On the Road to Prevention: Increasing Understanding and Prediction of Suicide Risk, Improving Care Delivery and Redirecting Scarce Resources with the Columbia-Suicide Severity Rating Scale
Prof. Kelly Pozner
Prevention of suicide depends upon appropriate identification and screening. However, the understanding of suicide and the prediction of suicide risk have been plagued by methodological limitations in the assessment of suicidal ideation and behavior. The variability in suicide definitions and terminology compromise surveillance efforts, international epidemiological comparisons and precise measurement of clinical outcomes. Improved methods of data collection are of critical importance, as debunking false notions of risk and accurately identifying true risk are equally critical across diverse settings from a public health perspective. Dr Posner will discuss an innovative suicide screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS) which assesses the full range of ideation and behavior and offers standard definitions that are necessary for accurate identification. The C-SSRS has shown robust predictive utility and has been used to optimize research outcomes and surveillance. Notably, it impacts care delivery through guidance for next steps in clinical management (e.g., triggering referrals to mental health professionals). As a result, it positively impacts service utilization through decreasing unnecessary interventions, redirecting scarce resources, and expediting care delivery to those at highest risk. The scale is available in several population-specific editions (e.g., pediatric, military) and in 112 languages demonstrating its flexibility and utility across all sectors of a community for improved identification. The C-SSRS is frequently requested or recommended by various national and international agencies such as the Food and Drug Administration, the WHO and the Joint Commission Best Practices Library and the definitions in the C-SSRS have been adopted by the U.S. Centers for Disease Control. Numerous states, counties and provinces have moved toward system-wide implementation enabling blanket coverage and linking of systems, fostering prevention. Its widespread international use includes the National Suicide Prevention Program in Israel, Health Canada, Israel Ministry of Health, Japanese National Institute of Mental Health and Neurology, the Israeli Defense Forces and the European Medicines Agency (EMA).