Suicide Risk Screening (C-SSRS)
Columbia Suicide Severity Rating Scale — Evidence-Based Screener
Understanding Suicide Risk
Suicide is a complex public health issue that affects people of all ages, genders, races, and backgrounds. Understanding risk factors and warning signs can help save lives.
Risk Factors:
- Mental health conditions: Depression, bipolar disorder, schizophrenia, PTSD, anxiety disorders, and substance use disorders are strongly associated with suicide risk
- Previous suicide attempts: A prior attempt is one of the strongest predictors of future suicidal behavior
- Family history: A family history of suicide or mental health conditions increases risk
- Chronic pain or illness: Ongoing physical health conditions can contribute to hopelessness and suicidal ideation
- Social isolation: Lack of social connection, loneliness, and feeling like a burden to others
- Access to lethal means: Having access to firearms, medications, or other means increases risk
- Major life stressors: Job loss, financial hardship, relationship breakdowns, legal problems, or bereavement
- History of trauma or abuse: Childhood adversity, domestic violence, and sexual assault
Warning Signs:
- Talking about wanting to die or kill oneself
- Searching for methods to end one's life
- Expressing feelings of hopelessness or having no reason to live
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others
- Increasing use of alcohol or drugs
- Withdrawing from friends, family, and activities
- Giving away prized possessions
- Extreme mood swings or sudden calmness after a period of depression
- Sleeping too much or too little
Protective Factors:
- Strong connections to family and community
- Access to effective mental health care
- Problem-solving and coping skills
- Reasons for living (e.g., children, pets, religious beliefs, future goals)
- Restricted access to lethal means
- Cultural and religious beliefs that discourage suicide
Myths vs. Facts:
- Myth: “Talking about suicide will give someone the idea.” Fact: Asking about suicide does not increase risk. It can actually provide relief and open the door to getting help.
- Myth: “People who talk about suicide are just seeking attention.” Fact: All talk of suicide should be taken seriously. It is often a cry for help, not a bid for attention.
- Myth: “Once someone is suicidal, they will always be suicidal.” Fact: Suicidal crises are often temporary. With proper support and treatment, people can and do recover.
- Myth: “Suicide only affects people with mental illness.” Fact: While mental illness is a risk factor, many people who die by suicide do not have a diagnosed mental health condition.
About the Columbia Suicide Severity Rating Scale (C-SSRS)
The C-SSRS was developed at Columbia University by Dr. Kelly Posner and colleagues. It is the most widely used evidence-based tool for assessing suicide risk and is endorsed by the FDA, CDC, WHO, NIH, DoD, VA, and many other organizations worldwide.
How the C-SSRS Works:
- The screener version uses a series of Yes/No questions that progressively assess the severity of suicidal ideation and behavior
- Questions are designed to distinguish between passive ideation (wishing for death), active ideation (thinking about killing oneself), method ideation, intent, planning, and actual behavior
- The adaptive flow means not all questions need to be answered — if early questions indicate low risk, later questions are skipped
- This approach reduces burden while still capturing the critical information needed for risk assessment
Why It Is Used Worldwide:
- Validated across ages (children, adolescents, and adults), settings (emergency departments, primary care, schools, military), and populations
- Available in over 140 languages
- Required by the FDA for all drug trials involving suicidal ideation
- Used in over 100 countries as a standard screening tool
- Adopted by the US military, VA healthcare system, and many major hospital networks
Clinical Background:
The C-SSRS was developed to address a critical gap in suicide risk assessment. Before its creation, there was no standardized measure that clearly distinguished between different types of suicidal thinking and behavior. The scale creates a clear classification system that helps clinicians determine the appropriate level of intervention.
Research has shown that the C-SSRS has strong sensitivity and specificity for identifying individuals at risk, and that its use in clinical settings has been associated with improved detection of suicidal ideation and reduction in suicidal behavior.
How to Help Someone at Risk
If you are concerned that someone you know may be at risk for suicide, your actions can make a life-saving difference. Here is what you can do:
The QPR Method (Question, Persuade, Refer):
- Question: Ask the person directly about suicidal thoughts. You can say: “Are you thinking about suicide?” or “Are you thinking about killing yourself?” Be direct and use the word “suicide” — it shows you are taking them seriously and are not afraid of the topic.
- Persuade: Listen without judgment. Validate their pain. Encourage them to seek professional help. Avoid minimizing their feelings or offering simple solutions. Say things like: “I care about you,” “You are not alone,” “I want to help you get through this.”
- Refer: Help them connect with a crisis service or mental health professional. Offer to call the 988 Lifeline together, accompany them to a therapist or emergency room, or help them make an appointment.
What to Do:
- Take all talk of suicide seriously — do not dismiss or minimize it
- Listen actively and compassionately without judgment
- Ask directly about suicide — this does not plant the idea
- Stay with the person if they are in immediate danger
- Help remove access to lethal means (firearms, medications, sharp objects)
- Encourage professional help and offer to assist with the process
- Follow up regularly — continued connection is protective
- Call 911 or take the person to the nearest emergency room if danger is imminent
What Not to Do:
- Do not promise to keep suicidal thoughts a secret
- Do not leave the person alone if they are in immediate danger
- Do not debate whether suicide is right or wrong
- Do not minimize their feelings (e.g., “You have so much to live for”)
- Do not act shocked or panicked — stay calm and supportive
Taking Care of Yourself:
Supporting someone who is suicidal can be emotionally exhausting. Make sure to seek your own support — talk to a counselor, friend, or call the 988 Lifeline yourself if you need to process your feelings.
Resources & Support
National Helplines (United States):
- 988 Suicide & Crisis Lifeline: Call or text 988 (24/7, free, confidential)
- Crisis Text Line: Text HOME to 741741 (24/7, free)
- Veterans Crisis Line: Call 1-800-273-8255, Press 1 — or text 838255
- Trevor Project (LGBTQ+ Youth): Call 1-866-488-7386 or text START to 678-678
- Trans Lifeline: Call 877-565-8860 (US) or 877-330-6366 (Canada)
- SAMHSA National Helpline: Call 1-800-662-4357 (24/7, free treatment referrals)
International Resources:
- International Association for Suicide Prevention: iasp.info/resources/Crisis_Centres
- Befrienders Worldwide: befrienders.org
- Samaritans (UK/Ireland): Call 116 123 (24/7, free)
- Lifeline (Australia): Call 13 11 14 (24/7)
- Canada Suicide Prevention Service: Call 1-833-456-4566 (24/7)
Support Organizations:
- American Foundation for Suicide Prevention (AFSP): afsp.org — education, advocacy, and support for survivors
- National Alliance on Mental Illness (NAMI): nami.org — support groups and education
- Suicide Prevention Resource Center (SPRC): sprc.org — strategies and best practices
- Alliance of Hope for Suicide Loss Survivors: allianceofhope.org
Apps for Safety Planning and Support:
- MY3: Free app to create a safety plan with your support network and coping strategies
- Safety Plan (Stanley-Brown): Evidence-based safety planning app recommended by clinicians
- Virtual Hope Box: Developed by the Department of Defense with coping tools and resources
- notOK: A digital panic button that sends your GPS location and a pre-written message to trusted contacts
Frequently Asked Questions
The Columbia Suicide Severity Rating Scale (C-SSRS) is an evidence-based screening tool developed at Columbia University by Dr. Kelly Posner and colleagues. It is designed to identify and assess suicidal ideation and behavior through a series of simple Yes/No questions. The C-SSRS is the most widely used suicide risk screening instrument in the world, employed in over 100 countries and available in more than 140 languages. It is endorsed by the FDA, CDC, WHO, NIH, Department of Defense, and the Veterans Administration. The screener version used here is a brief form suitable for community and self-screening purposes.
Suicide is a leading cause of death worldwide, yet it is largely preventable with timely intervention. Screening for suicide risk allows for early identification of individuals who may be in danger, enabling them to receive help before a crisis escalates. Research shows that many people who die by suicide visited a healthcare provider in the weeks or months before their death but were never asked about suicidal thoughts. Routine screening, including self-screening tools like this one, helps bridge that gap. The C-SSRS was specifically designed to provide a structured, evidence-based way to assess suicide risk that can be used by anyone — not just trained clinicians.
If this screening suggests elevated risk, the most important step is to reach out for professional support. You can call or text 988 to reach the Suicide & Crisis Lifeline (available 24/7), text HOME to 741741 for the Crisis Text Line, or contact your primary care provider or a mental health professional. If you are in immediate danger, call 911 or go to your nearest emergency room. A positive screening result does not mean you will attempt suicide — it means that professional support could be beneficial. Many effective treatments exist for suicidal ideation, including therapy, medication, and safety planning.
The C-SSRS screener is designed as a self-report tool, but it can also be administered by one person to another. If you are concerned about a friend, family member, or someone you care about, you can ask them these questions directly. Asking someone about suicide does not put the idea in their head — research consistently shows that asking about suicide actually reduces risk by opening the door to getting help. If the person answers “Yes” to any of the questions, encourage them to speak with a mental health professional or call the 988 Lifeline. If they are in immediate danger, stay with them and call 911.
If you or someone you know is in crisis right now, help is available immediately. Call or text 988 to reach the Suicide & Crisis Lifeline (available 24/7, free, confidential). Text HOME to 741741 for the Crisis Text Line. Veterans can call 1-800-273-8255 and press 1. LGBTQ+ youth can contact the Trevor Project at 1-866-488-7386. For immediate danger, call 911 or go to your nearest emergency room. The International Association for Suicide Prevention maintains a directory of crisis centers worldwide at iasp.info/resources/Crisis_Centres. You are not alone, and help is always available.
Important Medical Disclaimer
This C-SSRS Screening Tool is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. This is a self-administered screening tool, not a clinical assessment. It cannot predict or prevent suicide. Your results should be discussed with a qualified healthcare professional who can provide a comprehensive evaluation. If you are experiencing a mental health crisis or suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline (call or text 988), the Crisis Text Line (text HOME to 741741), or call 911 immediately. Regardless of your screening results, if you are struggling with thoughts of suicide, please seek professional help. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.
References
- Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266-1277.
- Mundt JC, Greist JH, Jefferson JW, Federico M, Mann JJ, Posner K. Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior assessed by the Columbia-Suicide Severity Rating Scale. J Clin Psychiatry. 2013;74(9):887-893.
- The Columbia Lighthouse Project. The Columbia Protocol (C-SSRS). Columbia University. Available at: cssrs.columbia.edu.
- Posner K, Brent D, Lucas C, et al. Columbia-Suicide Severity Rating Scale (C-SSRS) — Screen Version. Columbia University Medical Center. 2008.
- Stanley B, Brown GK. Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice. 2012;19(2):256-264.
C-SSRS: Developed at Columbia University by Kelly Posner, PhD, and colleagues. The C-SSRS Screener is free for all use. For more information, visit The Columbia Lighthouse Project.