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    Patent Pending

    Columbia Suicide Severity Rating Scale (C-SSRS Screener)

    Screens for suicidal ideation and behavior.
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    INSTRUCTIONS

    Note there are several versions of the C-SSRS; this is the screener version, which is a truncated version of the full scale intended for emergency settings.

    When to Use
    Pearls/Pitfalls
    Why Use

    Emergency patients in whom there is concern for suicidality.

    • 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).

    • 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).

    Part 1. Severity of ideation:
    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:
    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)

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    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.

    Content Contributors
    • Joshua Salvi, MD, PhD
    About the Creator
    Dr. Kelly Posner
    Are you Dr. Kelly Posner?
    Content Contributors
    • Joshua Salvi, MD, PhD