insytepsychiatric.com-COLUMBIA-SUICIDE SEVERITY RATING SCALE

COLUMBIA-SUICIDE SEVERITY RATING SCALE
SUICIDE IDEATION DEFINITIONS AND PROMPTS (Past Month)
Patient’s name
1) Have you wished you were dead or wished you could go to sleep and not wake up?

Yes No
2) Have you actually had any thoughts of killing yourself?

Yes No
3) Have you been thinking about how you might do this?

Yes No
E.g. “I thought about taking an overdose but I never made a specific plan as to when
where or how I would actually do it....and I would never go through with it.”
4) Have you had these thoughts and had some intention of acting on them?

Yes No
As opposed to “I have the thoughts but I definitely will not do anything about them.”
5) Have you started to work out or worked out the details of how to kill yourself?Do you intend to carry out this plan?

Yes No
6) Have you ever done anything, started to do anything, or prepared to do anything to end your life?

Yes No
Examples: Collected pills, obtained a gun, gave away valuables, wrote a will or suicide note, took out pills but didn’t swallow any, held a gun but changed your mind or it was grabbed from your hand, went to the roof but didn’t jump; or actually took pills, tried to shoot you rself, cut yourself, tried to hang yourself, etc.
Was this within the past three months?

Yes No
Should be Empty:

COLUMBIA-SUICIDE SEVERITY RATING SCALE