Form Structure: Columbia-Suicide Severity Rating Scale (C-SSRS)
This form structure is an organized set of data definitions for a copyrighted form
Title:
Columbia-Suicide Severity Rating Scale (C-SSRS)
Short Name:
CSSRS
Description:
C-SSRS has five versions. The repeating times vary. And two versions for adults only are: Screening and Already Enrolled Subjects. For reprints of the C-SSRS contact Kelly Posner, Ph.D., New York State Psychiatric Institute, 1051 Riverside Drive, New York, New York, 10032; inquiries and training requirements contact posnerk@childpsych.columbia.edu Copyright 2008 The Research Foundation for Mental Hygiene, Inc. Posner, K., Brown, G.K., Stanley, B., Brent, D.A., Yershova, K.V., Oquendo, M.A., Currier, G.W., Melvin, G., Greenhill, L., Shen, S., & Mann, J.J., The Columbia-Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults American Journal of Psychiatry, 2011; 168:1266-1277. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-06-01
Version:
1.3
Date Created:
2016-03-17
Owner:
Number of Data Elements:
55
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 2 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 3 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 4 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
C-SSRS- Version Type (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Version Type | Type of versions | CSSRSVersionTyp | Required | CDE |
C-SSRS- Suicidal Ideation (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Columbia-Suicide Severity Rating Scale (C-SSRS) -Time Frame Indicator | Indicator of time frame, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSTimeFrameInd | Recommended | CDE |
| 2 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Wish to be Dead Indicator | Indicates whether subject endorses thoughts about wish to be dead or not alive anymore, or wish to fall asleep and not wake up, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSWshDeadInd | Recommended | CDE |
| 3 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Wish to be Dead Txt | Description of wish to be dead when answering yes, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSWshDeadTxt | Recommended | CDE |
| 4 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Non-Specific Active Suicidal Thoughts Indicator | Indicates whether subject had general, non-specific thoughts of wanting to end one's life/commit suicide without thoughts of ways to kill oneself/associated methods, intent, or plan, as part of of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSNonSpcfcASucdThghtsInd | Recommended | CDE |
| 5 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Non-Specific Active Suicidal Thoughts Text | Description of non-specific active suicidal thoughtswhen answering yes, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSNonSpcfcASucdThghtsTxt | Recommended | CDE |
| 6 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Active Suicidal Ideation with Any Methods Without Intent to Act Indicator | Indicates whether the subject endorses thoughts of suicide and had thought of at least one method during the assessment, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSASucdIdtnAyMtdWtIntAtInd | Recommended | CDE |
| 7 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act Text | Description of active suicidal Ideation with any Methods (Not Plan) without Intent to act when answering yes, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSASucdIdtnAyMtdWtIntAtTxt | Recommended | CDE |
| 8 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Active Suicidal Ideation with Some Intent to Act, without Specific Plan Indicator | Indicates whether subject has active suicidal thoughts of killing oneself and subject reports having some intent to act on such thoughts, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSASucdIdtnSmIntActSpPnInd | Recommended | CDE |
| 9 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Active Suicidal Ideation with Some Intent to Act, without Specific Plan Text | Description of active suicidal ideation with some intent to act, without specific plan when answering yes, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSASucdIdtnSmIntActSpPnTxt | Recommended | CDE |
| 10 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Active Suicidal Ideation with Specific Plan and Intent Indicator | Indicates whether subject has thoughts of killing oneself with details of plan fully or partially worked out and subject has some intent to carry it out, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSASucdIdtnSpPnIntInd | Recommended | CDE |
| 11 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Active Suicidal Ideation with Specific Plan and Intent Text | Description of active suicidal ideation with specific plan and intent when answering yes, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSASucdIdtnSpPnIntTxt | Recommended | CDE |
C-SSRS- Intensity of Ideation (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Description of Most Severe Suicidal Ideation Text | Description of most severe suicidal ideation, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSMostSevrIdeationDescTxt | Recommended | CDE |
| 2 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Suicidal Ideation Frequency | Frequency of suicidal ideation, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSSucdIdtnFreq | Recommended | CDE |
| 3 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Duration of Suicidal Ideation | Duration of suicidal ideation, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSSucdIdtnDur | Recommended | CDE |
| 4 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Controllability scale | Scale of controllability of stopping thinking about killing yourself or wanting to die if the subject wants to, as part of as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSCntrllabilityScl | Recommended | CDE |
| 5 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Deterrents Scale | Scale of how much deterrents stopps the subject fromwanting to die or acting on thoughts of committing suicide, as part of as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSDeterrentsScl | Recommended | CDE |
| 6 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Suicidal Ideation Reason | Reasons for suicide ideation, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSSucdIdtnRsn | Recommended | CDE |
C-SSRS- Suicidal Behavior (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Columbia-Suicide Severity Rating Scale (C-SSRS) -Time Frame Indicator | Indicator of time frame, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSTimeFrameInd | Recommended | CDE |
| 2 | Columbia-Suicide Severity Rating Scale (C-SSRS) -Actual Attempt Indicator | Indicates whether the subject made actual suicidal attempts, as part of as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSActualAtmptInd | Recommended | CDE |
| 3 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Actutal Attempts number | Total numer of actual attempts, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSActualAtmptNum | Recommended | CDE |
| 4 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Way To End Life Text | Description of the way to end the subject's life that was ever used by him/her, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSWayToEndLifeTxt | Recommended | CDE |
| 5 | Columbia-Suicide Severity Rating Scale (C-SSRS) -Self-Injurious Behavior Without Suicidal Intent Indicator | Indicator of Self-injurious behavior without suicidal intent , as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSInjBehavrWtSucdIntInd | Recommended | CDE |
| 6 | Columbia-Suicide Severity Rating Scale (C-SSRS) -Self-Injurious Behavior Without Suicidal Intent Text | Description of Self-injurious behavior without suicidal intent , as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSInjBehavrWtSucdlIntTxt | Recommended | CDE |
| 7 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Non-Suicidal Self-Injurious Behavior Indicator | Indicates whether subject had non-suicidal self-injurious behavior as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSNonSucdlSlfInjBehavrInd | Recommended | CDE |
| 8 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Interrupted Attempt Indicator | Indicates whether subject was interrupted while attempting suicide as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSIntrptdAtmptInd | Recommended | CDE |
| 9 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Interrupted Attempt Text | Description of interrupted suicidal attempts that happened, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSIntrptdAtmptTxt | Recommended | CDE |
| 10 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Interrupted Attempt Number | Total number of interrupted attempts, as par of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSIntAtmptNum | Recommended | CDE |
| 11 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Aborted Attempt Indicator | Indicator of aborted attempts, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSAbrtdAtmptInd | Recommended | CDE |
| 12 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Aborted Attempt Text | Description of the aborted attempt that was taken by the subject, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSAbrtdAtmptTxt | Recommended | CDE |
| 13 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Aborted Attempt Number | Total number of aborted suicide attempts, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSAbrtdAtmptNum | Recommended | CDE |
| 14 | Columbia-Severity Rating Scale (C-SSRS) -Preparatory Acts Behavior Indicator | Indicates whether subject had suicidal preparatory acts or behavior, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSPreptryActBehvInd | Recommended | CDE |
| 15 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Preparatory Acts Behavior Text | Description of suicidal preparatory acts or behavior, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSPreptryActBehvTxt | Recommended | CDE |
| 16 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Suicidal Behavior Indicator | Indicates subject had suicidal behavior during the assessment period, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSSucdBehvInd | Recommended | CDE |
| 17 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Completed Suicide Indicator | Indicator of completed suicide, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSCompletedSucdInd | Recommended | CDE |
C-SSRS- Answer for Actual Attempts Only (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Most Recent Attempt Date | Most recent actual attempt date, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSMstRectAtmptDate | Recommended | CDE |
| 2 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Most Lethal Attempt Date | Most lethal actual attempt date, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSMstLethalAtmptDate | Recommended | CDE |
| 3 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Initial First Attempt Date | Initial First actual attempt date, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSInitial1stAtmptDate | Recommended | CDE |
| 4 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Actual Lethality Medical Damage Scale | Severity of actual lethality/medical damage from most lethal actual suicidal attempts, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSActualLethaltyMedDmgeScl | Recommended | CDE |
| 5 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Potential Lethality Scale | Severity of potential lethality from most lethal actual suicidal attempts, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSPotentialLethaltyScl | Recommended | CDE |
C-SSRS- Scoring (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Suicidal Ideation Score | Suicidal ideation score, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSSucdIdeationScore | Recommended | CDE |
| 2 | Columbia-Suicide Severity Rating Scale (C-SSRS) - Suicidal Ideation Intensity Rating Score | Suicidal ideation intensity rating score, as part of Columbia-Suicide Severity Rating Scale (C-SSRS) | CSSRSSucdIdeationIntstyRtScore | Recommended | CDE |
Keywords
