C-SSRS (Columbia Suicide Severity Rating Scale)
Structured assessment of suicidal ideation and behavior for risk stratification
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary
- Care settings
- Emergency department, Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The C-SSRS (Columbia Suicide Severity Rating Scale) can activate when the transcript or pasted chart context documents any of these:
- Suicidal ideation reported or suspected
- Psychiatric emergency evaluation
- Psychiatric admission or progress note
- PHQ-9 item 9 positive (thoughts of self-harm)
- History of suicide attempt
- Safety assessment required
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: R45.851, T14.91.
Note-type scope: it activates on notes whose subject resolves to psychiatry, emergency medicine, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
7 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Ideation category: none, passive, active_without_plan, active_with_plan, active_with_intent_and_plan | symptom | ||
| Actual suicide attempt (current period) | history | ||
| Preparatory acts toward attempt | history | ||
| Aborted attempt (self-interrupted) | history | ||
| Interrupted attempt (externally stopped) | history | ||
| Any lifetime suicide attempt | history | ||
| Protective factors present (family, religion, social support, future orientation) | history |
Scoring
Categorical: Ideation severity (none/passive/active) + Behavior history → Risk level (LOW/MODERATE/HIGH). Not a point-sum.
Interpretation
HIGH: Actual attempt, preparatory behavior, or active ideation with intent and plan. MODERATE: Active ideation with plan, aborted/interrupted attempt, or ideation + lifetime attempt without protective factors. LOW: No ideation, passive ideation only, or active without plan with protective factors.
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- Posner K et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findingsPosner et al. (C-SSRS) 2011 · 2011 · Columbia University · Level I · link last verified 2026-03-27
How Scribeable handles it in the note
When an encounter activates the C-SSRS (Columbia Suicide Severity Rating Scale) at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. Scribeable never inserts a C-SSRS (Columbia Suicide Severity Rating Scale) value into the draft. A stated value is compared against the computed one when the draft's structured summary carries it; no computed value is supplied to the drafting pass for this instrument.
Classified as a questionnaire: a patient-reported or clinician-rated instrument, where a spare activation carries low harm.
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