BACKGROUND: Past and repeated self-harm are long-term risks to completed 
suicide. A brief rating scale to assess repetition risk of self-harm is 
important for high-risk identification and early interventions in suicide 
prevention. The study aimed to examine the validity of the Chinese SAD PERSONS 
Scale (CSPS) and to evaluate its feasibility in clinical settings.
METHODS: One hundred and forty-seven patients with self-harm were recruited from 
the Emergency Department and assessed at baseline and the sixth month. The 
controls, 284 people without self-harm from the Family Medicine Department in 
the same hospital were recruited and assessed concurrently. The psychometric 
properties of the CSPS were examined using baseline and follow-up measurements 
that assessed a variety of suicide risk factors. Clinical feasibility and 
applicability of the CSPS were further evaluated by a group of general nurses 
who used case vignette approach in CSPS risk assessment in clinical settings. An 
open-ended question inquiring their opinions of scale adaptation to hospital 
inpatient assessment for suicide risks were also analyzed using content 
analysis.
RESULTS: The CSPS was significantly correlated with other scales measuring 
depression, hopelessness and suicide ideation. A cut-off point of the scale was 
at 4/5 in predicting 6-month self-harm repetition with the sensitivity and 
specificity being 65.4% and 58.1%, respectively. Based on the areas under the 
Receiver Operating Characteristic curves, the predictive validity of the scale 
showed a better performance than the other scales. Fifty-four nurses, evaluating 
the scale using case vignette found it a useful tool to raise the awareness of 
suicide risk and a considerable tool to be adopted into nursing care.
CONCLUSIONS: The Chinese SAD PERSONS Scale is a brief instrument with acceptable 
psychometric properties for self-harm prediction. However, cautions should be 
paid to level of therapeutic relationships during assessment, staff workload and 
adequate training for wider clinical applications.