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Columbia Suicide Severity Rating Scale (C-SSRS)

The C-SSRS (also known as the “Columbia Protocol”) is an interview-based tool used to quantify suicidal ideation and suicidal behavior in a patient. The C-SSRS was designed to be usable by anyone in any situation.
Description: The C-SSRS (also known as the “Columbia Protocol”) is an interview-based tool used to quantify suicidal ideation and suicidal behavior in a patient. The C-SSRS was designed to be usable by anyone in any situation.
Disease States: General
Validated Uses: Screening, Treatment Monitoring & Evaluation, Symptom Severity
Populations: Adolescent, Adult, Pediatric, Geriatric
Administration Method: Clinician-report
Time to administer: 5–15 minutes
Commonly used in: Clinical Trials & Research, Clinical Practice
Detailed Description:

The C-SSRS is the gold standard in the assessment of suicidal ideation and behavior and the designated “preferred” instrument of the US Food and Drug Administration for this purpose.6,7 The C-SSRS contains a series of questions framed in direct and plain language to use as clinical probes.1 Questions are divided into four subscales assessing severity, intensity, behavior, and lethality.3 The severity and intensity scales are both ranked on 5-point ordinal scales, while the behavior subscale is ranked on a 3-point nominal scale and the lethality subscale on a 6-point ordinal scale.3
Note: Although nominal scales sort data into categories with no known value, ordinal scales sort data into ranks with some relative value.8

The C-SSRS uses different assessment periods (e.g., lifetime, recent, since last contact) depending on research or clinical need.3,9 The C-SSRS was developed as an instrument for classification only.4 Therefore, there are no instructions for calculating a total score.4 Instead, triage instructions are included alongside the scale and vary depending on the setting.10

To complete the C-SSRS Training for Clinical Practice, visit the official training website. Training videos in a wide variety of languages are also available here.

Scale Validity: In a study of 124 patients with history of attempted suicide, the C-SSRS demonstrated 94% specificity and 100% sensitivity in correctly identifying aborted attempts and 100% sensitivity and specificity for both interrupted and actual attempts.3 In another study of 804 patients presenting for emergency psychiatric assessment following an episode of self-harm,4 both the intensity subscore and C-SSRS total score were found to be significant predictors of suicide attempt within the next six months.4 A cutoff score of 18.5 on the intensity subscale demonstrated 59% sensitivity and 57% specificity, while a cutoff score of 28.5 on the total score demonstrated a sensitivity of 69% and specificity of 54%.4
Alternative Versions: The C-SSRS is available in a wide variety of formats depending on setting (general; healthcare; schools; military; first responders), population (adults, adolescents, children who are aged 6 years and older, and children younger than 6 years; patients with cognitive impairments), assessment period (lifetime, recent, since last contact), use (screener, frequent monitoring), and more.3,9 Within the healthcare field, versions are tailored to primary care, emergency de/artments, medical/surgery inpatient services, and outpatient/ambulatory services.9 Custom toolkits tailored to the patient’s situation can be designed at the official website [https://cssrs.columbia.edu].9

There is also an electronic Columbia Suicide Severity Rating Scale (eC-SSRS), which is computer automated and patient reported.5,11,12 The eC-SSRS is primarily used by clinical researchers, but has also been adopted for screening by some schools and universities.7 The scale is not exhaustive and does not cover the full spectrum of suicidal ideation.7 Passive ideation is largely ignored, which may result in many high-risk patients going undetected.7 Additional criticisms include the unclear instructions for scoring compound questions7 and missing or ambiguous definitions for key terms (eg, “interrupted attempt”).7 Quality-control problems have also been reported, with updates to scoring instructions made inconsistently across the different formats.7

The C-SSRS and information on how to score it can be found here [https://cssrs.columbia.edu]
Cited Limitations: None identified.

Footnotes:

Supporting references for the filters are as follows:
Disease States: General1; Validated Uses: Screening1, Treatment Monitoring & Evaluation1,2, Symptom Severity1,3,4; Populations: Pediatric1, Adolescent1,3, Adult1,3,4, Geriatric1,4; Administration Method: Clinician-report2-4; Time to administer: 5–15 minutes5,6; Commonly used in: Clinical Trials & Research,1,4,6, Clinical Practice1,3,4

References:

  1. About the protocol. The Columbia Lighthouse Project website. 2020. https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/. Accessed June 15, 2020.
  2. Who Uses It. The Columbia Lighthouse Project website. 2020. https://cssrs.columbia.edu/the-scale-in-action/who-can-use-it/. Accessed June 15, 2020.
  3. Posner, K et al. Am J Psychiatry. 2011;168(12):1266-1277.
  4. Lindh, AU et al. BMC Psychiatry. 2018;18(1):319.
  5. Mundt, JC et al. J Psychiatr Res. 2010;44(16):1224-1228.
  6. Suicidal Ideation and Behavior: Prospective Assessment of Occurrence in Clinical Trials. 2012. Food and Drug Administration. Silverspring, MD.
  7. Giddens, JM et al. Innov Clin Neurosci. 2014;11(9-10):66-80.
  8. Goldstein, G et al. Handbook of Psychological Assessment. 4th edn (Elsevier, 2020).
  9. The Columbia Protocol for Healthcare and Other Community Settings. The Columbia Lighthouse Project website. 2020. https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/. Accessed June 15, 2020.
  10. Triage and Risk Identification. The Columbia Lighthouse Project website. 2020. https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/. Accessed June 15, 2020.
  1. Mundt, JC et al. J Clin Psychiatry. 2013;74(9):887-893.
  2. eC-SSRS. The Columbia Lighthouse Project website. 2020. https://cssrs.columbia.edu/ec-ssrs/. Accessed June 15, 2020.

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