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Common screening tool ineffective in detecting suicide risk

A commonly used screening tool does not adequately identify those at risk for suicide after a self-harm episode, according to recent study findings published in the Emergency Medicine Journal.

“The results of this study show that the SADPERSONS Scale is not an adequate screening tool following self-harm,” researchers wrote. “It does not accurately predict who requires referral to secondary care, admission to psychiatric hospital or repetition of self-harm. For the purposes of suicide prevention, a low false-negative rate is essential if any such a risk assessment scale is used to determine need and/or risk.”

The study included SADPERSONS scores for 126 consecutive admissions to a general hospital ED between June 14 and Aug. 13, 2011. More than half (57.1%) of participants were women. The mean age was 31.9 years for women and 34.5 years for men.

Researchers found that 81% of participants overdosed; 11.1% cut themselves; and 7.9% engaged in other forms of self-injury. Mean SADPERSONS score was 3.4 for women and 4.4 for men. After screening, 55.5% of participants were referred to secondary care psychiatric teams and 4.02% were admitted to a psychiatric hospital. Thirty-one of the participants repeated self-harm behavior at least once during the 6-month follow-up.

Specificity of the screening tool was more than 90% for all outcomes. However, the scale only detected 2% of patients requiring admission to a psychiatric unit, 5.8% needing community psychiatric aftercare, and 6.6% of those likely to self-harm again.

“The SADPERSONS Scale should not be used to screen self-harm patients presenting to general hospitals,” researchers wrote. “Greater attention needs to be paid to clinical assessment that takes account of the dynamic and individual nature of risk. This requires active training programs for all personnel who encounter self-harm patients in their clinical practice.”

Disclosure: The study was funded in part by the Department of Health Policy Research Programme. One researcher reports financial relationships with NIH and the National Suicide Prevention Strategy for England Advisory Group.