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CDC Self-Directed Violence: Uniform Definitions Adopted Columbia Definitions (link to C-SSRS in CDC document)
lack of conceptual clarity about suicidal behavior and absence of well- defined terminology Variability of terms referring to same behaviors Multiple terms for the same behavior Consequences If suicidal behavior and ideation cannot be properly identified, it cannot be properly understood, managed or treated in any population or diagnosis
Everyone, Everywhere Can Ask
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You Don’t Have to Rely on Individual’s Report
Examples… 11
C-SSRS Screener
Method or Plan?
C-SSRS Screener
C-SSRS Lifetime Assessment
19 INTENSITY OF IDEATION The following features should be rated with respect to the most severe type of ideation (i.e.,1-5 from above, with 1 being the least severe and 5 being the most severe ). Ask about time he/she was feeling the most suicidal. Most Severe Ideation: _____ _________________________________________________ Type # (1-5) Description of Ideation Most Severe Frequency How many times have you had these thoughts? (1) Less than once a week (2) Once a week (3) 2-5 times in week (4) Daily or almost daily (5) Many times each day ____ Duration When you have the thoughts, how long do they last? (1) Fleeting - few seconds or minutes (4) 4-8 hours/most of day (2) Less than 1 hour/some of the time (5) More than 8 hours/persistent or continuous (3) 1-4 hours/a lot of time ____ Controllability Could /can you stop thinking about killing yourself or wanting to die if you want to? (1) Easily able to control thoughts (4) Can control thoughts with a lot of difficulty (2) Can control thoughts with little difficulty (5) Unable to control thoughts (3) Can control thoughts with some difficulty (0) Does not attempt to control thoughts ____ Deterrents Are there things - anyone or anything (e.g. family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of committing suicide? (1) Deterrents definitely stopped you from attempting suicide (4) Deterrents most likely did not stop you (2) Deterrents probably stopped you (5) Deterrents definitely did not stop you (3) Uncertain that deterrents stopped you (0) Does not apply ____ Reasons for Ideation What sort of reasons did you have for thinking about wanting to die or killing yourself? Was it to end the pain or stop the way you were feeling (in other words you couldn’t go on living with this pain or how you were feeling) or was it to get attention, revenge or a reaction from others? Or both? (1) Completely to get attention, revenge or a reaction from others. (4) Mostly to end or stop the pain (you couldn’t go on (2) Mostly to get attention, revenge or a reaction from others. living with the pain or how you were feeling). (3) Equally to get attention, revenge or a reaction from others (5) Completely to end or stop the pain (you couldn’t go on and to end/stop the pain. living with the pain or how you were feeling). (0) Does not apply ____
20 INTENSITY OF IDEATION The following features should be rated with respect to the most severe type of ideation (i.e.,1-5 from above, with 1 being the least severe and 5 being the most severe ). Ask about time he/she was feeling the most suicidal. Most Severe Ideation: _____ _________________________________________________ Type # (1-5) Description of Ideation Most Severe Frequency How many times have you had these thoughts? (1) Less than once a week (2) Once a week (3) 2-5 times in week (4) Daily or almost daily (5) Many times each day ____ Duration When you have the thoughts, how long do they last? (1) Fleeting - few seconds or minutes (4) 4-8 hours/most of day (2) Less than 1 hour/some of the time (5) More than 8 hours/persistent or continuous (3) 1-4 hours/a lot of time ____ Controllability Could /can you stop thinking about killing yourself or wanting to die if you want to? (1) Easily able to control thoughts (4) Can control thoughts with a lot of difficulty (2) Can control thoughts with little difficulty (5) Unable to control thoughts (3) Can control thoughts with some difficulty (0) Does not attempt to control thoughts ____ Deterrents Are there things - anyone or anything (e.g. family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of committing suicide? (1) Deterrents definitely stopped you from attempting suicide (4) Deterrents most likely did not stop you (2) Deterrents probably stopped you (5) Deterrents definitely did not stop you (3) Uncertain that deterrents stopped you (0) Does not apply ____ Reasons for Ideation What sort of reasons did you have for thinking about wanting to die or killing yourself? Was it to end the pain or stop the way you were feeling (in other words you couldn’t go on living with this pain or how you were feeling) or was it to get attention, revenge or a reaction from others? Or both? (1) Completely to get attention, revenge or a reaction from others. (4) Mostly to end or stop the pain (you couldn’t go on (2) Mostly to get attention, revenge or a reaction from others. living with the pain or how you were feeling). (3) Equally to get attention, revenge or a reaction from others (5) Completely to end or stop the pain (you couldn’t go on and to end/stop the pain. living with the pain or how you were feeling). (0) Does not apply ____
21 INTENSITY OF IDEATION The following features should be rated with respect to the most severe type of ideation (i.e.,1-5 from above, with 1 being the least severe and 5 being the most severe ). Ask about time he/she was feeling the most suicidal. Most Severe Ideation: _____ _________________________________________________ Type # (1-5) Description of Ideation Most Severe Frequency How many times have you had these thoughts? (1) Less than once a week (2) Once a week (3) 2-5 times in week (4) Daily or almost daily (5) Many times each day ____ Duration When you have the thoughts, how long do they last? (1) Fleeting - few seconds or minutes (4) 4-8 hours/most of day (2) Less than 1 hour/some of the time (5) More than 8 hours/persistent or continuous (3) 1-4 hours/a lot of time ____ Controllability Could /can you stop thinking about killing yourself or wanting to die if you want to? (1) Easily able to control thoughts (4) Can control thoughts with a lot of difficulty (2) Can control thoughts with little difficulty (5) Unable to control thoughts (3) Can control thoughts with some difficulty (0) Does not attempt to control thoughts ____ Deterrents Are there things - anyone or anything (e.g. family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of committing suicide? (1) Deterrents definitely stopped you from attempting suicide (4) Deterrents most likely did not stop you (2) Deterrents probably stopped you (5) Deterrents definitely did not stop you (3) Uncertain that deterrents stopped you (0) Does not apply ____ Reasons for Ideation What sort of reasons did you have for thinking about wanting to die or killing yourself? Was it to end the pain or stop the way you were feeling (in other words you couldn’t go on living with this pain or how you were feeling) or was it to get attention, revenge or a reaction from others? Or both? (1) Completely to get attention, revenge or a reaction from others. (4) Mostly to end or stop the pain (you couldn’t go on (2) Mostly to get attention, revenge or a reaction from others. living with the pain or how you were feeling). (3) Equally to get attention, revenge or a reaction from others (5) Completely to end or stop the pain (you couldn’t go on and to end/stop the pain. living with the pain or how you were feeling). (0) Does not apply ____
22 INTENSITY OF IDEATION The following features should be rated with respect to the most severe type of ideation (i.e.,1-5 from above, with 1 being the least severe and 5 being the most severe ). Ask about time he/she was feeling the most suicidal. Most Severe Ideation: _____ _________________________________________________ Type # (1-5) Description of Ideation Most Severe Frequency How many times have you had these thoughts? (1) Less than once a week (2) Once a week (3) 2-5 times in week (4) Daily or almost daily (5) Many times each day ____ Duration When you have the thoughts, how long do they last? (1) Fleeting - few seconds or minutes (4) 4-8 hours/most of day (2) Less than 1 hour/some of the time (5) More than 8 hours/persistent or continuous (3) 1-4 hours/a lot of time ____ Controllability Could /can you stop thinking about killing yourself or wanting to die if you want to? (1) Easily able to control thoughts (4) Can control thoughts with a lot of difficulty (2) Can control thoughts with little difficulty (5) Unable to control thoughts (3) Can control thoughts with some difficulty (0) Does not attempt to control thoughts ____ Deterrents Are there things - anyone or anything (e.g. family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of committing suicide? (1) Deterrents definitely stopped you from attempting suicide (4) Deterrents most likely did not stop you (2) Deterrents probably stopped you (5) Deterrents definitely did not stop you (3) Uncertain that deterrents stopped you (0) Does not apply ____ Reasons for Ideation What sort of reasons did you have for thinking about wanting to die or killing yourself? Was it to end the pain or stop the way you were feeling (in other words you couldn’t go on living with this pain or how you were feeling) or was it to get attention, revenge or a reaction from others? Or both? (1) Completely to get attention, revenge or a reaction from others. (4) Mostly to end or stop the pain (you couldn’t go on (2) Mostly to get attention, revenge or a reaction from others. living with the pain or how you were feeling). (3) Equally to get attention, revenge or a reaction from others (5) Completely to end or stop the pain (you couldn’t go on and to end/stop the pain. living with the pain or how you were feeling). (0) Does not apply ____
23 INTENSITY OF IDEATION The following features should be rated with respect to the most severe type of ideation (i.e.,1-5 from above, with 1 being the least severe and 5 being the most severe ). Ask about time he/she was feeling the most suicidal. Most Severe Ideation: _____ _________________________________________________ Type # (1-5) Description of Ideation Most Severe Frequency How many times have you had these thoughts? (1) Less than once a week (2) Once a week (3) 2-5 times in week (4) Daily or almost daily (5) Many times each day ____ Duration When you have the thoughts, how long do they last? (1) Fleeting - few seconds or minutes (4) 4-8 hours/most of day (2) Less than 1 hour/some of the time (5) More than 8 hours/persistent or continuous (3) 1-4 hours/a lot of time ____ Controllability Could /can you stop thinking about killing yourself or wanting to die if you want to? (1) Easily able to control thoughts (4) Can control thoughts with a lot of difficulty (2) Can control thoughts with little difficulty (5) Unable to control thoughts (3) Can control thoughts with some difficulty (0) Does not attempt to control thoughts ____ Deterrents Are there things - anyone or anything (e.g. family, religion, pain of death) - that stopped you from wanting to die or acting on thoughts of committing suicide? (1) Deterrents definitely stopped you from attempting suicide (4) Deterrents most likely did not stop you (2) Deterrents probably stopped you (5) Deterrents definitely did not stop you (3) Uncertain that deterrents stopped you (0) Does not apply ____ Reasons for Ideation What sort of reasons did you have for thinking about wanting to die or killing yourself? Was it to end the pain or stop the way you were feeling (in other words you couldn’t go on living with this pain or how you were feeling) or was it to get attention, revenge or a reaction from others? Or both? (1) Completely to get attention, revenge or a reaction from others. (4) Mostly to end or stop the pain (you couldn’t go on (2) Mostly to get attention, revenge or a reaction from others. living with the pain or how you were feeling). (3) Equally to get attention, revenge or a reaction from others (5) Completely to end or stop the pain (you couldn’t go on and to end/stop the pain. living with the pain or how you were feeling). (0) Does not apply ____
C-SSRS Lifetime Assessment
Full Suicidal Behavior Subscale
C-SSRS Lifetime Assessment
Importance of Inference
C-SSRS Lifetime Assessment
When person starts to take steps to end their life but someone or something stops them Examples: Bottle of pills or gun in hand but someone grabs it On ledge poised to jump When person begins to take steps towards making a suicide attempt, but stops themselves before they actually have engaged in any self-destructive behavior Examples: Man walks up to the roof to jump, but changes his mind and turns around She has gun in her hand, but then puts it down Any other behavior (beyond saying something) with suicidal intent Examples: Collecting or buying pills Purchasing a gun Writing a will or a suicide note Interrupted Attempt Aborted Attempt Preparatory Acts
C-SSRS Lifetime Assessment
Practice
Yes Interrupted Yes Yes- Hanging Yes - Attempted Yes- Plans to attempt again 5
Practice
Yes Interrupted Yes Yes- Knife Yes – Cut Herself with Knife No- Attempt was Impulsive 4
Resources