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Pearls


Revised ‘SAD PERSONS’ helps assess suicide risk

Vol. 3, No. 3 / March 2004

The SAD PERSONS scale, an acronym based on 10 suicide risk factors,1 has found widespread acceptance in assessing the likelihood of a suicide attempt. It also has been adapted for use with children.2

However, a major risk factor omitted from the scale is the availability of a lethal means for suicide, such as a firearm, stockpiled medication, or other potentially lethal item. In particular, where firearm ownership levels are higher, a disproportionately higher number of people die from suicide. 3

Include ‘Availability of lethal means’

SAD PERSONS can be modified to “SAD PERSONAS” to remedy this omission, with the second ‘A’ representing “Availability of lethal means” (Table). This modification reminds the clinician to ask about lethal means when assessing suicidality. If lethal means are available, the clinician can then take whatever action is reasonably indicated to reduce the likelihood of a suicide.

Eliminate scoring

Because the listed risk factors are not equivalent with regard to suicide potential, a second modification is to eliminate scoring.

In SAD PERSONS, one point is scored for each risk factor. Consider these two patients:

  • a man who is depressed and has an organized plan to shoot himself with his handgun
  • an elderly widower who has dementia and is physically ill.

Both men would score a 4, but the risk of suicide would be substantially greater in the first case. Suicide risk factors are qualitative—not quantitative—measures and should be considered within the overall context of the clinical presentation.

Table

Modified SAD PERSONAS scale

Sex

Age

Depression

Previous attempt

Ethanol abuse

Rational thinking loss

Social supports lacking

Organized plan

No spouse

Availability of lethal means

Sickness

Eliminate scoring. Consider risk factors within the context of the clinical presentation

References

1. Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics 1983;24:343-9.

2. Juhnke GA. The adapted-SAD PERSONS: a suicide assessment scale designed for use with children. Elementary School Guidance & Counseling 1996;30:252-8.

3. Miller M, Azrael D, Hemenway D. Household firearm ownership and suicide rates in the United States. Epidemiology 2002;13:517-24.

Dr. Campbell is assistant professor, department of psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, and is clinical director, division of ambulatory care, department of psychiatry, University Hospitals of Cleveland.

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