New research out of the Columbia University Medical Center offers more hope than ever before for predicting suicidal behavior and ensuring that those at risk get treatment.
A team of researchers led by psychiatry professor Kelly Posner has found the Columbia Suicide Severity Rating Scale—first developed by Posner several years ago—can predict suicide attempts more effectively than any previous methods.
Suicide is the second-leading cause of death among college students. Three Columbia students have committed suicide in the last three years, including Tina Bu, CC ’13, who passed away in October.
The C-SSRS is a “very straightforward” survey, Posner said, that can be completed in a few minutes and does not have to be administered by a mental health professional. It asks about a patient’s history of thinking about suicide—known as ideation—and about previous suicide attempts or plans.
Posner’s team found that for every standard deviation above from the average level of lifetime suicidal ideation reported at study entry, the odds of attempting suicide during the study period—24 weeks—increased by 45 percent.
“The answers on the form actually predicted who made suicide attempts or behaviors over the course of a year,” Posner told Spectator. “There hasn’t been predictive data for as long as we can remember.
This predictive power has convinced some scientists that widespread deployment of the scale could help prevent many suicides.
“The public health benefits in terms of lives saved could be enormous,” psychiatry department chair and New York State Psychiatric Institute director Jeffrey Lieberman said in a CUMC statement about the scale.
Prevention, Posner said, depends upon “appropriate identification and screening.”
“We know that 50 percent of suicides see their primary care doctor the month before they die,” she said. “We should be asking these questions the way we monitor for blood pressure. We know that we can do it, and we know that it will help save lives.”
Posner originally developed the C-SSRS for use in drug trials after being commissioned several years ago by the Food and Drug Administration. She and a team of researchers published new research showing the effectiveness of the scale in an advance edition of the American Journal of Psychiatry last month.
According to Posner, the scale filled a “gaping hole in the field,” by providing a more nuanced and comprehensive picture of the risk factors and by creating clear standards for evaluating levels of suicidal thinking and behavior.
She added that greater precision helps make sure that at-risk patients don’t slip through the cracks, while “reducing a tremendous amount of unnecessary cost and burden.”
Even before the new research, the C-SSRS had been widely used by government agencies and health care providers. Now, Posner said her goal is to encourage more systematic adoption of the scale.
“Where you get real change is when you get kind of top-down efforts,” she said. “National efforts will really help us get to the next level.”
Interest in the scale has already accelerated since the new finding, Posner said. She said she is regularly fielding inquiries from people ranging from front-line troops in Afghanistan to Japanese naval doctors.
Once the scale is more broadly employed, she added, she hopes to make use of the abundant data it generates to further her study of suicide risk factors.
“Suicide is a major public health crisis, across ages, across the world,” she said. “And the good news is it’s a preventable public health issue, but we need to do better.”
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