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COLUMBIA-SUICIDE SEVERITY RATING SCALE  (C-SSRS) PART 1

Canada Online Therapy invites current clients who are accessed for hopelessness, sucidial ideations to take our online CSSR-S Full Scale after being assessed on our CSSRS-Screen.

 

Please note, there is no save option on this form.

 

Client may wish to complete their form on paper, take a picture of their results and send them to leepark.ca@gmail.com or, and, save those results.

 

Canada Online Therapy has over 20 years experience of successfully keeping clients suicidal from sucicial ideations with no relapse of suicidal ideations, cycles of hopelessness. 

Please note we are a private online mental health clinic, private practice is not appropriate for emergency, crisis suicidal ideation cases.

 

If you are feeling suicidal, know you are at imminent danger to harm yourself or others, reach out to a resource- person who you know who is nonjudgemental and go to your nearest emergency outpatient clinic or call 911.

"Disclaimer: This scale is intended to be used by individuals who have received training in its administration. The questions contained in  the Columbia-Suicide Severity Rating Scale are suggested probes. Ultimately, the determination of the presence of suicidal  ideation or behavior depends on the judgment of the individual administering the scale."

COLUMBIA-SUICIDE SEVERITY RATING SCALE  (C-SSRS) PART 1

🟪 SUICIDAL IDEATION

Answer questions 1 and 2.

If both are negative, proceed to 🟪 "Suicidal Behavior” section.

If the answer to  question 2 is “yes”, ask questions 3, 4 and 5.

If the answer to question 1 and/or 2 is “yes”, complete 

🟥“Intensity of Ideation” section below.

🟪 1. Wish to be Dead 


Do you have thoughts about a wish to be dead or not alive anymore, or wish to fall asleep and not wake up.


Have you wished you were dead or wished you could go to sleep and not wake up? 


Lifetime: Time He/She/They Felt Most Suicidal
Past Months: Time He/She/They Felt Most Suicidal

🟪 2. Non-Specific Active Suicidal Thoughts 


General non-specific thoughts of wanting to end one’s life/commit suicide (e.g., “I’ve thought about killing myself”) without thoughts of  ways to kill oneself/associated methods, intent, or plan during the assessment period. 


Have you actually had any thoughts of killing yourself?


Lifetime: Time He/She/They Felt Most Suicidal
Past Months: Time He/She/They Felt Most Suicidal

🟪 3. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act 


Have you had thoughts of suicide and has thought of at least one method during the assessment period. This is different than a specific  plan with time, place or method details worked out (e.g., thought of method to kill self but not a specific plan). Includes person who would  say, “I thought about taking an overdose but I never made a specific plan as to when, where or how I would actually do it… and I would  never go through with it.” 


Have you been thinking about how you might do this?


Lifetime: Time He/She/They Felt Most Suicidal
Past Months: Time He/She/They Felt Most Suicidal

🟪 4. Active Suicidal Ideation with Some Intent to Act, without Specific Plan 


Active suicidal thoughts of killing oneself and subject reports having some intent to act on such thoughts, as opposed to “I have the thoughts  but I definitely will not do anything about them.” 


Have you had these thoughts and had some intention of acting on them?


Lifetime: Time He/She/They Felt Most Suicidal
Past Months: Time He/She/They Felt Most Suicidal

🟪 5. Active Suicidal Ideation with Specific Plan and Intent 


Thoughts of killing oneself with details of plan fully or partially worked out and subject has some intent to carry it out.


Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?

Lifetime: Time He/She/They Felt Most Suicidal
Past Months: Time He/She/They Felt Most Suicidal

🟥 INTENSITY OF IDEATION

Rate the following features from the most severe type of ideation (i.e.,1-5 from above, with 1 being  the least severe and 5 being the most severe).


What was a time you were feeling the most suicidal ?

LIFETIME - Most Severe Ideation
Past X Months - Most Severe Ideation

LIFETIME

🟥 #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

Past RECENT Months

🟥 #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
FREQUENCY How many times have you had these thoughts?
DURATION When you have the thoughts how long do they last?
CONTROLLABILITY Could/can you stop thinking about killing yourself or wanting to die if you want to? (1) Easily able to control thoughts (5) Unab
Deterrents Are there things - anyone or anything (e.g., family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of committing suicide?

Reasons for Ideation

Reasons did you have for thinking about wanting to die or killing yourself? Was it to end the pain, stop the way you were feeling (you couldn’t go on living with this pain or how you were feeling), was it to get attention , revenge or a reaction or both ?
I agree to the terms and conditions of services.

"Definitions of behavioral suicidal events in this scale are based on those used in The Columbia Suicide History Form, developed by John Mann, MD and Maria Oquendo, MD, Conte Center for the Neuroscience of Mental Disorders (CCNMD), New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032. (Oquendo M. A., Halberstam B. & Mann J. J., Risk factors for suicidal behavior: utility and limitations of research instruments. In M.B. First [Ed.] Standardized Evaluation in Clinical Practice, pp. 103 -130, 2003.)"

"For reprints of the C-SSRS contact Kelly Posner, Ph.D., New York State Psychiatric Institute, 1051 Riverside Drive, New York, New York, 10032; inquiries and training requirements contact posnerk@nyspi.columbia.edu © 2008 The Research Foundation for Mental Hygiene, Inc."

"The fair dealing exemption in the Copyright Act provides that fair dealing with a copyright-protected work for one of the following eight purposes: research, private study, criticism, review, news reporting, education, satire, or parody, does not infringe copyright." Copyright Act, C -4229, 29.1. 29.2,  (1985).

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