[{"data":1,"prerenderedAt":492},["ShallowReactive",2],{"assessment-sad-persons":3,"assessments-related-sad-persons":479},{"id":4,"title":5,"body":6,"category":393,"categoryTitle":394,"clinicalCitations":395,"copyright":393,"description":414,"downloadLink":393,"extension":415,"faqs":416,"featured":432,"firstPublished":433,"i18nReady":432,"icon":393,"inHiBoop":393,"interpreter":434,"interpreterExempt":393,"lastReviewed":456,"meta":457,"navigation":458,"path":459,"permissionsNote":393,"published":458,"recommendedFrequency":393,"relatedCodes":393,"relatedConditions":393,"relevantSpecialty":393,"reviewedBy":393,"seo":460,"slug":461,"status":462,"stem":463,"summary":464,"takeaways":393,"timeline":465,"type":477,"usedToDiagnose":393,"__hash__":478},"assessments\u002Fassessments\u002Fsad-persons.md","SAD PERSONS Scale: Scoring, Bands and Why It Falls Short",{"type":7,"value":8,"toc":383},"minimark",[9,35,38,43,49,147,150,154,182,186,191,218,229,237,241,285,289,326,332,380],[10,11,12,13,17,18,21,22,25,26,28,29,28,31,34],"p",{},"The SAD PERSONS scale is a 10-item checklist of suicide risk factors, built around a mnemonic in which each letter names one factor ",[14,15],"cite-ref",{"n":16},"1",". It scores one point per factor present for a total of 0-10 ",[14,19],{"n":20},"2",". It is easy to remember and has been widely used in clinical and educational settings ",[14,23],{"n":24},"3",", but later research found that it does not accurately predict suicidal behaviour ",[14,27],{"n":20}," ",[14,30],{"n":24},[14,32],{"n":33},"4",".",[10,36,37],{},"Read this page as reference material on an older tool and its evidence, not as a recommendation to use it.",[39,40,42],"h2",{"id":41},"what-does-the-sad-persons-scale-measure","What does the SAD PERSONS scale measure?",[10,44,45,46,48],{},"The scale counts how many of ten suicide risk factors are present. Patterson and colleagues introduced it in 1983 as an easily learned acronym for assessing the likelihood of a suicide attempt ",[14,47],{"n":16},". The ten factors are:",[50,51,52,65],"table",{},[53,54,55],"thead",{},[56,57,58,62],"tr",{},[59,60,61],"th",{},"Letter",[59,63,64],{},"Risk factor",[66,67,68,77,85,93,101,109,117,124,132,140],"tbody",{},[56,69,70,74],{},[71,72,73],"td",{},"S",[71,75,76],{},"Sex",[56,78,79,82],{},[71,80,81],{},"A",[71,83,84],{},"Age group",[56,86,87,90],{},[71,88,89],{},"D",[71,91,92],{},"Depression",[56,94,95,98],{},[71,96,97],{},"P",[71,99,100],{},"Previous suicide attempt",[56,102,103,106],{},[71,104,105],{},"E",[71,107,108],{},"Ethanol (alcohol) use",[56,110,111,114],{},[71,112,113],{},"R",[71,115,116],{},"Rational thinking loss",[56,118,119,121],{},[71,120,73],{},[71,122,123],{},"Social supports lacking",[56,125,126,129],{},[71,127,128],{},"O",[71,130,131],{},"Organized plan",[56,133,134,137],{},[71,135,136],{},"N",[71,138,139],{},"No spouse",[56,141,142,144],{},[71,143,73],{},[71,145,146],{},"Sickness (physical illness)",[10,148,149],{},"The scale records static and demographic factors alongside a few clinical ones. Apart from an organized plan, it does not ask about current suicidal thoughts, intent or recent behaviour, which are the questions validated screens put first.",[39,151,153],{"id":152},"how-do-you-give-the-sad-persons-scale","How do you give the SAD PERSONS scale?",[155,156,157,167,176],"ul",{},[158,159,160,164,165,34],"li",{},[161,162,163],"strong",{},"Format."," A clinician-completed checklist; each factor is marked present or absent from the current presentation ",[14,166],{"n":20},[158,168,169,172,173,175],{},[161,170,171],{},"Original purpose."," In the 1983 paper, medical students taught the mnemonic judged the risk in a low-risk and a high-risk case more accurately than an untrained comparison group, as rated by experienced psychiatrists ",[14,174],{"n":16},". That study measured whether teaching the scale improved judgements; it did not test whether scores predict suicidal behaviour.",[158,177,178,181],{},[161,179,180],{},"Current use."," If a service still uses it, treat it as a prompt to cover risk factors during a full clinical assessment, never as the screen or the decision.",[39,183,185],{"id":184},"how-do-you-score-and-interpret-the-sad-persons-scale","How do you score and interpret the SAD PERSONS scale?",[10,187,188,189,34],{},"Each of the ten factors scores 1 if present and 0 if absent, for a total of 0-10 ",[14,190],{"n":20},[155,192,193,201,210],{},[158,194,195,198,199,34],{},[161,196,197],{},"Original categories."," The original cutoffs grouped totals into four categories: 0-2, 3-4, 5-6 and 7-10 ",[14,200],{"n":20},[158,202,203,206,207,209],{},[161,204,205],{},"Condensed bands."," Later use condensed these to three: low (0-4), moderate (5-6) and high (7-10) ",[14,208],{"n":20},". The band lookup above uses these.",[158,211,212,215,216,34],{},[161,213,214],{},"Modified SAD PERSONS (MSPS)."," Hockberger and Rothstein's modified version replaces sickness with stated future intent and weights four items at 2 points, for a total of 0-14; its authors described 0-5 as low, 6-8 as moderate and 9-14 as high risk ",[14,217],{"n":20},[10,219,220,223,224,28,226,228],{},[161,221,222],{},"Caution."," These bands are shown for reference only. In the studies below, neither the original nor the modified scale predicted future suicide attempts accurately, and many people who later died by suicide were scored low risk ",[14,225],{"n":20},[14,227],{"n":33},". A band should never be used to rule risk out, to decide discharge, or to stand in for asking about suicidal thoughts directly.",[10,230,231,232,34],{},"If there is any concern about suicide risk, call or text 988 (the Suicide & Crisis Lifeline in the US and Canada) or contact emergency services (911). See ",[233,234,236],"a",{"href":235},"\u002Fcrisis\u002F","crisis resources",[39,238,240],{"id":239},"psychometric-properties","Psychometric properties",[155,242,243,251,259,267,276],{},[158,244,245,248,249,34],{},[161,246,247],{},"Systematic review."," Of 149 studies identified, 9 met inclusion criteria; only 3 examined whether the scale predicted suicide outcomes, and none found that it accurately predicted suicidal behaviour. The review concluded that the evidence is insufficient to support its use in assessing or predicting suicidal behaviour ",[14,250],{"n":24},[158,252,253,256,257,34],{},[161,254,255],{},"Suicide attempts."," In 4,019 consecutive emergency psychiatric referrals in Manitoba, high-risk scores had low sensitivity for a future attempt within 6 months (19.6% for SAD PERSONS, 40.0% for the modified version) and low positive predictive value (5.3% and 7.4%). SAD PERSONS did not predict attempts better than chance (area under the curve 0.572) ",[14,258],{"n":20},[158,260,261,264,265,34],{},[161,262,263],{},"Suicide deaths."," In 5,462 adults seen by emergency psychiatry teams, medium and high scores had a sensitivity of 49% and a specificity of 60% for suicide within 12 months, and half of the suicides at 6 and 12 months had been classed as low risk at the index visit ",[14,266],{"n":33},[158,268,269,272,273,34],{},[161,270,271],{},"Self-harm presentations."," In 126 consecutive emergency presentations after self-harm, specificity was above 90%, but sensitivity was 2.0% for psychiatric admission, 5.8% for community psychiatric aftercare and 6.6% for repeat self-harm within 6 months. The authors concluded that the scale should not be used to screen people presenting to general hospitals after self-harm ",[14,274],{"n":275},"5",[158,277,278,281,282,34],{},[161,279,280],{},"Disposition."," In 276 people with suicidal ideation in an emergency department, the modified scale, like the other tools tested, showed only modest negative predictive value for disposition ",[14,283],{"n":284},"6",[39,286,288],{"id":287},"limitations","Limitations",[155,290,291,304,312,318],{},[158,292,293,296,297,28,299,28,301,303],{},[161,294,295],{},"It does not predict suicidal behaviour."," A systematic review and several large studies found that neither the original nor the modified SAD PERSONS scale accurately predicts suicide attempts or deaths ",[14,298],{"n":20},[14,300],{"n":24},[14,302],{"n":33},". A low score is not reassurance.",[158,305,306,309,310,34],{},[161,307,308],{},"It misses most people who go on to need care."," In self-harm presentations, it identified only a small fraction of those who later needed admission or aftercare or who self-harmed again ",[14,311],{"n":275},[158,313,314,317],{},[161,315,316],{},"Fixed and acute factors count equally."," Several items are fixed or historical (such as sex, age and a previous attempt) and count the same as acute ones in a simple sum. Apart from an organized plan, the scale does not ask about current suicidal thoughts or intent.",[158,319,320,323,324,34],{},[161,321,322],{},"Prediction was never tested at the start."," The scale was proposed for assessing the likelihood of a suicide attempt, but its original study measured the accuracy of trainees' judgements, not prediction ",[14,325],{"n":16},[10,327,328,331],{},[161,329,330],{},"Better-supported alternatives."," Ask directly about suicidal thoughts and behaviour with a validated screen, then complete a structured clinical assessment:",[155,333,334,343,352,362,371],{},[158,335,336,342],{},[161,337,338],{},[233,339,341],{"href":340},"\u002Fassessments\u002Fasq\u002F","ASQ",": a four-question suicide screen validated in youth and adult medical settings.",[158,344,345,351],{},[161,346,347],{},[233,348,350],{"href":349},"\u002Fassessments\u002Fc-ssrs\u002F","C-SSRS",": the Columbia screener and full scale rate the severity of ideation and behaviour.",[158,353,354,361],{},[161,355,356,360],{},[233,357,359],{"href":358},"\u002Fassessments\u002Fphq-9\u002F","PHQ-9"," item 9",": in depression screening, a positive answer to the self-harm item calls for a direct suicide risk assessment rather than a checklist total.",[158,363,364,370],{},[161,365,366],{},[233,367,369],{"href":368},"\u002Fassessments\u002Fsafe-t\u002F","SAFE-T",": a five-step framework for a risk formulation, triage and documentation.",[158,372,373,379],{},[161,374,375],{},[233,376,378],{"href":377},"\u002Fassessments\u002Fsidas\u002F","SIDAS",": a self-report measure for tracking the severity of suicidal thoughts over time.",[10,381,382],{},"If you or someone you know is in crisis, call or text 988 or contact local emergency services. Help is available 24\u002F7.",{"title":384,"searchDepth":385,"depth":385,"links":386},"",3,[387,389,390,391,392],{"id":41,"depth":388,"text":42},2,{"id":152,"depth":388,"text":153},{"id":184,"depth":388,"text":185},{"id":239,"depth":388,"text":240},{"id":287,"depth":388,"text":288},null,"Risk & Safety",[396,399,402,405,408,411],{"text":397,"link":398},"Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics. 1983;24(4):343-345, 348-349.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F6867245\u002F",{"text":400,"link":401},"Bolton JM, Spiwak R, Sareen J. Predicting suicide attempts with the SAD PERSONS scale: a longitudinal analysis. J Clin Psychiatry. 2012;73(6):e735-e741.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F22795212\u002F",{"text":403,"link":404},"Warden S, Spiwak R, Sareen J, Bolton JM. The SAD PERSONS scale for suicide risk assessment: a systematic review. Arch Suicide Res. 2014;18(4):313-326.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F24884399\u002F",{"text":406,"link":407},"Katz C, Randall JR, Sareen J, et al. Predicting suicide with the SAD PERSONS scale. Depress Anxiety. 2017;34(9):809-816.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F28471534\u002F",{"text":409,"link":410},"Saunders K, Brand F, Lascelles K, Hawton K. The sad truth about the SADPERSONS Scale: an evaluation of its clinical utility in self-harm patients. Emerg Med J. 2014;31(10):796-798.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F23896589\u002F",{"text":412,"link":413},"Mullinax S, Chalmers CE, Brennan J, Vilke GM, Nordstrom K, Wilson MP. Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department. Am J Emerg Med. 2018;36(10):1779-1783.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F29530359\u002F","SAD PERSONS scale: the 10 risk factors, 0-10 scoring, the modified version, and the evidence that it does not predict suicidal behaviour. Better options inside.","md",[417,420,423,426,429],{"question":418,"answer":419},"What does SAD PERSONS stand for?","Each letter of SAD PERSONS stands for a suicide risk factor: Sex, Age, Depression, Previous attempt, Ethanol (alcohol) use, Rational thinking loss, Social supports lacking, Organized plan, No spouse and Sickness. Patterson and colleagues proposed it in 1983 as an easily learned mnemonic for assessing the likelihood of a suicide attempt.",{"question":421,"answer":422},"How is the SAD PERSONS scale scored?","Each of the 10 factors scores 1 if present and 0 if absent, based on the current presentation, for a total of 0-10. The original paper grouped totals into four categories (0-2, 3-4, 5-6 and 7-10); later use condensed these to low (0-4), moderate (5-6) and high (7-10). These bands have not been shown to predict suicidal behaviour.",{"question":424,"answer":425},"Is the SAD PERSONS scale accurate?","No. A systematic review found insufficient evidence to support its use for assessing or predicting suicidal behaviour. In a study of 4,019 emergency psychiatric referrals it did not predict future suicide attempts better than chance, and in a study of 5,462 adults half of those who died by suicide within a year had been rated low risk.",{"question":427,"answer":428},"What is the Modified SAD PERSONS scale?","The Modified SAD PERSONS scale (MSPS), from Hockberger and Rothstein, replaces the sickness item with stated future intent and weights four items at 2 points, for a total of 0-14. Its authors described 0-5 as low, 6-8 as moderate and 9-14 as high risk. Like the original, it did not accurately predict future suicide attempts in later research.",{"question":430,"answer":431},"What should be used instead of SAD PERSONS?","Use a validated screen that asks directly about suicidal thoughts and behaviour, such as the ASQ in medical settings or the C-SSRS screener, followed by a structured clinical risk assessment such as the SAFE-T framework and safety planning. Risk factors still matter as context for that assessment, but a checklist total should not decide the level of risk.",false,"1983",{"heading":435,"scaleLabel":436,"min":437,"max":438,"note":439,"source":440,"bands":441},"SAD PERSONS band lookup (historical bands, not predictive)","SAD PERSONS total",0,10,"One point per risk factor present, total 0-10. These are the condensed bands described by Bolton et al. (2012). In that study the scale did not predict future suicide attempts better than chance, and in Katz et al. (2017) half of suicides were rated low risk. Do not use a band to rule risk in or out.","Bolton JM, Spiwak R, Sareen J (2012). J Clin Psychiatry. Condensed bands 0-4 \u002F 5-6 \u002F 7-10; original categories 0-2, 3-4, 5-6, 7-10.",[442,447,452],{"min":443,"label":444,"level":445,"note":446},7,"High (historical band)","error","A high band calls for a full clinical risk assessment. High-risk scores had low sensitivity and low positive predictive value for future attempts (Bolton et al., 2012).",{"min":448,"label":449,"level":450,"note":451},5,"Moderate (historical band)","warning","The band does not set the level of risk. Ask directly about current suicidal thoughts, plans, behaviour and intent.",{"min":437,"label":453,"level":454,"note":455},"Low (historical band)","neutral","A low score does not mean low risk: half of the suicides at 6 and 12 months in Katz et al. (2017) had been rated low risk. Assess directly whenever there is concern.","2026-10-30",{},true,"\u002Fassessments\u002Fsad-persons",{"title":5,"description":414},"sad-persons","published","assessments\u002Fsad-persons","The SAD PERSONS scale is a 10-item suicide risk-factor checklist, proposed in 1983 as an easily learned mnemonic for assessing the likelihood of a suicide attempt, that scores one point for each factor present for a total of 0-10. Later studies found that it does not accurately predict suicide attempts or deaths, so it should not be used to screen for or stratify suicide risk.",[466,468,471,474],{"year":433,"label":467},"Proposed as an easily learned mnemonic for assessing suicide attempt risk (Patterson et al., Psychosomatics)",{"year":469,"label":470},"2012","Did not predict suicide attempts better than chance in 4,019 emergency referrals (Bolton et al.)",{"year":472,"label":473},"2014","Systematic review: insufficient evidence to support its use (Warden et al.)",{"year":475,"label":476},"2017","Did not support its use to predict suicide in adults seen by emergency psychiatry (Katz et al.)","assessment","i982L8_XFbw5fVbJzl-UN2FPex8xK9E-RmncmnqL-UA",[480,483,486,489],{"slug":481,"title":482},"asq","ASQ Suicide Screening: Ask Suicide-Screening Questions",{"slug":484,"title":485},"c-ssrs","C-SSRS Scoring · Columbia Suicide Severity Rating Scale",{"slug":487,"title":488},"safe-t","SAFE-T Suicide Risk Assessment: Five Steps and Triage",{"slug":490,"title":491},"sidas","Suicidal Ideation Attributes Scale (SIDAS)",1794129721671]