From the Guidelines
The Columbia-Suicide Severity Rating Scale (C-SSRS) triage is not recommended as a standalone tool for screening suicide risk due to its limited accuracy and lack of sufficient studies to support its use.
Key Points
- The C-SSRS is a screening tool used to assess suicide risk, but its accuracy is limited and not recommended for screening suicide risk 1.
- The tool has a high false-positive prediction rate and a low degree of accuracy for identifying true cases of suicide risk 1.
- Clinicians should use caution when assessing suicide risk and not rely exclusively on any one tool, instead using multiple means to evaluate risk such as self-reported measures and clinical interviews 1.
- Other screening tools, such as the Patient Health Questionnaire-9 (PHQ-9) item 9, have been found to be effective in identifying suicide risk, but also have limitations 1.
Triage and Assessment
- The C-SSRS may still be used as part of a comprehensive assessment of suicide risk, but should be used in conjunction with other tools and clinical judgment 1.
- A thorough assessment of suicide risk should include evaluation of warning signs, coping strategies, social support, and crisis resources, as well as referral to treatment and follow-up care 1.
- The use of safety planning-type interventions, such as the Crisis Response Plan (CRP) and Safety Planning Intervention (SPI), have been found to be effective in reducing suicidal behavior and ideation 1.
From the Research
Columbia-Suicide Severity Rating Scale (CSSRS) Triage
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a tool used to assess suicidal ideation and behavior. The C-SSRS triage refers to the process of using this scale to identify individuals at risk of suicide and to track treatment response.
- The C-SSRS has been shown to have good convergent and divergent validity with other measures of suicidal ideation and behavior, as well as high sensitivity and specificity for suicidal behavior classifications 2.
- However, criticism of the instrument has been mounting, with some studies suggesting that it does not address the full spectrum of suicidal ideation or behavior, and has the potential to miss many combinations of suicidal ideation and behavior that present to clinicians in practice 3.
- The C-SSRS has been used in various studies to predict suicide risk, with mixed results. For example, one study found that the C-SSRS screener was insensitive to suicide risk after emergency department discharge, with most patients who died by suicide screening negative and not receiving psychiatric services in the ED 4.
- Other studies have found that the C-SSRS has predictive validity in identifying individuals at risk of non-fatal and fatal suicidal behaviors, although the ability to correctly predict future suicidal behavior was limited 5, 6.
Key Components of C-SSRS Triage
The C-SSRS triage involves assessing the following components:
- Suicidal ideation: The C-SSRS assesses the severity of suicidal ideation, including the frequency, duration, and intensity of suicidal thoughts.
- Suicidal behavior: The C-SSRS also assesses suicidal behavior, including attempts and preparatory behaviors.
- Risk factors: The C-SSRS takes into account various risk factors, such as previous suicide attempts, mental health conditions, and substance abuse.
Clinical Applications of C-SSRS Triage
The C-SSRS triage can be used in various clinical settings, including:
- Emergency departments: The C-SSRS can be used to quickly assess suicide risk in patients presenting to the ED.
- Psychiatric clinics: The C-SSRS can be used to monitor treatment response and adjust treatment plans as needed.
- Primary care settings: The C-SSRS can be used to identify individuals at risk of suicide and refer them to specialized care.