Suicide Severity Rating Scale

COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS)

Posner, Brent, Lucas, Gould, Stanley, Brown, Fisher, Zelazny, Burke, Oquendo, & Mann

© 2008 The Research Foundation for Mental Hygiene, Inc.

RISK ASSESSMENT

Instructions: Check all risk and protective factors that apply. To be completed following the patient interview, review of medical record(s) and/or consultation with family members and/or other professionals.

Past 3 Months

Suicidal and Self-Injurious Behavior

Lifetime

Clinical Status (Recent)

Suicidal Ideation - Check Most Severe in Past Month

Activating Events (Recent)

Treatment History

Protective Factors (Recent)

Other Risk Factors:

Other Protective Factors:

Describe any suicidal, self-injurious, or aggressive behavior (include dates):