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The sad truth about the SADPERSONS Scale: an evaluation of its clinical utility in self-harm patients
  1. Kate Saunders1,
  2. Fiona Brand2,
  3. Karen Lascelles2,
  4. Keith Hawton1
  1. 1Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
  2. 2Deliberate Self-Harm and Psychiatric Liaison Service, Barnes Unit, Oxford Health NHS Foundation Trust, The John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Professor K Hawton, Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK; keith.hawton{at}psych.ox.ac.uk

Abstract

Background The SADPERSONS Scale is commonly used as a screening tool for suicide risk in those who have self-harmed. It is also used to determine psychiatric treatment needs in those presenting to emergency departments. To date, there have been relatively few studies exploring the utility of SADPERSONS in this context.

Objectives To determine whether the SADPERSONS Scale accurately predicts psychiatric hospital admission, psychiatric aftercare and repetition of self-harm at presentation to the emergency department following self-harm.

Methods SADPERSONS scores were recorded for 126 consecutive admissions to a general hospital emergency department. Clinical management outcomes following assessment were recorded, including psychiatric hospital admission, community psychiatric aftercare and repetition of self-harm in the following 6 months.

Results Psychiatric hospital admission was required in five cases (4.0%) and community psychiatric aftercare in 70 (55.5%). 31 patients (24.6%) repeated self-harm. While the specificity of the SADPERSONS scores was greater than 90% for all outcomes, sensitivity for admission was only 2.0%, for community aftercare was 5.8% and for repetition of self-harm in the following 6 months was just 6.6%.

Conclusions For the purposes of suicide prevention, a low false negative rate is essential. SADPERSONS failed to identify the majority of those either requiring psychiatric admission or community psychiatric aftercare, or to predict repetition of self-harm. The scale should not be used to screen self-harm patients presenting to general hospitals. Greater emphasis should be placed on clinical assessment which takes account of the individual and dynamic nature of risk assessment.

  • mental health, self harm
  • mental health, assessment
  • mental health, overdose

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