Columbia Suicide Severity Rating Scale (C-SSRS Screener)

C-SSRS Screener

1. Wish to Be Dead

2. Non-Specific Active Suicidal Thoughts

3. Active Suicidal Ideation with Any Methods (Not Plan) Without Intent to Act

4. Active Suicidal Ideation with Some Intent to Act, Without Specific Plan

5. Active Suicidal Ideation with Specific Plan and Intent

6. Suicidal Behavior (Actual attempt, interrupted attempt, aborted attempt, or preparatory acts)

Risk Assessment: –

Awaiting input

Select responses.

Screens for suicidal ideation and behavior.

Why Use

Suicide risk assessment is complex, and the C-SSRS can assist clinicians with their evalulation of patients in the ER to predict their overall risk and need for admission. Extensively validated in various patient populations, including children as young as five years old and adolescents. Recommended and adopted by the US Food and Drug Administration for clinical trials ( FDA 2012 ) and Centers for Disease Control to define and stratify suicidal ideation and behavior ( Crosby 2011 ).

When to Use

Emergency patients in whom there is concern for suicidality.

Formula

Part 1. Severity of ideation ( select most severe in the past month ): Variable 0. No reported suicidal ideation 1. Wish to be dead 2. Nonspecific active suicidal thoughts 3. Active suicidal ideation with any methods (not plan) without intent to act 4. Active suicidal ideation with some intent to act, without specific plan 5. Active suicidal ideation with specific plan and intent Part 2. Suicidal behavior (select most severe in lifetime): Variable 0. No reported suicidal behavior 1. Actual attempt Potentially self-injurious act committed with some wish to die as a result; injury/harm not necessary to be considered “attempt” 2. Interrupted attempt If not for outside interruption, actual attempt would have occurred 3. Aborted attempt or self-interrupted attempt Takes steps toward suicide attempt but stops self before engaging in actual self-destructive behavior 4. Preparatory acts or behavior Anything beyond verbalization or thought, like assembling specific method (e.g. buying pills or gun) or preparing for death by suicide (e.g. giving things away, writing suicide note) 5. Suicide* Death by suicide occurred *Suicide option is listed for research purposes for patients who have died by suicide.

Pearls / Pitfalls

Often based entirely on patient-reported items, but also allows for integration of information from other sources (e.g. family and friends, healthcare professionals, hospital records, coroner’s report/death certificate). Best validated in emergency settings (i.e., to triage patients in the emergency department) and also has limited validation in the outpatient psychiatry setting ( Viguera 2015 ).

Critical Actions

Should not replace a complete clinical evaluation; may be employed as an initial screener to guide a clinician’s suicide risk assessment and to help stratify patients into low, moderate, or high risk categories.

Advice

Protocols vary by institution, but most suggest complete assessment by a psychiatrist and inpatient admission for high risk patients (level 4-5). Low and moderate risk patients should be reassessed by a trained clinician and may not require admission.

More Information

Interpretation: Suicidal ideation ( most severe in the past month ) Risk of suicide Management 1-2 Low Behavioral health referral at discharge 3, or reported suicidal behavior in lifetime Moderate Behavioral health consult (psychiatric nurse/social worker) and consider patient safety precautions 4-5, or reported suicidal behavior within the past three months High Immediate notification of physician and/or behavioral health and patient safety precautions