Columbia Suicide Severity Rating Scale

Aka: Columbia Suicide Severity Rating Scale, C-SSRS

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II. Approach: C-SSRS Abreviated Screener Version (Emergency Department Use)

  1. Severity of Suicidal Ideation in the last month
    1. Score 0: No Suicidal Ideation
    2. Score 1: Wish to be dead
    3. Score 2: Non-specific active suicidal thoughts
    4. Score 3: Active Suicidal Ideation by any method, without a plan, and without intent to act
    5. Score 4: Active Suicidal Ideation with some intent to act, but without a specific plan
    6. Score 5: Active Suicidal Ideation with specific plan and intent
  2. Suicidal Behavior in Lifetime
    1. Score 0: No suicidal behavior
    2. Score 1: Suicide attempt (act of attempted self injury with a wish to die)
    3. Score 2: Interrupted Suicide attempt
    4. Score 3: Aborted attempt (or self interrupted)
    5. Score 4: Preparatory act or behavior before planned Suicide
  3. Interpretation
    1. Low Risk: Behavioral health referral at ED discharge
      1. Score 1-2 on Severity of Suicidal Ideation in past month
    2. Moderate Risk: Consider Behavioral health consult while in ED (and patient safety precautions)
      1. Score 3 on Severity of Suicidal Ideation in past month OR
      2. Any suicidal behavior in lifetime
    3. High Risk: Medical Provider notification
      1. Score 4-5 on Severity of Suicidal Ideation in past month OR
      2. Suicidal behavior in last 3 months
  4. Resources
    1. Columbia Suicide Severity Rating Scale (C-SSRS Screener)
      1. https://www.mdcalc.com/calc/10169/columbia-suicide-severity-rating-scale-c-ssrs
  5. References
    1. Bjureberg (2021) Psychol Med 52(16):1-9 +PMID: 33766155 [PubMed]

III. Approach: C-SSRS Full Version

  1. Technique
    1. Ask Q1, Q2 and Q6 for all patients
      1. Ask Q3-5 if patient answers yes to Q2
    2. Ask each question Q1 to Q5 in terms of the last month AND lifetime
      1. Ask Q6 in terms of the last 3 months and lifetime
  2. Criteria
    1. Q1: Have you WISHED you were dead or wished you could go to sleep and not wake up?
    2. Q2: Have you had any THOUGHTS of killing yourself? (if yes, ask the following 3 questions)
      1. Q3: Have you been thinking or PLANNING about how you might do this?
      2. Q4: Do you have some INTENTION on acting on these thoughts?
      3. Q5: Have you started to work out or worked out the details of how to kill yourself?
        1. Q5b: Do you intend to carry out this plan?
    3. Q6: Have you done anything or started doing anything, or PREPARED to do anything to end your life?
  3. Interpretation
    1. High Risk Criteria
      1. Q4 or Q5 positive in the last month
      2. Q6 positive in the last 3 months
    2. Moderate Risk Criteria
      1. Q3 positive in the last month
      2. Q4 or Q5 positive at any point in lifetime
      3. Q6 positive at any point in lifetime (earlier than the last 3 months)
    3. Low Risk Criteria
      1. All other answers
  4. References
    1. Posner (2011) Am J Psychiatry 168(12): 1266-77 [PubMed]

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