Objective Research on suicide prevention and interventions requires a standard method for assessing both suicidal ideation and behavior to identify those at risk and to track treatment response. The Columbia–Suicide Severity Rating Scale (C-SSRS) was designed to quantify the severity of suicidal ideation and behavior. The authors examined the psychometric properties of the scale. Method The C-SSRS’s validity relative to other measures of suicidal ideation and behavior and the internal consistency of its intensity of ideation subscale were analyzed in three multisite studies: a treatment study of adolescent suicide attempters (N=124); a medication efficacy trial with depressed adolescents (N=312); and a study of adults presenting to an emergency department for psychiatric reasons (N=237). Results The C-SSRS demonstrated good convergent and divergent validity with other multi-informant suicidal ideation and behavior scales and had high sensitivity and specificity for suicidal behavior classifications compared with another behavior scale and an independent suicide evaluation board. Both the ideation and behavior subscales were sensitive to change over time. The intensity of ideation subscale demonstrated moderate to strong internal consistency. In the adolescent suicide attempters study, worst-point lifetime suicidal ideation on the C-SSRS predicted suicide attempts during the study, whereas the Scale for Suicide Ideation did not. Participants with the two highest levels of ideation severity (intent or intent with plan) at baseline had higher odds for attempting suicide during the study. Conclusions These findings suggest that the C-SSRS is suitable for assessment of suicidal ideation and behavior in clinical and research settings.

Utilizing a methodical, anchored approach to categorizing suicidality provides an accurate and comprehensive identification of suicidal events. The FDA's audit of the C-CASA demonstrated excellent transportability of this approach. The Columbia algorithm was used to classify suicidal adverse events in the recent FDA adult antidepressant safety analyses and has also been mandated to be applied to all anticonvulsant trials and other centrally acting agents and nonpsychotropic drugs.

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Objective-To evaluate the link between antidepressants and suicidal behavior and ideation (suicidality) in youth, adverse events from pediatric clinical trials were classified in order to identify suicidal events. The authors describe the Columbia Classification Algorithm for Suicide Assessment (C-CASA), a standardized suicidal rating system that provided data for the pediatric suicidal risk analysis of antide-pressants conducted by the Food and Drug Administration (FDA).Method-Adverse events (N=427) from 25 pediatric antidepressant clinical trials were systematically identified by pharmaceutical companies. Randomly assigned adverse events were evaluated by three of nine independent expert suicidologists using the Columbia classification algorithm. Reliability of the C-CASA ratings and agreement with pharmaceutical company classification were estimated.Results-Twenty-six new, possibly suicidal events (behavior and ideation) that were not originally identified by pharmaceutical companies were identified in the C-CASA, and 12 events originally labeled as suicidal by pharmaceutical companies were eliminated, which resulted in a total of 38 discrepant ratings. For the specific label of "suicide attempt," a relatively low level of agreement was observed between the C-CASA and pharmaceutical company ratings, with the C-CASA reporting a 50% reduction in ratings. Thus, although the C-CASA resulted in the identification of more suicidal events overall, fewer events were classified as suicide attempts. Additionally, the C-CASA ratings were highly reliable (intraclass correlation coefficient [ICC]=0.89).Address correspondence and reprint requests to Dr. Posner, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Dr., Unit 74, New York, NY 10032; posnerk@childpsych.columbia.edu. CME Disclosure Dr. Posner has received funding from the FDA to develop the suicidality classification system used in their antidepressant safety analysis. Subsequently, as part of an effort to help execute the FDA adult suicidality classification mandates that followed this FDAsponsored pediatric study, Dr. Posner has had research support from GlaxoSmith-Kline, Forest Laboratories, Eisai, Inc., AstraZeneca, Johnson and Johnson, Abbott Laboratories, Wyeth, Organon USA, Bristol-Myers Squibb, Sanofi-Aventis, Cephalon, Novartis, Shire Pharmaceuticals, and UCB Pharma. Dr. Oquendo has received funding from NIMH, National Institute on Alcohol Abuse and Alcoholism, Moody's Foundation, American Foundation for Suicide Prevention, and Eli Lilly (unrestricted educational grant); she has also served as a consultant to Pfizer. Dr. Stanley has received fluoxetine/placebo for a randomized controlled trial from Eli Lilly. Mr. Davies is a shareholder with Merck, Pfizer, Wyeth, GlaxoSmithKline, Johnson and Johnson, Amgen, and Bard. Dr. Gould reports no competing interests. APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Offlabel use of m...