SAD PERSONS scale: what it scores and why it cannot predict suicide

What each letter stands for

Patterson published the scale in 1983 as a quick checklist of risk factors. S is male sex. A is age, scored at the younger and older ends; one recent study uses younger than 19 or older than 45. D is depression or hopelessness. P is a previous attempt or psychiatric care. E is excessive alcohol or drug use.

R is loss of rational thinking, such as psychosis. The second S is separated, divorced or widowed. O is an organized plan or a serious attempt. N is no social support. The last S is sickness, usually a chronic illness, though some versions use that letter for stated future intent. Wording varies between textbooks, so learn the risk factor behind each letter rather than one exact word.

How the scale is scored, and the modified version

Each letter present earns one point, for a total from 0 to 10. In the bands reported by Sanz-Gómez and colleagues in 2025, 4 or less is low risk, 5 to 6 is moderate and 7 to 10 is high. The bands are labels on a checklist, and they say nothing about what the person intends to do right now.

The Modified SAD PERSONS scale gives double weight to four items: depression or hopelessness, loss of rational thinking, an organized or serious attempt, and stated future intent. That stretches the range to 0 to 14 and shifts weight toward findings the nurse can actually assess in conversation, rather than fixed facts such as sex and age.

Is SAD PERSONS still recommended?

Not as a predictor. Sanz-Gómez and colleagues scored the records of people who later died by suicide and found that nearly half had been classified as low risk. They cite an earlier pooled sensitivity of about 15 percent, meaning most people who go on to a suicidal act are not flagged. Their conclusion is that scales should not replace a clinical interview.

The scale also leans on characteristics that never change, such as sex and age, while it has no item for current intent, access to means or a recent loss. A married middle-aged woman with a plan and a store of medication can score low. That gap is exactly what exam items probe: the number is reassuring, but the client's words are not.

When nurses use it, and a worked scenario

The scale is still widely used, often as a documentation prompt that makes sure common risk factors get asked about. Brief screens such as the NIMH Ask Suicide-Screening Questions take about 20 seconds, and a positive answer leads to a fuller safety assessment by a trained clinician. In either case the nurse asks directly about thoughts, plan, intent and means, and escalates under facility policy whatever the score.

Hypothetical scenario, not a real exam item: a 38-year-old married woman with no prior attempts scores 2 on SAD PERSONS. During the interview she mentions she has been saving her sleeping pills 'just in case.' Which action comes first: document low risk and continue the care plan, ask whether she intends to take the pills and where they are, or rescore the scale at the next shift?

Asking about intent and the location of the pills comes first, because saving medication suggests a plan and access to means. Documenting low risk is the tempting answer since the score supports it, but the disclosure outweighs the number. Rescoring later delays action on a risk the client has just described, and it would likely produce the same misleading total.

Sources and further reading

Sanz-Gómez et al. (2025), Predictive validity of the SAD PERSONS and NO HOPE scales in a sample of suicide cases, Frontiers in Psychology. Origin (Patterson 1983), the 10 items, scoring bands, the modified version doubling four items to 0 to 14, low sensitivity, nearly half of suicide cases scored low risk, and scales not replacing clinical interview.

National Institute of Mental Health: Ask Suicide-Screening Questions (ASQ) Toolkit. Four-question, 20-second suicide screen and the brief safety assessment by a trained clinician after a positive screen.