SAD PERSONS
Suicide Risk Assessment
0-4 low · 5-6 consider admit · 7-10 strongly consider involuntary admit.
The board-friendly take on suicide risk is that no score replaces a careful conversation, but SAD PERSONS provides a structured 10-item framework. Sex (male), Age (under 19 or over 45), Depression, Previous attempt, Ethanol/drug use, Rational thinking loss, Social support lacking, Organized plan, No spouse/partner, Sickness (chronic illness). Score 0-4 low risk, 5-6 consider admission, 7-10 strongly consider involuntary hold. AANP exam questions use SAD PERSONS to test whether you escalate appropriately — a patient with an organized plan and access to means is hospitalized, regardless of whether they verbally deny intent. Means restriction and warm handoff to crisis services are the right next steps.
- SSex (male)Males have higher completion rate; females have higher attempt rate.
- AAge (<19 or >45)Extremes of age carry higher risk.
- DDepressionActive depressive episode.
- PPrevious attemptSingle strongest predictor of future attempt.
- EEthanol / substance abuseDisinhibits and lowers threshold to act.
- RRational thinking lossPsychosis, severe depression with cognitive distortions.
- SSocial support lackingIsolation increases risk.
- OOrganized planSpecific method, means available, timeline set.
- NNo spouse / significant relationshipSingle, divorced, widowed.
- SSickness (serious chronic illness)Especially recent terminal diagnosis or uncontrolled pain.
Clinical Context
Quick bedside risk stratification. The score guides disposition but never replaces clinical judgment — anyone with a concrete plan, access to means, and intent gets admitted regardless of score.
Before discharge: reduce access to means (remove firearms, lock medications), establish follow-up within 1 week, and give the 988 Suicide & Crisis Lifeline. Safety contracts are NOT evidence-based and don't substitute for means restriction and close follow-up. Pair with PHQ-9 question 9 (thoughts of being better off dead) as a screening entry point.
AANP primary-care trap: an elderly widowed male with a recent cancer diagnosis, alcohol use, and sleep disturbance scores 6-7 easily — don't underestimate quiet presentations.
Related Mnemonics
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