Asking about suicide as suicide prevention: The Columbia suicide severity rating scale (C-SSRS)

Abstract

Suicide has long resisted prevention efforts and continues to be a major cause of mortality and morbidity worldwide. Improving methods for identifying and predicting suicide risk is critical to suicide prevention. Historically, variability in definitions, terminology and assessment methods stymied suicide risk identification and communication. Uniform language and guidelines for characterizing suicidal thoughts and behaviors can render suicide risk assessment reliable independent of the setting, accessible to non-mental health professionals, and can unlock the possibility of nationwide suicide prevention programs built on communication across all sectors of society. The Columbia Suicide Severity Rating Scale (C-SSRS) was developed to distinguish the domains of suicidal ideation, suicidal and non-suicidal self-injurious behavior, differentiate types of thoughts and behaviors and provide standard definitions and suggested questions to guide assessment. The scale has helped mitigate some of the weaknesses of the traditional open-ended clinical inquiry, improved screening accuracy and predictive validity of risk estimates relative to several other measures that combine the ideation and behavior domains. The growing utilization of the scale across clinical practice, research and public health is changing the way we accumulate knowledge about the etiology, epidemiology and treatment of suicide and is beginning to affect suicidal behavior rates. Examples of successful implementation programs in healthcare, the military and research are discussed.