C-SSRS (Suicide Severity)

C-SSRS: FDA-mandated structured clinician interview. Assess the HIGHEST level of ideation that occurred in the rating period. Any positive behavior requires immediate clinical response.

Suicidal Ideation — Select highest level present

Suicidal Behavior — Check all that apply (lifetime or specified period)

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

ALL patients presenting with suicidal ideation, self-harm, or psychiatric emergency

Baseline and follow-up assessment in any patient with known depression, bipolar disorder, schizophrenia, or substance use disorder

Mandatory FDA assessment protocol for all psychiatric drug trials since 2012

ED triage of patients presenting after self-poisoning or self-harm

Inpatient: daily during admission; outpatient: at every visit for high-risk patients

FDA Regulatory Status

The FDA requires C-SSRS or equivalent validated instrument for all drug trials with psychiatric primary or secondary outcomes. It is mandated in all US Veterans Affairs facilities.

How it Works

Ideation Hierarchy (Rate the Highest Level Present)

Level	Definition
0	No suicidal ideation
1	Wish to be dead (passive)
2	Non-specific active suicidal ideation
3	Active ideation with method (no plan or intent)
4	Active ideation with some intent to act
5	Active ideation with specific plan and intent

Suicidal Behavior Categories

Actual suicide attempt

Interrupted attempt (by another person)

Aborted/self-interrupted attempt

Preparatory acts or behavior

Non-suicidal self-injurious behavior (documented separately)

Clinical Pearls

Risk Stratification

Finding	Risk Level	Action
Ideation Level 1–2	Low	Safety plan, follow-up within 1 week
Ideation Level 3	Moderate	Same-day psychiatric evaluation, means restriction
Ideation Level 4–5	High	Emergency assessment, consider admission
Any suicidal behavior	High/Immediate	Emergency psychiatric assessment

Critical Points

C-SSRS is NEVER administered as a self-report tool — must be clinician-administered interview

ANY positive suicidal behavior (regardless of ideation score) warrants emergency response

The timeframe must be specified: rating period (past week, past month, lifetime) must be consistent within a study or clinical protocol

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

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C-SSRS (Suicide Severity)

When to Use

When to Use

FDA Regulatory Status

How it Works

Ideation Hierarchy (Rate the Highest Level Present)

Suicidal Behavior Categories

Clinical Pearls

Risk Stratification

Critical Points

Next Steps

Mandatory Documentation

The Evidence

Origins & History

Development

In Recent Clinical News

C-SSRS (Suicide Severity)

When to Use

When to Use

FDA Regulatory Status

How it Works

Ideation Hierarchy (Rate the Highest Level Present)

Suicidal Behavior Categories

Clinical Pearls

Risk Stratification

Critical Points

Next Steps

Mandatory Documentation

The Evidence

Origins & History

Development

In Recent Clinical News