The Columbia-Suicide Severity Rating Scale

http://cssrs.columbia.edu/index.html

http://c-ssrs.trainingcampus.net/uas/modules/trees/windex.aspx

I ran across an article in the American Journal of Psychiatry about suicide risk assessment using another well-validated scale called the Columbia-Suicide Severity Rating Scale (C-SSRS). The C-SSRS is a scale used for suicide risk assessment developed by Kelly Posner, PhD and colleagues at Columbia University Medical Center [1].

The links above will take you the home page for the C-SSRS (top) and a site for training in the use of the instrument (. You need to contact Dr. Kelly Posner for permission to use it and for copies of the scale (posnerk@nyspi.columbia.edu).

I’ve posted about a couple of suicide risk assessment scales, including the Self-Harm Subscale of the SNAP at short link http://wp.me/p1glcu-1zk and the Suicide Trigger Scale at short link http://wp.me/p1glcu-tq.

The issue of what scales to use and even whether to use them can turn on our perception of whether busy clinicians can make time to implement them. The pace in the emergency room and in the general hospital can be brutally fast. However, if we can prevent suicide by learning how to use well-validated tools like those mentioned above, then it’s time well spent. Ideally, the components of clinical suicide risk assessment should be:

  • Easy to remember
  • Based on empirically demonstrable essential features
  • Readily transferable from emergency room or intensive care unit to consulting room
  • Foster a therapeutic alliance
  • Facilitate the gathering of valid information
  • Guide treatment decisions [2]

1. Posner, K., Ph.D., and e. al (2011). “The Columbia-Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults.” The American Journal of Psychiatry 168(12): 1266-1277.
Objective: Research on suicide prevention and interventions requires a standard method for assessing both suicidal ideation and behavior to identify those at risk and to track treatment response. The Columbia-Suicide Severity Rating Scale (C-SSRS) was designed to quantify the severity of suicidal ideation and behavior. The authors examined the psychometric properties of the scale.
Method: The C-SSRS’s validity relative to other measures of suicidal ideation and behavior and the internal consistency of its intensity of ideation subscale were analyzed in three multisite studies: a treatment study of adolescent suicide attempters (N=124); a medication efficacy trial with depressed adolescents (N=312); and a study of adults presenting to an emergency department for psychiatric reasons (N=237).
Results: The C-SSRS demonstrated good convergent and divergent validity with other multi-informant suicidal ideation and behavior scales and had high sensitivity and specificity for suicidal behavior classifications compared with another behavior scale and an independent suicide evaluation board. Both the ideation and behavior subscales were sensitive to change over time. The intensity of ideation subscale demonstrated moderate to strong internal consistency. In the adolescent suicide attempters study, worst-point lifetime suicidal ideation on the C-SSRS predicted suicide attempts during the study, whereas the Scale for Suicide Ideation did not. Participants with the two highest levels of ideation severity (intent or intent with plan) at baseline had higher odds for attempting suicide during the study.
Conclusions: These findings suggest that the C-SSRS is suitable for assessment of suicidal ideation and behavior in clinical and research settings.

2. Amos, J. J., M.D. (2010). Suicide risk assessment. Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. J. J. amos, M.D., and R. G. Robinson, M.D. New York, Cambridge University Press: 51-57.

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