C-SSRS

Structured assessment of suicidal ideation severity and behavior

Indication

Structured assessment of suicidal ideation severity and behavior

Criteria

id: wish_dead; label: Wish to be dead (passive suicidal ideation); type: yesno
id: nonspecific; label: Non-specific active suicidal thoughts ("want to kill myself" without plan); type: yesno
id: method_no_plan; label: Active ideation with method but no plan or intent; type: yesno
id: intent_no_plan; label: Active ideation with intent but no specific plan; type: yesno
id: intent_with_plan; label: Active ideation with specific plan and intent; type: yesno
id: behavior; label: Suicidal behavior (actual attempt, interrupted attempt, aborted attempt, preparatory behavior); type: yesno

Interpretation

function(score, vals) { if (vals.behavior) return { risk: 'Suicidal Behavior', tier: 'Highest Risk', action: 'Immediate psychiatric evaluation. 1:1 observation. Medical stabilization if attempt. Inpatient psychiatric admission likely indicated.', color: 'red' }; if (vals.intent_with_plan) return { risk: 'Active Ideation with Plan & Intent', tier: 'High Risk', action: 'Immediate psychiatric evaluation. 1:1 observation. Lethal means restriction. Safety planning. Likely inpatient admission.', color: 'red' }; if (vals.intent_no_plan) return { risk: 'Active Ideation with Intent', tier: 'High Risk', action: 'Psychiatric consultation. 1:1 observation. Safety planning. Consider admission.', color: 'red' }; if (vals.method_no_plan) return { risk: 'Active Ideation with Method', tier: 'Moderate Risk', action: 'Psychiatric evaluation. Safety planning. Lethal means counseling. May consider outpatient with close follow-up if safe disposition.', color: 'yellow' }; if (vals.nonspecific) return { risk: 'Non-specific Active Ideation', tier: 'Moderate Risk', action: 'Safety assessment. Safety planning. Follow-up within 48-72 hours. Lethal means counseling.', color: 'yellow' }; if (vals.wish_dead) return { risk: 'Passive Ideation', tier: 'Low-Moderate Risk', action: 'Safety assessment. Outpatient referral. Safety planning. Lethal means counseling. Follow-up within 1 week.', color: 'yellow' }; return { risk: 'No Ideation', tier: 'Low Risk', action: 'No current suicidal ideation. Document screen. Reassess if clinical status changes.', color: 'green' }; }

Clinical pearls

C-SSRS is an FDA-recommended tool for assessing suicidality in clinical trials
Ask directly — asking about suicide does NOT increase risk
Lethal means restriction (firearms, medications) is one of the most effective suicide prevention strategies
Follow up within 48 hours of discharge for patients with suicidal ideation — this is the highest risk period

Source and review

Posner et al., Am J Psychiatry 2011. Last reviewed: 2024-11-01