C-SSRS
Columbia Suicide Severity Rating Scale (Screener)
The evidence-based standard for assessing suicide risk.
6
2 min
adolescent / adult
v1.0
About the C-SSRS
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a structured set of questions for assessing suicidal ideation and behaviour. Rather than producing a simple summed score, it establishes the presence and severity of ideation (from a wish to be dead through to active ideation with plan and intent) and the presence of any suicidal behaviour, and uses these to determine a risk tier.
The C-SSRS is used across emergency, inpatient, primary-care, and research settings to support triage and safety planning. Because it maps directly onto risk level, it is designed to inform clinical action, not to be averaged or trended like a symptom score.
What it measures
- Severity of suicidal ideation — from passive wish to active ideation with plan and intent
- Intensity of ideation — frequency, duration, controllability, and deterrents
- Suicidal behaviour — actual, aborted, and interrupted attempts and preparatory acts
C-SSRS questions
- 1
Have you wished you were dead or wished you could go to sleep and not wake up?
Risk item - 2
Have you actually had any thoughts of killing yourself?
Risk item - 3
Have you been thinking about how you might do this?
Risk item - 4
Have you had these thoughts and had some intention of acting on them?
Risk item - 5
Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
Risk item - 6
Have you ever done anything, started to do anything, or prepared to do anything to end your life? (Including in the past three months.)
Risk item
Items reproduced from a documented, freely usable source. Item wording is preserved exactly as published.
Scoring & interpretation
| Range | Band | Interpretation |
|---|---|---|
| 0–0 | No risk indicated | No suicidal ideation or behaviour endorsed on this screen. |
| 1–1 | Low risk | Passive or active ideation endorsed without method, intent, or behaviour. Document. Safety plan recommended. |
| 2–2 | Moderate risk | Ideation with method or intent endorsed. Conduct full risk assessment within 24 hours; intensify treatment; consider higher level of care. |
| 3–3 | High risk | Past suicidal behaviour endorsed (any timeframe). If endorsed within past 3 months — consider this an emergency: do not leave the client alone; contact emergency services or refer for immediate evaluation. |
Higher scores indicate greater symptom severity.
Clinical applications
- Structured suicide-risk assessment and triage in any clinical setting
- Supporting safety planning and level-of-care decisions
- Standardised risk documentation for research and quality programmes
Strengths & considerations
- The C-SSRS supports — it does not replace — clinical judgement and a safety plan.
- A positive screen requires immediate clinical follow-up.
Frequently asked questions
How is the C-SSRS scored?
It is not summed like a symptom scale. Responses establish the severity of ideation and the presence of any suicidal behaviour, which together determine a risk tier guiding clinical action.
Who can administer the C-SSRS?
It is designed to be administered by clinicians and trained non-clinicians across emergency, primary-care, inpatient, and community settings.
Source & references
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