The second construct, the intensity of ideation subscale, has five items rated on a 5-point scale. These items include frequency, duration, controllability, deterrents, and reason for ideation. The third construct, the behavior subscale, is also rated on a nominal scale representing different coding for actual, aborted, and interrupted attempts; preparatory behavior; and non- suicidal self-injurious behavior. The fourth construct, the lethality subscale, helps the clinician make a clear assessment of actual attempts. Actual lethality is rated on a 6-point scale. However, if actual lethality is scored as zero, potential lethality of attempts is rated on a 3-point scale (Comparelli et al., 2022). Although the C-SSRS appears bulky in the amount of information to be considered before suicidality is properly coded, the design makes it easier to conclusively consider all risk factors and triggers that might be implicated in a suicide case. The score is based on the patient’s response to screening questions and also allows for the integration of information gathered from third- party entities, including family members, colleagues, and first responders. Its multifaceted approach to suicide assessment makes it the go-to tool in the emergency department for the
assessment of patients in whom suicidality is a primary concern. The definition of suicidal behavior included in the C-SSRS was adapted from the Columbia History Form. See Figure 2. These definitions are also consistent with the early Columbia Classification Algorithm for Suicide Assessment (C-CASA). By summing its individual parts, it is safe to conclude that the Columbia-Suicide Severity Rating Scale (C-SSRS) was designed to: ● Provide unambiguous definitions for suicidal ideations and behavior, suicide attempts, and non-suicidal-related but injurious behaviors; ● Clearly distinguish between suicidal behavior and non- suicidal-related but injurious behaviors; ● Describe the full continuum and dimensionality of suicidal ideations and suicidal behavior measured by severity; and ● Provide a user-friendly format for the integration of direct patient interviews with reports from third-party entities in the assessment of suicidality. (Harmer et al., 2022)
Figure 2. Suicidal Ideation Definitions and Prompts
Note . From “Suicidal ideation,” by Harmer et al., 2023. StatPearls. (https://www.ncbi.nlm.nih.gov/books/NBK565877). Suicidal Ideation and Behavior Assessment Tool (SIBAT) Following the advent of telemedicine and its wide adoption in primary care, including psychiatry, researchers have argued for the development of suicidal ideation and behavior assessment
See Figure 3. The patient-reported modules are completed and self-reported by the patient to provide a comprehensive and clear understanding of information relating to SIB, risk factors, triggers, and protective factors. The information provided is compiled and coded for review by the clinician. In turn, in Modules 7 and 8, the clinician conducts a semi-structured interview to clarify ambiguities in the patient modules and/or request information that might be missing or wrongly coded. Here, the clinician leverages the four main outcomes of SIBAT to determine the severity of suicidality including: Frequency of Suicidality Thinking (FoST)
tools based on the modalities of telemedicine. Such tools, if developed, would provide a means to assess suicidality in an emergency situation without primary care personnel present. The SIBA tool is designed as a computerized suicidality assessment method requiring input from both the clinician and patient. This is important to ensure the integration of third-party data and reports as contained in the C-CSSRS is preserved. SIBAT captures patients’ reported suicidality scores, risk factor scores, and protective factors, and it and helps the clinician make an informed diagnosis and classifications of SIB. The rating system on SIBAT is based on the Clinician Global Impression (CGI) rating of suicide risk and severity of suicidality. The assessment points on this computerized tool are contained in modules, with each module designed to have a 5.8-grade reading level for easy comprehension (Alphs et al., 2022). To make sure assessments are done in a structured way and the integration of reports is seamless, SIBAT features three clinician-reported modules and five patient-reported modules.
1. CGI of Severity of Suicidality 2. CGI of Imminent Suicide Risk 3. CGI of Long-Term Suicide Risk (Alphs et al., 2020).
Based on information gathered from the structured interview, the clinician completes the scoring of Module 7. In Module 8, the clinician documents the outcome of the assessment, the severity of suicidal ideation, and an optimal management regimen for the patient.
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Book Code: PYMA2024
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