000 individuals in 2014 [3,4].…”