3. Active ideation with any methods (not plan), without intent to act
4. Active ideation with some intent to act, without a specific plan
5. Active ideation with a specific plan and intent
Suicidal behaviour
6. Any suicidal behaviour, ever (attempt, aborted or interrupted attempt, preparatory acts)
Evidence
Original publication
Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Established the C-SSRS ideation severity (1–5) and behaviour subscales, with good convergent and divergent validity and sensitivity to change.
American Journal of Psychiatry, 2011
Open source
Guideline
The C-SSRS is endorsed by the US FDA, CDC and many health systems for systematic suicide-risk screening. The screener flags who needs a fuller assessment; it does not by itself determine disposition. Any positive behaviour item, or ideation item 4 or 5, warrants urgent mental-health evaluation and attention to means safety. Follow local safeguarding and mental-health pathways.
Last reviewed: 2026-09
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MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.