Columbia Suicide Severity Rating Scale (C-SSRS)

The Columbia Suicide Severity Rating Scale (C-SSRS) is often considered the gold standard of suicide risk assessment (Giddens, Sheehan & Sheehan, 2014). It was developed in 2011 by a team from Columbia University and has been validated with both adult and adolescent populations (Posner, et. al., 2011)

Items in the C-SSRS

The C-SSRS can be downloaded here. It has the following categories and questions. Suicidal Ideation and Behaviour are scored as yes/no, while Intensity of Ideation and Actual Attempts are scored by points.

Suicidal Ideation

  1. Wish to be dead
  2. Non-Specific Active Suicidal Thoughts
  3. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act
  4. Active Suicidal Ideation with Some Intent to Act, without Specific Plan
  5. Active Suicidal Ideation with Specific Plan and Intent

Intensity of Ideation

  • Frequency
  • Duration
  • Controllability
  • Deterrents
  • Reasons for Ideation

Suicidal Behaviour

  • Actual Attempt
  • Has subject engaged in Non-Suicidal Self-Injurious Behavior?
  • Aborted Attempt
  • Preparatory Acts or Behavior
  • Suicidal Behavior
  • Completed Suicide

Answer for Actual Attempts Only

  • Actual Lethality/Medical Damage
  • Potential Lethality: Only Answer if Actual Lethality=0


There are different scoring systems depending on the population. The important elements to note are that the higher the scores on the individual items and the more “yes” items, the higher the suicide risk. The C-SSRS training noted below lists high risk as being “ideation, a four or five in the past month; or any of the four behaviors in the last three months.”

Additionally, linked here are some scoring systems that can be used in various environments (community agencies, military, hospital inpatients, etc.)

C-SSRS Training

There is full training available online through the C-SRSS website.


Giddens, J.M., Sheehan, K.H., Sheehan, D.V. (2014) “The Columbia–Suicide Severity Rating Scale (C–SSRS): Has the “Gold Standard” Become a Liability?” Innovations in Clinical Neuroscience. 11(9–10):66–80

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., & … Mann, J. J. (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), 1256. doi:10.1176/appi.ajp.2011.10111704

Cite this article as: MacDonald, D.K., (2015), "Columbia Suicide Severity Rating Scale (C-SSRS)," retrieved on August 25, 2019 from
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