UMass Chan Medical School Faculty Publications


C-SSRS performance in emergency department patients at high risk for suicide

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Emergency Medicine | Health Services Administration | Mental and Social Health | Mental Disorders | Psychiatry and Psychology


OBJECTIVE: To evaluate the psychometric and predictive performance of the Columbia-Suicide Severity Rating Scale (C-SSRS) in emergency department (ED) patients with suicidal ideation or attempts (SI/SA).

METHODS: Participants (n = 1,376, mean age 36.8, 55% female, 76.8% white) completed the C-SSRS during the ED visit and were followed for one year. Reliability analyses, exploratory structural equation modeling, and prediction of future SA were explored.

RESULTS: Reliability of the Suicidal Ideation subscale was adequate, but was poor for the Intensity of Ideation and Suicidal Behavior subscales. Three empirically derived factors characterized the C-SSRS. Only Factor 1 (Suicidal Ideation and Attempts) was a reliable predictor of subsequent SA, though odds ratios were small (ORs: 1.09-1.10, CI95% : 1.04, 1.15). The original C-SSRS Suicidal Ideation and Suicidal Behavior subscales and the C-SSRS ED screen predicted subsequent SA, again with small odds ratios (ORs: 1.07-1.19, CI95% : 1.01, 1.29). In participants without a SA history, no C-SSRS subscale predicted subsequent SA. History of any SA (OR: 1.98, CI95% : 1.43, 2.75) was the strongest predictor of subsequent SA.

CONCLUSIONS: The psychometric evidence for the C-SSRS was mixed. History of a prior SA, as measured by the C-SSRS, provided the most parsimonious and powerful assessment for predicting future SA.

DOI of Published Version



Brown LA, Boudreaux ED, Arias SA, Miller IW, May AM, Camargo CA Jr, Bryan CJ, Armey MF. C-SSRS performance in emergency department patients at high risk for suicide. Suicide Life Threat Behav. 2020 Jul 24. doi: 10.1111/sltb.12657. Epub ahead of print. PMID: 32706437. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Suicide and life-threatening behavior

PubMed ID