Rating Scale Successfully Predicts Suicide Attempts and Guides Intervention

Kelly Posner is trying to save lives. As director of the Center for Suicide Risk Assessment, she led a team from Columbia’s Department of Psychiatry in developing a tool that successfully predicts suicidal intent.

In a study published in the November 8 AJP in Advance, the early edition of The American Journal of Psychiatry, University researchers found that the Columbia-Suicide Severity Rating Scale (C-SSRS) is not only pivotal to assessing suicidal behavior, but it can help predict an attempt.

“The results are likely to have tremendous impact both nationally and internationally,” said Posner, who is also an associate clinical professor of medical psychology at the College of Physicians and Surgeons. “Now clinicians have a real scientific footing on which to base treatment interventions. What our study shows is that using the C-SSRS helps to identify patients that would have fallen through the cracks.”

The assessment tool, which is available in 103 languages, consists of a series of questions that determine a person’s suicidal thoughts and behavior. It can be administered in minutes in emergency rooms, clinical settings, schools or primary care offices by anyone trained in the protocol—not just healthcare professionals. If patients reach a certain threshold on the scale they can be referred for further evaluation and possible intervention.

“We know that 50 percent of people who die by suicide see their primary care doctor the month before they die,” said Posner. “We should be asking these questions the way we monitor for blood pressure.”

Before the scale was introduced, researchers and clinicians had no diagnostic screening guidelines by which to define suicide risk. In 2002, the Institute of Medicine, a non-governmental advisory group, noted that a lack of definitions and standardization presented major obstacles to suicide prevention. The FDA then requested the creation of a standardized assessment tool for suicidal behavior, selecting Columbia researchers to lead that initiative. The study, which builds upon that work, was carried out at three sites that treated adolescents and adults who had attempted suicide, and who had been admitted to emergency rooms.

“It gives us a great deal of hope that those individuals at greatest risk can be identified and treated,” said Jeffrey Lieberman, M.D., chairman of Columbia’s Department of Psychiatry and director of the New York State Psychiatric Institute. “The public health benefits in terms of lives saved could be enormous.”

The ratings scale is used worldwide in intervention studies and clinical trials across a broad range of disorders and diseases. Institutions—including the U.S. military, the World Health Organization and local fire departments—have successfully used it to better identify people who need intervention—and to manage the cost of treatments. One California correctional facility spends almost $20 million a year on suicide watch; a cost that could be greatly reduced with effective screening.

Funding for the study was provided by the National Institutes of Health and the American Foundation for Suicide Prevention.