SEVERITYRATINGSCALE(C-SSRS)
Children’sBaseline
Version6/23/10
Posner,
K.;Brent,
D.;Lucas,
C.;Gould,
M.;Stanley,
B.;Brown,
G.;Fisher,
P.;Zelazny,
J.;Burke,
A.;Oquendo,
M.;Mann,
J. Disclaimer:Thisscaleisintendedtobeusedbyindividualswhohavereceivedtraininginitsadministration.Thequestionscontained intheColumbia-SuicideSeverityRatingScalearesuggestedprobes.Ultimately,thedeterminationofthepresenceofsuicidalideationorbehaviordependsonthejudgmentoftheindividualadministeringthescale. DefinitionsofbehavioralsuicidaleventsinthisscalearebasedonthoseusedinTheColumbiaSuicideHistoryForm,developedbyJohnMann,MDandMariaOquendo,MD,ConteCenterfortheNeuroscienceofMentalDisorders(CCNMD),NewYorkStatePsychiatricInstitute,1051RiversideDrive,NewYork,NY,10032.(OquendoM.A.,HalberstamB.&MannJ.J.,Riskfactorsforsuicidalbehavior:utilityandlimitationsofresearchinstruments.InM.B.First[Ed.]StandardizedEvaluationinClinicalPractice,pp.103-130,2003.) ForreprintsoftheC-SSRScontactKellyPosner,Ph.D.,NewYorkStatePsychiatricInstitute,1051RiversideDrive,NewYork,NewYork,10032;inquiriesandtrainingrequirementscontactposnerk@nyspi.columbia.edu ©2008TheResearchFoundationforMentalHygiene,Inc. SUICIDALIDEATION Askquestions1and2.Ifbotharenegative,proceedto“SuicidalBehavior”section.Iftheanswertoquestion2is“yes”,askquestions3,4and5.Iftheanswertoquestion1and/or2is“yes”,plete“IntensityofIdeation”sectionbelow. Lifetime
1.WishtobeDead Subjectendorsesthoughtsaboutawishtobedeadornotaliveanymore,orwishtofallasleepandnotwakeup.Haveyouthoughtaboutbeingdeadorwhatitwouldbeliketobedead?
Haveyouwishedyouweredeadorwishedyoucouldgotosleepandneverwakeup?
Doyoueverwishyouweren’taliveanymore?
Ifyes,describe:
2.Non-SpecificActiveSuicidalThoughts General,non-specificthoughtsofwantingtoendone’smitsuicide(e.g.,“I’vethoughtaboutkillingmyself”)withoutthoughtsofwaystokilloneself/associatedmethods,intent,orplan.Haveyouthoughtaboutdoingsomethingtomakeyourselfnotaliveanymore?
Haveyouhadanythoughtsaboutkillingyourself?
Ifyes,describe:
3.ActiveSuicidalIdeationwithAnyMethods(NotPlan)withoutIntenttoAct Subjectendorsesthoughtsofsuicideandhasthoughtofatleastonemethodduringtheassessmentperiod.Thisisdifferentthanaspecificplanwithtime,placeormethoddetailsworkedout(e.g.,thoughtofmethodtokillselfbutnotaspecificplan).Includespersonwhowouldsay,“IthoughtabouttakinganoverdosebutInevermadeaspecificplanastowhen,whereorhowIwouldactuallydoit…andIwouldnevergothroughwithit.”Haveyouthoughtabouthowyouwoulddothatorhowyouwouldmakeyourselfnotaliveanymore(killyourself)?
Whatdidyouthinkabout?
Ifyes,describe: YesNo □□ YesNo □□ YesNo □□
4.ActiveSuicidalIdeationwithSomeIntenttoAct,withoutSpecificPlan Activesuicidalthoughtsofkillingoneselfandsubjectreportshavingsomeintenttoactonsuchthoughts,asopposedto“IhavethethoughtsbutIdefinitelywillnotdoanythingaboutthem.”Whenyouthoughtaboutmakingyourselfnotaliveanymore(orkillingyourself),didyouthinkthatthiswassomethingyoumightactuallydo?
Thisisdifferentfrom(asopposedto)havingthethoughtsbutknowingyouwouldn’tdoanythingaboutit. Ifyes,describe:
5.ActiveSuicidalIdeationwithSpecificPlanandIntent Thoughtsofkillingoneselfwithdetailsofplanfullyorpartiallyworkedoutandsubjecthassomeintenttocarryitout.Haveyoueverdecidedhoworwhenyouwouldmakeyourselfnotaliveanymore/killyourself?
Haveyoueverplannedout(workedoutthedetailsof)howyouwoulddoit?
Whatwasyourplan?
Whenyoumadethisplan(orworkedoutthesedetails),wasanypartofyouthinkingaboutactuallydoingit?
Ifyes,describe: INTENSITYOFIDEATION Thefollowingfeatureshouldberatedwithrespecttothemostseveretypeofideation(i.e.,1-5fromabove,with1beingtheleastsevereand5beingthemostsevere). MostSevereIdeation:___________ _________________________________________________ Type#(1-5)Frequency Howmanytimeshaveyouhadthesethoughts?
(1)Onlyonetime
(2)Afewtimes
(3)Alot
(4)Allthetime DescriptionofIdeation Writeresponse___________________________________
(0)Don’tknow/Notapplicable YesNo □□ YesNo □□ MostSevere____ ©2008ResearchFoundationforMentalHygiene,Inc. C-‐SSRS—Children’sBaseline(Version6/23/10) Page1of2 SUICIDALBEHAVIOR (Checkallthatapply,solongastheseareseparateevents;mustaskaboutalltypes)ActualAttempt:Apotentiallyself-injuriousmittedwithatleastsomewishtodie,asaresultofact.Behaviorwasinpartthoughtofasmethodtokilloneself.Intentdoesnothavetobe100%.Ifthereisanyintent/desiretodieassociatedwiththeact,thenitcanbeconsideredanactualsuicideattempt.Theredoesnothavetobeanyinjuryorharm,justthepotentialforinjuryorharm.Ifpersonpullstriggerwhilegunisinmouthbutgunisbrokensonoinjuryresults,thisisconsideredanattempt.InferringIntent:Evenifanindividualdeniesintent/wishtodie,itmaybeinferredclinicallyfromthebehaviororcircumstances.Forexample,ahighlylethalactthatisclearlynotanidentsonootherintentbutsuicidecanbeinferred(e.g.,gunshottohead,jumpingfromwindowofahighfloor/story).Also,ifsomeonedeniesintenttodie,buttheythoughtthatwhattheydidcouldbelethal,intentmaybeinferred.Didyoueverdoanythingtotrytokillyourselformakeyourselfnotaliveanymore?
Whatdidyoudo?
Didyoueverhurtyourselfonpurpose?
Whydidyoudothat?
Didyou______asawaytoendyourlife?
Didyouwanttodie(evenalittle)whenyou_____?
Wereyoutryingtomakeyourselfnotaliveanymorewhenyou_____?
Ordidyouthinkitwaspossibleyoucouldhavediedfrom_____?
Ordidyoudoitpurelyforotherreasons,notatalltoendyourlifeorkillyourself(liketomakeyourselffeelbetter,orgetsomethingelsetohappen)?
(Self-InjuriousBehaviorwithoutsuicidalintent) Ifyes,describe: HassubjectengagedinNon-SuicidalSelf-InjuriousBehavior?
HassubjectengagedinSelf-InjuriousBehavior,intentunknown?
InterruptedAttempt: Whenthepersonisinterrupted(byanoutsidecircumstance)fromstartingthepotentiallyself-injuriousact(ifnotforthat,actualattemptwouldhaveurred).Overdose:Personhaspillsinhandbutispedfromingesting.Oncetheyingestanypills,thisesanattemptratherthananinterruptedattempt.Shooting:Personhasgunpointedtowardself,gunistakenawaybysomeoneelse,orissomehowpreventedfrompullingtrigger.Oncetheypullthetrigger,evenifthegunfailstofire,itisanattempt.Jumping:Personispoisedtojump,isgrabbedandtakendownfromledge.Hanging:Personhasnoosearoundneckbuthasnotyetstartedtohang-ispedfromdoingso. Hastherebeenatimewhenyoustartedtodosomethingtomakeyourselfnotaliveanymore(endyourlifeorkillyourself)butsomeoneorsomethingpedyoubeforeyouactuallydidanything?
Whatdidyoudo?
Ifyes,describe: AbortedAttempt: Whenpersonbeginstotakestepstowardmakingasuicideattempt,butsthemselvesbeforetheyactuallyhaveengagedinanyself-destructivebehavior.Examplesaresimilartointerruptedattempts,exceptthattheindividualshim/herself,insteadofbeingpedbysomethingelse. Hastherebeenatimewhenyoustartedtodosomethingtomakeyourselfnotaliveanymore(endyourlifeorkillyourself)butyouchangedyourmind(pedyourself)beforeyouactuallydidanything?
Whatdidyoudo?
Ifyes,describe: PreparatoryActsorBehavior: Actsorpreparationtowardsimminentlymakingasuicideattempt.Thiscanincludeanythingbeyondaverbalizationorthought,suchasassemblingaspecificmethod(e.g.,buyingpills,purchasingagun)orpreparingforone’sdeathbysuicide(e.g.,givingthingsaway,writingasuicidenote). Haveyoudoneanythingtogetreadytomakeyourselfnotaliveanymore(toendyourlifeorkillyourself)-likegivingthingsaway,writingagoodbyenote,gettingthingsyouneedtokillyourself?
Ifyes,describe: LifetimeYesNo □□ Total#ofAttempts______ □□YesNo□□YesNo YesNo □□ Total#ofinterrupted ______YesNo □□ Total#ofaborted______YesNo □□ SuicidalBehavior: Suicidalbehaviorwaspresentduringtheassessmentperiod?
AnswerforActualAttemptsOnly MostRecentAttemptDate: ActualLethality/MedicalDamage:
0.Nophysicaldamageorveryminorphysicaldamage(e.g.,surfacescratches).1.Minorphysicaldamage(e.g.,lethargicspeech;first-degreeburns;mildbleeding;sprains).2.Moderatephysicaldamage;medicalattentionneeded(e.g.,consciousbutsleepy,somewhatresponsive;second-degree burns;bleedingofmajorvessel).3.Moderatelyseverephysicaldamage;medicalhospitalizationandlikelyintensivecarerequired(e.g.,atosewith reflexesintact;third-degreeburnslessthan20%ofbody;extensivebloodlossbutcanrecover;majorfractures).4.Severephysicaldamage;medicalhospitalizationwithintensivecarerequired(e.g.,atosewithoutreflexes;third- degreeburnsover20%ofbody;extensivebloodlosswithunstablevitalsigns;majordamagetoavitalarea).5.Death EnterCode ______ PotentialLethality:OnlyAnswerifActualLethality=
0 Likelylethalityofactualattemptifnomedicaldamage(thefollowingexamples,whilehavingnoactualmedicaldamage,hadpotentialforveryseriouslethality:putguninmouthandpulledthetriggerbutgunfailstofiresonomedicaldamage;layingontraintrackswithingtrainbutpulledawaybeforerunover). EnterCode 0=Behaviornotlikelytoresultininjury1=Behaviorlikelytoresultininjurybutnotlikelytocausedeath2=Behaviorlikelytoresultindeathdespiteavailablemedicalcare ©2008ResearchFoundationforMentalHygiene,Inc. C-‐SSRS—Children’sBaseline(Version6/23/10) ______ MostLethalAttemptDate: EnterCode YesNo □□ Initial/FirstAttemptDate: EnterCode ____________ EnterCodeEnterCode ____________ Page2of2
K.;Brent,
D.;Lucas,
C.;Gould,
M.;Stanley,
B.;Brown,
G.;Fisher,
P.;Zelazny,
J.;Burke,
A.;Oquendo,
M.;Mann,
J. Disclaimer:Thisscaleisintendedtobeusedbyindividualswhohavereceivedtraininginitsadministration.Thequestionscontained intheColumbia-SuicideSeverityRatingScalearesuggestedprobes.Ultimately,thedeterminationofthepresenceofsuicidalideationorbehaviordependsonthejudgmentoftheindividualadministeringthescale. DefinitionsofbehavioralsuicidaleventsinthisscalearebasedonthoseusedinTheColumbiaSuicideHistoryForm,developedbyJohnMann,MDandMariaOquendo,MD,ConteCenterfortheNeuroscienceofMentalDisorders(CCNMD),NewYorkStatePsychiatricInstitute,1051RiversideDrive,NewYork,NY,10032.(OquendoM.A.,HalberstamB.&MannJ.J.,Riskfactorsforsuicidalbehavior:utilityandlimitationsofresearchinstruments.InM.B.First[Ed.]StandardizedEvaluationinClinicalPractice,pp.103-130,2003.) ForreprintsoftheC-SSRScontactKellyPosner,Ph.D.,NewYorkStatePsychiatricInstitute,1051RiversideDrive,NewYork,NewYork,10032;inquiriesandtrainingrequirementscontactposnerk@nyspi.columbia.edu ©2008TheResearchFoundationforMentalHygiene,Inc. SUICIDALIDEATION Askquestions1and2.Ifbotharenegative,proceedto“SuicidalBehavior”section.Iftheanswertoquestion2is“yes”,askquestions3,4and5.Iftheanswertoquestion1and/or2is“yes”,plete“IntensityofIdeation”sectionbelow. Lifetime
1.WishtobeDead Subjectendorsesthoughtsaboutawishtobedeadornotaliveanymore,orwishtofallasleepandnotwakeup.Haveyouthoughtaboutbeingdeadorwhatitwouldbeliketobedead?
Haveyouwishedyouweredeadorwishedyoucouldgotosleepandneverwakeup?
Doyoueverwishyouweren’taliveanymore?
Ifyes,describe:
2.Non-SpecificActiveSuicidalThoughts General,non-specificthoughtsofwantingtoendone’smitsuicide(e.g.,“I’vethoughtaboutkillingmyself”)withoutthoughtsofwaystokilloneself/associatedmethods,intent,orplan.Haveyouthoughtaboutdoingsomethingtomakeyourselfnotaliveanymore?
Haveyouhadanythoughtsaboutkillingyourself?
Ifyes,describe:
3.ActiveSuicidalIdeationwithAnyMethods(NotPlan)withoutIntenttoAct Subjectendorsesthoughtsofsuicideandhasthoughtofatleastonemethodduringtheassessmentperiod.Thisisdifferentthanaspecificplanwithtime,placeormethoddetailsworkedout(e.g.,thoughtofmethodtokillselfbutnotaspecificplan).Includespersonwhowouldsay,“IthoughtabouttakinganoverdosebutInevermadeaspecificplanastowhen,whereorhowIwouldactuallydoit…andIwouldnevergothroughwithit.”Haveyouthoughtabouthowyouwoulddothatorhowyouwouldmakeyourselfnotaliveanymore(killyourself)?
Whatdidyouthinkabout?
Ifyes,describe: YesNo □□ YesNo □□ YesNo □□
4.ActiveSuicidalIdeationwithSomeIntenttoAct,withoutSpecificPlan Activesuicidalthoughtsofkillingoneselfandsubjectreportshavingsomeintenttoactonsuchthoughts,asopposedto“IhavethethoughtsbutIdefinitelywillnotdoanythingaboutthem.”Whenyouthoughtaboutmakingyourselfnotaliveanymore(orkillingyourself),didyouthinkthatthiswassomethingyoumightactuallydo?
Thisisdifferentfrom(asopposedto)havingthethoughtsbutknowingyouwouldn’tdoanythingaboutit. Ifyes,describe:
5.ActiveSuicidalIdeationwithSpecificPlanandIntent Thoughtsofkillingoneselfwithdetailsofplanfullyorpartiallyworkedoutandsubjecthassomeintenttocarryitout.Haveyoueverdecidedhoworwhenyouwouldmakeyourselfnotaliveanymore/killyourself?
Haveyoueverplannedout(workedoutthedetailsof)howyouwoulddoit?
Whatwasyourplan?
Whenyoumadethisplan(orworkedoutthesedetails),wasanypartofyouthinkingaboutactuallydoingit?
Ifyes,describe: INTENSITYOFIDEATION Thefollowingfeatureshouldberatedwithrespecttothemostseveretypeofideation(i.e.,1-5fromabove,with1beingtheleastsevereand5beingthemostsevere). MostSevereIdeation:___________ _________________________________________________ Type#(1-5)Frequency Howmanytimeshaveyouhadthesethoughts?
(1)Onlyonetime
(2)Afewtimes
(3)Alot
(4)Allthetime DescriptionofIdeation Writeresponse___________________________________
(0)Don’tknow/Notapplicable YesNo □□ YesNo □□ MostSevere____ ©2008ResearchFoundationforMentalHygiene,Inc. C-‐SSRS—Children’sBaseline(Version6/23/10) Page1of2 SUICIDALBEHAVIOR (Checkallthatapply,solongastheseareseparateevents;mustaskaboutalltypes)ActualAttempt:Apotentiallyself-injuriousmittedwithatleastsomewishtodie,asaresultofact.Behaviorwasinpartthoughtofasmethodtokilloneself.Intentdoesnothavetobe100%.Ifthereisanyintent/desiretodieassociatedwiththeact,thenitcanbeconsideredanactualsuicideattempt.Theredoesnothavetobeanyinjuryorharm,justthepotentialforinjuryorharm.Ifpersonpullstriggerwhilegunisinmouthbutgunisbrokensonoinjuryresults,thisisconsideredanattempt.InferringIntent:Evenifanindividualdeniesintent/wishtodie,itmaybeinferredclinicallyfromthebehaviororcircumstances.Forexample,ahighlylethalactthatisclearlynotanidentsonootherintentbutsuicidecanbeinferred(e.g.,gunshottohead,jumpingfromwindowofahighfloor/story).Also,ifsomeonedeniesintenttodie,buttheythoughtthatwhattheydidcouldbelethal,intentmaybeinferred.Didyoueverdoanythingtotrytokillyourselformakeyourselfnotaliveanymore?
Whatdidyoudo?
Didyoueverhurtyourselfonpurpose?
Whydidyoudothat?
Didyou______asawaytoendyourlife?
Didyouwanttodie(evenalittle)whenyou_____?
Wereyoutryingtomakeyourselfnotaliveanymorewhenyou_____?
Ordidyouthinkitwaspossibleyoucouldhavediedfrom_____?
Ordidyoudoitpurelyforotherreasons,notatalltoendyourlifeorkillyourself(liketomakeyourselffeelbetter,orgetsomethingelsetohappen)?
(Self-InjuriousBehaviorwithoutsuicidalintent) Ifyes,describe: HassubjectengagedinNon-SuicidalSelf-InjuriousBehavior?
HassubjectengagedinSelf-InjuriousBehavior,intentunknown?
InterruptedAttempt: Whenthepersonisinterrupted(byanoutsidecircumstance)fromstartingthepotentiallyself-injuriousact(ifnotforthat,actualattemptwouldhaveurred).Overdose:Personhaspillsinhandbutispedfromingesting.Oncetheyingestanypills,thisesanattemptratherthananinterruptedattempt.Shooting:Personhasgunpointedtowardself,gunistakenawaybysomeoneelse,orissomehowpreventedfrompullingtrigger.Oncetheypullthetrigger,evenifthegunfailstofire,itisanattempt.Jumping:Personispoisedtojump,isgrabbedandtakendownfromledge.Hanging:Personhasnoosearoundneckbuthasnotyetstartedtohang-ispedfromdoingso. Hastherebeenatimewhenyoustartedtodosomethingtomakeyourselfnotaliveanymore(endyourlifeorkillyourself)butsomeoneorsomethingpedyoubeforeyouactuallydidanything?
Whatdidyoudo?
Ifyes,describe: AbortedAttempt: Whenpersonbeginstotakestepstowardmakingasuicideattempt,butsthemselvesbeforetheyactuallyhaveengagedinanyself-destructivebehavior.Examplesaresimilartointerruptedattempts,exceptthattheindividualshim/herself,insteadofbeingpedbysomethingelse. Hastherebeenatimewhenyoustartedtodosomethingtomakeyourselfnotaliveanymore(endyourlifeorkillyourself)butyouchangedyourmind(pedyourself)beforeyouactuallydidanything?
Whatdidyoudo?
Ifyes,describe: PreparatoryActsorBehavior: Actsorpreparationtowardsimminentlymakingasuicideattempt.Thiscanincludeanythingbeyondaverbalizationorthought,suchasassemblingaspecificmethod(e.g.,buyingpills,purchasingagun)orpreparingforone’sdeathbysuicide(e.g.,givingthingsaway,writingasuicidenote). Haveyoudoneanythingtogetreadytomakeyourselfnotaliveanymore(toendyourlifeorkillyourself)-likegivingthingsaway,writingagoodbyenote,gettingthingsyouneedtokillyourself?
Ifyes,describe: LifetimeYesNo □□ Total#ofAttempts______ □□YesNo□□YesNo YesNo □□ Total#ofinterrupted ______YesNo □□ Total#ofaborted______YesNo □□ SuicidalBehavior: Suicidalbehaviorwaspresentduringtheassessmentperiod?
AnswerforActualAttemptsOnly MostRecentAttemptDate: ActualLethality/MedicalDamage:
0.Nophysicaldamageorveryminorphysicaldamage(e.g.,surfacescratches).1.Minorphysicaldamage(e.g.,lethargicspeech;first-degreeburns;mildbleeding;sprains).2.Moderatephysicaldamage;medicalattentionneeded(e.g.,consciousbutsleepy,somewhatresponsive;second-degree burns;bleedingofmajorvessel).3.Moderatelyseverephysicaldamage;medicalhospitalizationandlikelyintensivecarerequired(e.g.,atosewith reflexesintact;third-degreeburnslessthan20%ofbody;extensivebloodlossbutcanrecover;majorfractures).4.Severephysicaldamage;medicalhospitalizationwithintensivecarerequired(e.g.,atosewithoutreflexes;third- degreeburnsover20%ofbody;extensivebloodlosswithunstablevitalsigns;majordamagetoavitalarea).5.Death EnterCode ______ PotentialLethality:OnlyAnswerifActualLethality=
0 Likelylethalityofactualattemptifnomedicaldamage(thefollowingexamples,whilehavingnoactualmedicaldamage,hadpotentialforveryseriouslethality:putguninmouthandpulledthetriggerbutgunfailstofiresonomedicaldamage;layingontraintrackswithingtrainbutpulledawaybeforerunover). EnterCode 0=Behaviornotlikelytoresultininjury1=Behaviorlikelytoresultininjurybutnotlikelytocausedeath2=Behaviorlikelytoresultindeathdespiteavailablemedicalcare ©2008ResearchFoundationforMentalHygiene,Inc. C-‐SSRS—Children’sBaseline(Version6/23/10) ______ MostLethalAttemptDate: EnterCode YesNo □□ Initial/FirstAttemptDate: EnterCode ____________ EnterCodeEnterCode ____________ Page2of2
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