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
- Actual suicide attempt
- Interrupted attempt
- Aborted or Self-Interrupted attempt
- Other preparatory acts to kill self
- Self-injurious behavior without suicidal intent
Lifetime
Clinical Status (Recent)
- Hopelessness
- Major depressive episode
- Mixed affective episode (e.g. Bipolar)
- Command hallucinations to hurt self
- Highly impulsive behavior
- Substance abuse or dependence
- Agitation or severe anxiety
- Perceived burden on family or others
- Chronic physical pain or other acute medical problem (HIV/AIDS, COPD, cancer, etc.)
- Homicidal ideation
- Aggressive behavior towards others
- Method for suicide available (guns, pills, etc.)
- Sexual abuse (lifetime)
- Refuses or feels unable to agree to safety plan
- Family history of suicide (lifetime)
Suicidal Ideation - Check Most Severe in Past Month
- Wish to be dead
- Suicidal thoughts with method (but without specific plan or intent to act)
- Suicidal thoughts
- Suicidal intent (without specific plan)
- Suicidal intent with specific plan
Activating Events (Recent)
- Recent loss(es) or other significant negative event(s) (legal, financial, relationship, etc.)
- Describe:
- Pending incarceration or homelessness
- Current or pending isolation or feeling alone
Treatment History
- Previous psychiatric diagnosis and treatments
- Hopeless or dissatisfied with treatment
- Non-compliant with treatment
- Not receiving treatment
Protective Factors (Recent)
- Identifies reasons for living
- Responsibility to family or others; living with family
- Supportive social network or family
- Fear of death or dying due to pain and suffering
- Belief that suicide is immoral; high spirituality
- Engaged in work or school
Other Risk Factors:
Other Protective Factors:
Describe any suicidal, self-injurious, or aggressive behavior (include dates):