Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
J Clin Psychiatry. 2012 Jun;73(6):e735-41. doi: 10.4088/JCP.11m07362.
The SAD PERSONS scale is a widely used risk assessment tool for suicidal behavior despite a paucity of supporting data. The objective of this study was to examine the ability of the scale in predicting suicide attempts.
Participants consisted of consecutive referrals (N=4,019) over 2 years (January 1, 2009 to December 31, 2010) to psychiatric services in the emergency departments of the 2 largest tertiary care hospitals in the province of Manitoba, Canada. SAD PERSONS and Modified SAD PERSONS (MSPS) scale scores were recorded for individuals at their index and all subsequent presentations. The 2 main outcome measures in the study included current suicide attempts (at index presentation) and future suicide attempts (within the next 6 months). The ability of the scales to predict suicide attempts was evaluated with logistic regression, sensitivity and specificity analyses, and receiver operating characteristic curves.
566 people presented with suicide attempts (14.1% of the sample). Both SAD PERSONS and MSPS showed poor predictive ability for future suicide attempts. Compared to low risk scores, high risk baseline scores had low sensitivity (19.6% and 40.0%, respectively) and low positive predictive value (5.3% and 7.4%, respectively). SAD PERSONS did not predict suicide attempts better than chance (area under the curve =0.572; 95% confidence interval [CI], 0.51-0.64; P value nonsignificant). Stepwise regression identified 5 original scale items that accounted for the greatest proportion of future suicide attempt variance. High risk scores using this model had high sensitivity (93.5%) and were associated with a 5-fold higher likelihood of future suicide attempt presentation (odds ratio =5.58; 95% CI, 2.24-13.86; P<.001).
In their current form, SAD PERSONS and MSPS do not accurately predict future suicide attempts.
尽管缺乏支持数据，SAD PERSONS 量表仍是一种广泛用于自杀行为风险评估的工具。本研究旨在检验该量表预测自杀未遂的能力。
参与者为 2009 年 1 月 1 日至 2010 年 12 月 31 日期间，在加拿大马尼托巴省最大的 2 家三级保健医院的急诊部门连续就诊的连续转诊者（N=4019）。为个体在其就诊时和所有后续就诊时记录 SAD PERSONS 和改良 SAD PERSONS（MSPS）量表评分。本研究中的 2 个主要结局指标为当前自杀未遂（就诊时）和未来 6 个月内自杀未遂。使用逻辑回归、敏感性和特异性分析以及受试者工作特征曲线评估量表预测自杀未遂的能力。
566 人出现自杀未遂（样本的 14.1%）。SAD PERSONS 和 MSPS 对未来自杀未遂的预测能力均较差。与低风险评分相比，高风险基线评分的敏感性较低（分别为 19.6%和 40.0%），阳性预测值较低（分别为 5.3%和 7.4%）。SAD PERSONS 并不能比随机更好地预测自杀未遂（曲线下面积=0.572；95%置信区间[CI]，0.51-0.64；P 值无统计学意义）。逐步回归确定了 5 个原始量表条目，这些条目占未来自杀未遂变异的最大比例。使用该模型的高风险评分具有较高的敏感性（93.5%），并且与未来自杀未遂就诊的可能性增加 5 倍相关（优势比=5.58；95%CI，2.24-13.86；P<.001）。
在当前形式下，SAD PERSONS 和 MSPS 不能准确预测未来自杀未遂。
