Suicide Risk Assessment: C-SSRS Screen and Full Scale

What it includes

Three structured approaches to documenting suicide risk, on separate tabs. They support clinical assessment and do not replace it. Any positive screen needs immediate further evaluation. For crisis support, call or text the 988 Suicide & Crisis Lifeline, 24/7.

C-SSRS Screen Version

Six yes/no questions from the Columbia-Suicide Severity Rating Scale. Q1 and Q2 ask about the past month. Q3 to Q5 appear only if Q2 is yes. Q6 asks about lifetime suicidal behavior, with a follow-up asking whether it happened in the past three months. Calculate Risk Level applies this triage:

Responses	Result	Guidance shown
Yes to Q4 (intent) or Q5 (plan with intent), or behavior in the past 3 months	High risk	Immediate safety assessment; consider psychiatric consultation, safety planning and level of care; restrict access to lethal means
Yes to Q3 (method), or lifetime behavior not in the past 3 months	Moderate risk	Further evaluation; develop or review a safety plan; consider closer contact and monitoring
Yes to Q1 or Q2 only	Low risk	Continue monitoring, address underlying conditions, provide crisis resources
No to all	None	Continue routine screening per protocol

C-SSRS Full Risk Assessment and AFSP framework

The full assessment has five expandable sections:

• A: a risk and protective factors checklist covering recent behavior, ideation, activating events, treatment history and clinical status
• B: the five levels of suicidal ideation, from wish to be dead to active ideation with a specific plan and intent, rated lifetime and past month
• C: intensity of ideation (frequency, duration, controllability, deterrents, reasons for ideation)
• D: suicidal behavior, covering actual, interrupted and aborted attempts, preparatory acts and non-suicidal self-injury, with counts
• E: actual and potential lethality for the most recent, most lethal and initial attempts

The third tab follows American Foundation for Suicide Prevention guidance. It lists 18 risk factors (health, environmental and historical), 7 protective factors, and 22 warning signs grouped as talk, behavior and mood, with a running count for each list. You then record the care setting, your overall clinical risk judgment (high, medium or low), and the modifiable factors to target. The tool does not compute that overall judgment; the clinician makes it.

What the summaries include

Each tab produces a plain-text summary to copy into the record: the screen responses and triage result; the findings from each section of the full assessment; or the checked factors, warning signs, setting, overall risk level, modifiable factors and counts. A blank form can be printed. Sources: Posner K, Brown GK, Stanley B, et al. J Clin Psychiatry. 2011;72(2):233-239, and AFSP guidance on risk factors, protective factors and warning signs.