A Sad Performance by the SADPERSONS Scale

Summary and Comment |
August 2, 2013

A Sad Performance by the SADPERSONS Scale

  1. Diane M. Birnbaumer, MD, FACEP

The scale, which is designed to evaluate potential self-harm patients, misses so many at-risk patients it may actually be harmful.

  1. Diane M. Birnbaumer, MD, FACEP

To evaluate the performance of the SADPERSONS Scale for predicting whether self-harm patients would repeat self-harm, need hospitalization, or need referral for psychiatric care, researchers administered the scale to 126 consecutive self-harm patients presenting to a general hospital emergency department in the U.K.

Of these patients, 25% repeated self-harm within 6 months, 4% were admitted to the hospital, and 55% were referred for psychiatric aftercare. While the scale was more than 90% specific for all three outcomes, sensitivity was very low, ranging from 2.0% (hospitalization) to 6.6% (repeated self-harm).


The Joint Commission's Hospital National Patient Safety Goal 15 includes identifying patients at risk for suicide, and it applies to patients being treated for emotional or behavioral disorders in general hospitals. Using a simple tool such as the SADPERSONS Scale to assess risk is tempting. Unfortunately, this study shows that trying to distill a complex issue such as suicidality into to a scoring system may actually cause harm by missing many patients at risk. At this point, the best way to assess suicide risk is by listening to patients and their loved ones, seeking corroborative information, and then using your judgment.

Editor Disclosures at Time of Publication

  • Disclosures for Diane M. Birnbaumer, MD, FACEP at time of publication Consultant / Advisory board Securisyn Editorial boards The Merck Manuals (Home and Physician Editions)


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