New Suicide Scale a Reliable Method of Risk Assessment

Megan Brooks

November 10, 2011

November 10, 2011 — The Columbia-Suicide Severity Rating Scale (C-SSRS) is a reliable, user-friendly tool for assessment of suicidal ideation and behavior in adolescents and adults, according to a report published online November 8 in the American Journal of Psychiatry.

"Research on suicide prevention and interventions requires a standard method for assessing both suicidal ideation and behavior to identify those at risk and to track treatment response," Kelly Posner, PhD, director of the Center for Suicide Risk Assessment at Columbia University in New York City, and colleagues note in the report.

"However, to date, the field has lacked a single standard measure that assesses both suicidal ideation and behavior," they point out. Dr. Posner and colleagues developed the C-SSRS to fill this need.

In contrast to other assessment tools, the C-SSRS assesses suicidal ideation and behavior and more precisely identifies the severity and intensity, or lethality, of suicidal thoughts and behaviors, its developers say. It is also the only scale that provides definitions of suicidal behavior, which have been adopted by the Centers for Disease Control and Prevention.

Validated in 3 Studies

Dr. Posner's team tested the validity of the C-SSRS in 3 separate studies that used it along with other established assessment tools, including the Columbia Suicide History Form (which assesses behavior) and the Beck Scale for Suicide Ideation (which assesses ideation).

One study involved 237 adults presenting to an emergency department for psychiatric problems, a second involved 124 adolescent suicide attempters participating in a treatment study, and the third was a medication efficacy trial of 312 depressed adolescents without current ideation or a history of suicide attempt.

The C-SSRS showed "good convergent and divergent validity" with the established ideation and behavior scales, the investigators say. It also had "high sensitivity and specificity" for suicidal behavior, was sensitive to change in behavior over time, and could accurately pinpoint those at greatest risk for suicide attempt.

These findings, they say, support its use in the clinical and research settings.

Suicide remains a major preventable public health problem, according to the National Institute of Mental Health's Web site. In 2007, it was the tenth leading cause of death in the United States, accounting for 34,598 deaths.

"Prevention depends on appropriate identification of phenomena," Dr. Posner commented in a prepared statement. "If we can't identify something, it limits our ability to understand, manage, and treat illness. That limits our confidence in drug trials and epidemiological findings. Fifty percent of suicides see their primary care doctor the month before they die; we should be asking these questions the way we monitor for blood pressure," she said.

The C-SSRS is available on Columbia University's Web site.

Dr. Posner receives royalty payments for the electronic self-rated versions of the C-SSRS from ERT, Inc. A complete list of author disclosures is provided in the original article.

Am J Psychiatry. Published online November 8, 2011. Abstract

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