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    Columbia-Suicide Severity Rating Scale (C-SSRS) : Past 3 Months Lifetime

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    Izabel Estevam

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    Columbia-Suicide Severity Rating Scale (C-SSRS) : Past 3 Months Lifetime

    Uploaded by

    Izabel Estevam
    221 views1 page

    Original Title

    C SSRS Risk Assessment Page

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    Columbia-Suicide Severity Rating Scale (C-SSRS) : Past 3 Months Lifetime

    Uploaded by

    Izabel Estevam

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS) 

    Posner, Brent, Lucas, Gould, Stanley, Brown, Fisher, Zelazny, Burke, Oquendo, & Mann
    © 2008 The Research Foundation for Mental Hygiene, Inc.
    RISK ASSESSMENT

    Instructions: Check all risk and protective factors that apply. To be completed following the patient interview,
    review of medical record(s) and/or consultation with family members and/or other professionals.

    Past 3 Suicidal and Self-Injurious


    Months
    Lifetime Clinical Status (Recent)
    Behavior
    Actual suicide attempt Hopelessness
    Interrupted attempt Major depressive episode
    Aborted or Self-Interrupted attempt
    Mixed affective episode (e.g. Bipolar)
    Lifetime
    Other preparatory acts to kill self Command hallucinations to hurt self
    Lifetime
    Self-injurious behavior without
    Highly impulsive behavior
    suicidal intent
    Suicidal Ideation
    Substance abuse or dependence
    Check Most Severe in Past Month
    Wish to be dead Agitation or severe anxiety
    Suicidal thoughts Perceived burden on family or others
    Suicidal thoughts with method Chronic physical pain or other acute medical
    (but without specific plan or intent to act) problem (HIV/AIDS, COPD, cancer, etc.)
    Suicidal intent (without specific plan) Homicidal ideation
    Suicidal intent with specific plan Aggressive behavior towards others
    Activating Events (Recent) Method for suicide available (gun, pills, etc.)
    Recent loss(es) or other significant negative
    Refuses or feels unable to agree to safety plan
    event(s) (legal, financial, relationship, etc.)
    Describe: Sexual abuse (lifetime)
    Family history of suicide (lifetime)
    Pending incarceration or homelessness Protective Factors (Recent)
    Current or pending isolation or feeling alone Identifies reasons for living
    Responsibility to family or others; living with
    Treatment History
    family
    Previous psychiatric diagnoses and treatments Supportive social network or family
    Hopeless or dissatisfied with treatment Fear of death or dying due to pain and suffering
    Non-compliant with treatment Belief that suicide is immoral; high spirituality
    Not receiving treatment Engaged in work or school
    Other Risk Factors Other Protective Factors

    Describe any suicidal, self-injurious or aggressive behavior (include dates)

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