Cara Katz1, Jason R Randall2, Jitender Sareen1,2,3, Dan Chateau3,4, Randy Walld4, William D Leslie4,5, JianLi Wang6,7, James M Bolton1,2,3,4. 1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. 2. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 3. Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada. 4. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 6. Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. 7. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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.
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.
Authors: Ronald C Kessler; Robert M Bossarte; Alex Luedtke; Alan M Zaslavsky; Jose R Zubizarreta Journal: Mol Psychiatry Date: 2019-09-30 Impact factor: 15.992
Authors: Michael Sanderson; Andrew Gm Bulloch; JianLi Wang; Kimberly G Williams; Tyler Williamson; Scott B Patten Journal: EClinicalMedicine Date: 2020-02-18
Authors: Sarah Steeg; Leah Quinlivan; Rebecca Nowland; Robert Carroll; Deborah Casey; Caroline Clements; Jayne Cooper; Linda Davies; Duleeka Knipe; Jennifer Ness; Rory C O'Connor; Keith Hawton; David Gunnell; Nav Kapur Journal: BMC Psychiatry Date: 2018-04-25 Impact factor: 3.630