Psychometric Reevaluation of the Columbia–Suicide Severity Rating Scale: Findings From a Prospective, Inpatient Cohort of Severely Mentally Ill Adults
Abstract
OBJECTIVE: Accurate prediction of suicide remains elusive due to lack of predictive measures. Given the Columbia-Suicide Severity Rating Scale's (C-SSRS) emerging "gold-standard" status for risk assessment, studies are needed to assess its psychometric properties, particularly predictive validity. The current study adds to the limited literature by assessing the C-SSRS's internal consistency, factor structure, concurrent validity, and predictive validity. METHODS: In this longitudinal study of 1,055 adults with DSM-IV diagnoses consecutively admitted to a specialized psychiatric hospital between July 1, 2012, and June 30, 2014, patients completed standardized assessments, including the C-SSRS, at admission and 2, 12, and 24 weeks postdischarge. RESULTS: The C-SSRS evidenced excellent internal consistency (ordinal α = .95). Principal components analysis (PCA) revealed a 2-factor solution, accounting for 65.3% of the variance across items. The severity of ideation and behavioral items loaded onto the first factor, and the intensity of ideation items loaded onto the second factor. The total score, factors, and the most severe ideation single item were moderately correlated with other measures of suicidality (0.27 ≤ r ≤ 0.58; P < .0001). The summary score from the ideation/behavior factor was found to be modestly correlated with any suicide-related behavior within the 6 months following hospitalization. Receiver operator characteristics indicated that the C-SSRS performed adequately in correctly classifying any suicide-related behavior within 6 months of discharge from the hospital (AUC = 0.757, P < .001) with the total score and summary score from the ideation/behavior factor providing the best balance between sensitivity (0.694) and specificity (0.652-0.674). CONCLUSIONS: This study is the first to assess the factor structure of the C-SSRS in a large, high-risk sample. The measure has solid psychometric properties and merits use as a suicide risk assessment measure.
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The Columbia-Suicide Severity Rating Scale demonstrates sound psychometric properties.
“The scale demonstrates sound psychometric properties [34, 41]”
From Internet videoconferencing delivered cognitive behavior therapy for generalized anxiety disorder: protocol for a randomized controlled trial (2022) · cites this paper as [34]
The Columbia Suicide Severity Rating Scale has internal validity a=0.95 and test-retest reliability rtt=0.90-1.0 (very high).
“Internal validity a=0.95 and test-retest reliability rtt=0.90-1.0 (very high) [93,94]”
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“Data from the primary study showed that the convergent and divergent validity, predictive validity, sensitivity, specificity, sensitivity to change, and internal consistency of the C-SSRS are at a desirable level (11, 19, 20).”
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“This interview has demonstrated acceptable concurrent and predictive validity in previous research (Madan et al., 2016) and in the current sample ( ɑ = 0.84, ⍵ = 0.84).”
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“[89] (rater administered) r tt= 0.90-1.0 ( very high) [93,94] or no; lethality: 0-2, higher scores=more severe of SI, presence of suicidal behaviors, lethality of behaviors Cronbach α =0.91 (very high) [41,97] 4-point Likert scale questions, scored by each trait, some reverse-coded.”
InfluentialTypologies of Psychiatric Diagnoses Among Inpatients with Recent Suicide Attempts
Lord, K. A., Tolin, D. F., & Diefenbach, G. J. (2024) · Archives of Suicide Research · doi:10.1080/13811118.2024.2405732 · Cited by 2 · see citing works
“The C-SSRS has good psychometric properties for coding suicide attempts (Madan et al., 2016; Posner et al., 2011).”
Benz, M. B., Rafferty, N. S., Arias, S. A., Rabasco, A., Miller, I. W., Weinstock, L. M., Boudreaux, E. D., Camargo, C. A., & Gaudiano, B. A. (2024) · Academic Emergency Medicine · doi:10.1111/acem.15023 · Cited by 5 · see citing works
“40 Using variables calculated by the original study team, 33 we exam - ined suicidal ideation intensity and severity, as well as SA severity, at baseline and follow-up.”
van Velzen, L. S., Toenders, Y. J., Kottaram, A., Youzchalveen, B., Pilkington, V., Cotton, S., Brooker, A., McKechnie, B., Rice, S., & Schmaal, L. (2022) · Crisis · doi:10.1027/0227-5910/a000860 · Cited by 2 · see citing works
Bautista, A. D., Reyes, M. E. S., & Delariarte, C. F. (2023) · Clinical Medicine Insights Psychiatry · doi:10.1177/11795573231218126 · Cited by 3 · see citing works
“To wit, suicide risk appraisal instruments, according to Posner et al. 46 and Madan et al. 47 include the use of the highly validated Columbia Suicide Severity Rating Scale (C-SSRS) because it explores both lifetime and recent suicidal thoughts and behaviors.”
MethodMethodologies on the Enhanced Spatial Resolution of Non-Invasive Optical Brain Imaging: A Review
Shoaib, Z., Kamran, M. A., Mannan, M. M. N., & Jeong, M. Y. (2019) · IEEE Access · doi:10.1109/access.2019.2939475 · Cited by 2 · see citing works
“The recent ‘‘gold standard’’ for identifying awareness indications of patient are standardized behavioral assessments [21], [22].”
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“The instrument exhibits excellent internal consistency (ordinal α = 0.98) and satisfactory construct validity (predictive and concurrent) [70, 71].”
InfluentialSokol, Y., Glatt, S., Andrusier, S., Levin, C., Boucher, C., Ridley, J., Brown, C. H., Landa, Y., Glynn, S. M., & Goodman, M. S. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101576 · Cited by 1 · see citing works
“It is regarded as a gold standard tool for suicide risk assessment [34].”
Lee, J., Oh, Y., & You, S. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.116950 · Cited by 1 · see citing works
Swahn, M. H., Natuhamya, C., Culbreth, R. E., Palmier, J. B., Mobley, K., Bbosa, G. S., Matovu, G., Kavuma, A., Bukuluki, P., Rukundo, G. Z., et al. (2026) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23020170 · Cited by 1 · see citing works
Group-Based Suicide Safety Planning and Skills Training for Veterans With High Suicide Risk
Goodman, M. S., Jager‐Hyman, S., Monahan, M. F., Glatt, S., Thase, M. E., O’Brien, S., Krauss, A., Galfalvy, H., Sullivan, S. R., Luther, J. F., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.15029 · Cited by 2 · see citing works
Damiano, R. F., Bryan, C. J., Pan, P. M., Rohde, L. A., Miguel, E. C., Salum, G. A., & Hoffmann, M. S. (2026) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.70118 · Cited by 1 · see citing works
Firearm Suicide in the United States From a Broader Preventive Perspective
Kapusta, N. D., & Cramer, R. J. (2017) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2016.16070850 · Cited by 1 · see citing works
Development and Pilot Testing of the Mobile Application to Prevent Suicide (MAPS)
Schatten, H. T., Hughes, C. D., Kimble, S. K., Wallace, G. T., Benz, M. B., Kraines, M. A., Germain, E., Brick, L. A. D., Armey, M. F., Elwy, A. R., et al. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10568-9 · Cited by 2 · see citing works
“The C-SSRS shows excellent internal consistency and good predictive validity (Madan et al., 2016).”
The Continuing Challenge of Suicide Prevention
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Self-citationScales for the evaluation of suicide risk
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The association between cannabis use and suicidal intensity in psychiatric inpatients
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“The C-SSRS has demonstrated validity and reliability (Posner et al., 2011), including for adults with serious mental illness (Madan et al., 2016).”
Suicidality Among Sexual or Gender Minority College Students With a Schizophrenia Spectrum Disorder
Gouse, B. M., Schwarz, A. G., Lewczyk, J., Streed, C. G., Boliver, E. E., Xu, C., Blanton, A. C., & Brown, H. E. (2025) · Crisis · doi:10.1027/0227-5910/a001009
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Emotion Differentiation and Dynamics Predicting Suicide Outcomes in High‐Risk Adults
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“The C-SSRS has demonstrated strong validity among psychiatric inpatients (Madan et al. 2016).”
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- Authors
- Madan, A., Frueh, B. C., Allen, J. G., Ellis, T. E., Rufino, K. A., Oldham, J. M., & Fowler, J. C.
- Affiliations
- Baylor College of Medicine (US)
- University of Hawaii at Hilo (US)
- University of Houston - Downtown (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2016-07-27
- Volume
- 77
- Issue
- 07
- Pages
- e867-e873
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2492926143
- Cited by
- 96
- References
- 0
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 9 · 2023: 10 · 2022: 11 · 2021: 8 · 2020: 8 · 2019: 7 · 2018: 11 · 2017: 9 · 2016: 3
- FWCI
- 13.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- Columbia Suicide Severity Rating Scale, suicide risk assessment, suicide risk prediction, suicidal ideation, suicidal behavior, factor structure, predictive validity, concurrent validity, internal consistency, psychiatric inpatients
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Inpatients, Longitudinal Studies, Male, Prospective Studies, Psychiatric Status Rating Scales, Psychometrics, Suicide, Attempted, Risk Assessment, Persons with Psychiatric Disorders, Mentally Ill Persons, Young Adult, Suicidal Ideation
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