This form structure is an organized set of data definitions for a copyrighted form

 General Details

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

 Documentation


 Groups & Attached Data Elements

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

 Change History

 Administrative Change History