Columbia-Suicide Severity Rating Scale (Screening Version) (C-SSRS(Screening Version)) / Échelle d’évaluation de Columbia sur la gravité du risque suicidaire (C-SSRS)

Introduction

The Columbia Suicide Severity Rating Scale (C‐SSRS) is a measure used to identify and assess individuals at risk for suicide. There are four available versions of the scale, including: (1) Lifetime/Recent version, (2) Since Last Visit version, (3) Screen version, and (4) Risk Assessment Page. At Youth Wellness Hubs Ontario (YWHO), the six-item Screen version is used, a shortened version of the full questionnaire, measuring the presence and severity of suicidal ideation, and suicidal behaviour. Questions are phrased in an interview format, to be completed by the service provider with the young person, and responses are recorded in binary yes/no format. The C-SSRS shows good convergent and divergent validity with other similar scales.

Why are we asking service providers to complete this questionnaire with youth?

A fundamental step in suicide prevention is identifying individuals who need help. The C-SSRS (Screen version) is a simple, efficient, effective, universal, evidence-supported measure of screening youth for factors that indicate heightened risk of suicidality. The C-SSRS (Screen version) is completed when the service provider judges it to be clinically necessary, and/or when a young person’s positive response to question 9 on the PHQ-9 triggers an immediate alert to a service provider at the hub. Responses regarding risk levels can then be used to guide suitable clinical decisions and interventions, measure treatment progress over time, and facilitate safety monitoring and/or crisis planning. Trust, compassion, and empathy are important when using this screening tool with youth.

Responding to youth asking why they are being asked to respond to this questionnaire:

We know that mental health and substance use issues can be related to thoughts of suicide, and that suicide, suicide attempts, and thoughts of suicide are common occurrences among young people in Canada. Because topics like this are sometimes hard to bring up, I would like to ask you some questions about them. Then we could make a plan moving forward that takes into account how you are feeling.

Clinical questionnaire:

At the hub, the service provider verbally asks questionnaire items (e.g., from the Data Collection platform or via hard copy) to youth, and notes the responses. The questions are as follows:

When do youth respond to these questions?

Young people are asked to respond to the questionnaire items asked by their service provider at their first clinical visit, and subsequent clinical visits more than seven days later (either 8-29 days later, or 30 or more days, depending on when they return), if deemed necessary by the service provider’s clinical judgment or if alerted by the relevant PHQ-9 response (as per above).

It is critical that service providers review previous completion of forms by youth on the Data Collection Platform prior to meeting with youth at any time. If it has been seven or fewer days (or even more) since a youth’s last clinical visit, and suicidal ideation was present last time, service providers will notice a green checkmark beside the completed C-SSRS form (as well as next to the PHQ-9). This is an indication to follow up with the youth about suicidality (and possibly re-administer the C-SSRS), regardless of the number of days since the last clinical visit.

What if youth don’t understand a question?

If a young person requires assistance with an item due to developmental, cognitive, language, or other issues, try to provide these supports:

• Read all items aloud again exactly as printed word for word, at an appropriate pace;
• If there is some misunderstanding, repeat the item;
• Determine which word is confusing and define the word, but try not to reword the question (it may alter the meaning of the question, as well as the response); and
• Do not suggest answers.
  

Scoring/results:

How can I go over results with youth?

• Responses are recorded automatically on the YWHO Data Collection platform, although there is no scoring.
• Service providers are able to view the “yes” or “no" responses regarding youth’s suicidal ideation and behaviour, in the past month, to provide information regarding risk levels, and inform crisis planning, monitoring, and treatment decisions.
• The first five questions screen for suicidal thoughts. The sixth question screens for suicidal behaviour.
  

Positive endorsements of other questions on the screener could also indicate a need for further evaluation, mental health intervention, or clinical management depending on individual and/or context.