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Suicide Severity Rating Scale

Suicide Severity Rating Scale

Pastoral Staff

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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):