Columbia-Suicide Severity Rating Scale (C-SSRS)
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The C-SSRS is a structured screening tool designed to assess suicidal ideation and behavior. It helps clinicians evaluate both the severity and immediacy of suicide risk and is used widely in clinical, emergency, and research settings.
Recommended Frequency: Use at intake for all patients and repeat as clinically indicated—especially following changes in mood, hospitalization, or reports of suicidal thoughts or behaviour.
About the C-SSRS
Developed by Columbia University, the C-SSRS offers a standardized way to assess suicide risk based on ideation severity, behavior history, and lethality. It includes:
- Suicidal ideation: intensity and frequency of thoughts
- Suicidal behaviour: past attempts, preparatory acts, and interruptions
- Lethality assessment: for actual attempts
There are several versions, including:
- Screener (short-form used in primary care, outpatient)
- Lifetime/Recent (used in research and psychiatric settings)
- Risk Assessment (in-depth version for mental health providers)
Psychometric Properties
The C-SSRS has demonstrated excellent validity and predictive power:
- Predictive validity: associated with future suicide attempts
- Concurrent validity: correlates strongly with clinician-rated scales
- Inter-rater reliability: > 0.90 across versions
Endorsed by the FDA, CDC, NIH, and the WHO for standardized suicide risk screening.
Sources: Posner et al., 2011; Mundt et al., 2013
The Scale
Items vary by version, but the full C-SSRS includes:
- 5 ideation questions (from “wish to be dead” to “active ideation with specific plan and intent”)
- 5 behaviour items (e.g., actual attempt, interrupted attempt, preparatory behaviour)
- Additional severity, lethality, and timeframe tracking
Responses help determine whether immediate intervention, safety planning, or monitoring is needed.
Score Range
The C-SSRS is not scored numerically. Instead, responses are categorized to indicate:
- Presence and severity of ideation
- Presence, frequency, and type of behavior
- Level of clinical concern (e.g., imminent risk, moderate concern, low concern)
Clinical interpretation should always be contextualized within the broader patient presentation.
Copyright
© The Research Foundation for Mental Hygiene, Inc. Licensed by Columbia University. Freely available for use in clinical and research settings with appropriate citation.
References
- Posner, K., Brown, G. K., Stanley, B., et al. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
- Columbia Lighthouse Project. (n.d.). The Columbia Protocol (C-SSRS). https://cssrs.columbia.edu
- Mundt, J. C., Greist, J. H., Jefferson, J. W., et al. (2013). Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the C-SSRS. Journal of Clinical Psychiatry, 74(9), 887–893. https://doi.org/10.4088/JCP.13m08761
Disclaimer
This summary is for informational purposes only. The C-SSRS is a screening tool and does not replace clinical judgment or full risk assessment. HiBoop does not interpret responses. Use must be aligned with organizational safety protocols and follow-up procedures.
Permissions
The C-SSRS is freely available for non-commercial use through the Columbia Lighthouse Project. Use requires training and adherence to published guidelines. For details, visit cssrs.columbia.edu.