Columbia-Suicide Severity Rating Scale Research Articles

Detailed assessment of suicidal ideation in youth with bipolar disorder versus major depressive disorder.

There is a critical need to better understand the factors underlying the increased suicide risk for youth with bipolar disorder (BD) in order to develop targeted prevention efforts. This study aimed to examine differences in characteristics of suicide ideation (SI) in youth with BD compared to youth with major depressive disorder (MDD) that may be associated with increased suicide risk. One hundred and fifty-one participants (92 MDD and 59 BD), ages 13-21, completed a diagnostic interview and clinical assessments. Lifetime symptoms of SI and SA were assessed using the Columbia Suicide Severity Rating Scale. Ordinal logistic regression models were used to investigate whether the diagnostic group predicted the severity and intensity of the most severe or most common SI with the age of onset, age, and gender as covariates. Compared to MDD youth, BD youth were more likely to report experiencing more severe SI, p= 0.039, experiencing the most severe SI more frequently, p= 0.002, having less control of the most severe SI, p= 0.012, and that deterrents were less likely to stop them from acting on the most severe SI, p= 0.006. This study highlights differences in the severity and intensity of SI in youth with BD and suggests that youth with BD have greater difficulty inhibiting thoughts of SI which may lead to less resistance to suicide action. Findings underscore the need for a more detailed assessment of SI in youth with BD to better understand SI as a proximal risk factor for future SA and a potential target for intervention.

The Impact of Affective Temperaments on Suicidal Ideation and Behaviors: Results from an Observational Multicentric Study on Patients with Mood Disorders.

Suicide ideation and behaviors are major health issues in the field of mental health. Several psychological and psychosocial factors have been taken into account as possible predictors of suicidality. Only recently affective temperaments have been considered as possible factors linked to suicide. This study aims to investigate the relationship between affective temperaments and suicidality, including the lifetime onset of suicide ideation, lifetime presence of suicide attempts and the total number of lifetime suicide attempts. This is a naturalistic multicentric observational study, involving outpatient units of seven University sites in Italy. Patients were administered with the short version of TEMPS-M and the Columbia Suicide Severity Rating Scale. A total of 653 participants were recruited, with a diagnosis of bipolar (55.7%), unipolar (35.8%) and cyclothymic disorder (8.4%). Regression models showed that the presence of lifetime suicide behaviors was increased in patients presenting trait related impulsivity (p < 0.0001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.01), higher number of hospitalizations (p < 0.0001), cyclothymic and irritable affective temperaments (p < 0.05 and p < 0.05, respectively). Conversely, the presence of hyperthymic affective disposition reduced the likelihood of having suicidal behaviors (p < 0.01). Lifetime suicidal ideation was associated with trait-related impulsivity (p < 0.001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.001) and of hospitalizations (p < 0.001). Depressive temperaments increased the likelihood of presenting suicidal ideation (p < 0.05), along with irritable temperaments (p < 0.01), contrary to hyperthymic affective (p < 0.05). Results of the present study confirm that affective disposition has a significant impact on the onset of suicidal ideation and behaviors, and that affective dispositions should be assessed in clinical settings to identify people at risk of suicide. Moreover, a wider clinical evaluation, including different clinical psychopathological dimensions, should be taken into consideration to develop effective preventive interventions.

Ideação Suicida em Estudantes Universitários: Avaliação com Rorschach

Abstract University students are particularly susceptible to suicidal ideation and behavior due to issues inherent to this vital lives’ moment. The Rorschach test can help to understand these students’ suffering. The objective was to evaluate perception, thinking, stress, and distress in the Rorschach test domains in university students attended at a public university mental health service, comparing students with suicidal ideation with those without it. A total of 36 students aged 18 or over were assessed. The instruments were: Rorschach Performance Assessment System (R-PAS), Columbia Suicide Severity Rating Scale (C-SSRS) and Self Report Questionnaire (SRQ-20). Two analyses were performed using Wilcoxon Mann-Whitney test, according to the presence of suicidal ideation in the last 30 days (SRQ-20) and in the last six months (C-SSRS). Statistically significant differences were found in the two analyses, indicative of greater perceptual distortion in students without suicidal ideation and of stress and distress in students with ideation.

Vincent Van Gogh: A Negative Result from his Modern Suicidal Profile Assessment

Killing Vincent Project (KVP) Team evaluates Vincent van Gogh’s ‘Suicide Profile’ while living in France, namely, Arles, St Remy Asylum, and Auvers-sur-Oise Profile utilizing the C-SSRS (Columbia – Suicide Severity Rating Scale). This evaluation of Van Gogh indicates that there were some risks factors and concerns for suicide in Arles and St Remy Asylum; however, while living in Auvers-sur-Oise, the C-SSRS evaluation reinforces that Van Gogh was living an extremely productive artistic life, doing a painting a day with breakthrough originality. There were no further vertigo attacks; he expressed no suicidal ideation nor gestures or self-injurious behavior. While in Auvers-sur-Oise, Van Gogh had become emotionally settled, found love, and was becoming a recognized breakthrough artist. KVP’s C-SSRS evaluation indicates a ‘negative suicidal profile assessment’ in his last 70 days. Therefore, it is reasonable to conclude: Vincent van Gogh did not commit suicide.

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach.

Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

Factors associated with self-harm behaviors during military service in the Israel Defense Forces, rates of such behaviors and their outcomes

ABSTRACT The military environment involves stressful situations that may trigger or aggravate suicidal behaviors, such as suicide attempts (SAs), which significantly increase the likelihood of future suicide. This cross-sectional study aims to assess risk factors for severe SAs and non-suicidal self-injury (NSSI) among Israel Defense Forces (IDF) soldiers. Data were retrieved from an IDF computerized self-harm surveillance database and were based on the criteria of the Columbia Suicide Severity Rating Scale (C-SSRS) and the Suicide Attempt Self-Injury Interview (SASII). The cohort included all 1,238 occurrences of self-harm behavior, during 2017–2021. Other investigated variables included adjustment difficulty (AD, as per IDF definition) and psychiatric diagnosis (PD) as reported by mental health officers (MHOs) during recruitment. Higher rates of adjustment difficulties were found among soldiers who had conducted NSSIs. Higher rates of previous psychiatric diagnoses were found among individuals with SAs, and their risk of dying by suicide during military service was twice as high (OR = 2.356; p < .001). If the latter also served in a combat unit, the risk was almost fourfold (OR = .3.860; p < .001). The current study demonstrates a clear difference between IDF soldiers who conduct NSSI vs. those conducting SA with regard to adjustment difficulty (as per IDF definition) and PD.

Pain, mood, and suicidal behavior among injured working adults in Chile

BackgroundChronic pain is comorbid with psychiatric disorders, but information on the association of chronic pain with depressive symptoms, generalized anxiety, and suicidal behavior among occupational cohorts is inadequate. We investigated these associations among employed Chilean adults.MethodsA total of 1946 working adults were interviewed during their outpatient visit. Pain was assessed using the Short Form McGill Pain questionnaire (SF-MPG) while depression and generalized anxiety were examined using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. The Columbia–Suicide Severity Rating Scale was used to assess suicidal behavior and suicidal ideation. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95%CI) for the association of chronic pain with mood disorders, as well as suicidal behavior.ResultsHigh chronic pain (SF-MPG > 11) was reported by 46% of participants. Approximately two-fifths of the study participants (38.2%) had depression, 23.8% generalized anxiety, 13.4% suicidal ideation, and 2.4% suicidal behavior. Compared to those with low pain (SF-MPG ≤11), participants with high chronic pain (SF-MPG > 11) had increased odds of experiencing depression only (aOR = 2.87; 95% CI: 2.21–3.73), generalized anxiety only (aOR = 2.38; 95% CI: 1.42–3.99), and comorbid depression and generalized anxiety (aOR = 6.91; 95% CI: 5.20–9.19). The corresponding aOR (95%CI) for suicidal ideation and suicidal behavior were (aOR = 2.20; 95% CI: 1.58–3.07) and (aOR = 2.18 = 95% CI: 0.99–4.79), respectively.ConclusionsChronic pain is associated with increased odds of depression, generalized anxiety, and suicidal behavior. Mental health support and appropriate management of patients experiencing chronic pain are critical.

Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality

BackgroundImpulsivity and aggression have been associated with all forms of suicidal behaviour and linked to theories of suicide capability. There is a need to clarify the role of impulsivity and aggression in the progression from suicidal thoughts to suicide attempts and suicide.MethodIn this naturalistic cross-sectional study, suicide ideators (35), low lethal suicide attempters (37), and high lethal suicide attempters (26) were compared with the Columbia-suicide severity rating scale (C-SSRS), Barratt impulsiveness scale (BIS-11), and the Buss & Perry aggression questionnaire (AQ).ResultsPhysical aggression score (p = 0.032) contributed to the difference between predicted low lethal suicide attempt and predicted high lethal suicide attempt. This model predicting physical aggression showed a fairly weak positive relationship (OR = 1.1) to high lethal attempt and explained 13% of the variance so there is a need for further replications to verify these results. Impulsive behaviour scores in females were significantly higher in the low lethal suicide attempt group compared to suicide ideators (F(2.51) = 3.47, p = 0.039, η²= 0.12). Hostility aggression in females was significantly higher in the high lethal suicide attempters compared to suicide ideators (F(2.52) = 3.53, p = 0.037, η² = 0.12). Physical aggression scores in females were significantly higher in the high lethal attempters compared to suicide ideators (F(2.52) = 6.79, p = 0.002, η²= 0.21). When these analyses were conducted without the participants who died in suicide, men in the high lethal attempt group scored significantly higher than men in the low lethal attempt group (F(2.37) = 3.8, p = 0.031, η² = 0.17), but men did not differ in aggression and impulsivity scores in other comparisons.ConclusionSuicide prevention should address physical aggression, as high levels can be associated with high lethal attempts. Assessment of suicidal patients should address impulsive behaviour with the insight that it can be more prominent in female low lethal suicide attempters. It could be that assessment and treatment of suicidal patients should be tailored differently for men and women. Aggression as a feature of suicide capability could be the link that makes suicide possible.

Concordance between the Columbia-Suicide Severity Rating Scale and Beck Scale for Suicide Ideation in assessing suicide behaviour in young adults with schizophrenia spectrum disorders

The Columbia Suicide Severity Rating Scale (C–SSRS) is considered the gold standard for collecting information on suicidal ideation and behavior by the Food and Drug Administration (FDA) of the United States. To determine the accuracy of the C-SSRS compared to the Beck Scale for Suicidal Ideation (BSS) for collecting suicide attempt history in the schizophrenia population, 202 participants aged 18–40 with schizophrenia spectrum disorders were administered the C-SSRS, followed by the BSS. Medical charts were reviewed to confirm the lifetime history of actual suicide attempts. The BSS had an 83.5% accuracy in reporting single suicide attempts and 81.7% for multiple suicide attempts; while the C-SSRS had 84.1% and 83.9% accuracy respectively. This difference was not statistically significant (p = 0.849). Both the BSS and C-SSRS demonstrated high sensitivity and specificity in collecting suicide attempt history for young patients with psychosis, with no significant differences. Future investigators may choose the scale that is best suited to the level of detail required.

Psychotic experiences, emotion regulation, and suicidal ideation among Chilean adolescents in the general population.

Psychotic experiences are associated with increased risk for suicide. Despite this well-established finding, very little is known about factors that contribute to this relationship. The current study investigated the relationship between psychotic experiences, emotion regulation, and suicidal ideation among 1,590 Chilean adolescents in the general population. Participants completed self-report measures of psychotic experiences (Community Assessment of Psychic Experiences), emotion regulation (Emotion Regulation Questionnaire), depression (Patient Health Questionnaire-9), and suicidal ideation (Columbia Suicide Severity Rating Scale). Statistical analyses included Mann-Whitney U tests, point-biserial correlations, logistic regression, and moderation analyses. Results suggest that paranoid ideation, bizarre experiences, and perceptual abnormalities were moderately associated with suicidal ideation. Additionally, greater expressive suppression and cognitive reappraisal were associated with suicidal ideation. Results from the logistic regression indicate that paranoid ideation, perceptual abnormalities, and expressive suppression have the strongest relationship with suicidal ideation, even when controlling for depression and relevant demographic variables. Additionally, paranoid ideation interacted with expressive suppression to predict suicidal ideation, with expressive suppression having the strongest relationship with suicidal ideation when paranoid ideation was low to moderate. Taken together, these findings support the broader literature suggesting that emotion regulation might be a transdiagnostic risk factor for suicidal ideation. Additional longitudinal research is needed to examine whether expressive suppression and other maladaptive emotion regulation strategies serve as a mechanism for suicidal ideation both in the general population and among individuals with psychotic experiences.

Tools to Detect Risk of Death by Suicide: A Systematic Review and Meta-Analysis.

Objective: There is limited knowledge about the ability of instruments to detect risk of suicide in a range of settings. Prior reviews have not considered whether the utility of instruments depends on prior probability of risk. We performed a systematic review to determine the diagnostic accuracy of instruments to detect risk of suicide in adults using likelihood ratio analysis. This method aids evaluation of prior probabilities of risk. Data Sources: We searched MEDLINE, Cochrane Database of Systematic Reviews, PsycINFO, EMBASE, and Scopus from inception through January 19, 2021. Study Selection: We included clinical trials, observational studies, and quasi-experimental studies assessing the diagnostic accuracy of instruments to detect risk of suicide in adults. There were no language restrictions. Data Extraction: Three reviewers in duplicate assessed full texts to determine eligibility and extracted data from included studies. Positive (LR+) and negative likelihood ratio (LR–) and 95% CIs were calculated for each instrument. Results: Thirty studies met inclusion criteria. Most instruments showed minimal utility to detect or rule out risk of suicide, with LR+ ≤ 2.0 and LR– ≥ 0.5. A few instruments had a high utility for improving risk detection in emergency department, inpatient mental health, and prison settings when patients scored above the cutoff (LR+ > 10). For example, among patients discharged from an emergency department, the Columbia Suicide Severity Rating Scale–Clinical Practice Screener had a LR+ of 10.3 (95% CI, 6.3–16.8) at 3-month follow-up. The clinical utility of the instruments depends on the pretest probability of suicide in the setting. Because studies spanned over 6 decades, the findings are at risk for secular trends. Discussion: We identified several instruments that may hold promise for detecting risk of suicide in emergency department, inpatient mental health, or prison settings. The utility of the instrument hinges, in part, on baseline suicide risk. Registration: PROSPERO: CRD42021285528

ALEXITHYMIA, SUICIDAL IDEATION AND BEHAVIOUR IN MOROCCAN PSYCHOACTIVE SUBSTANCE USERS

Alexithymia is an emotion regulation problem that may be related to suicidality, especially in patients with SUD. The study aimed at estimating the prevalence of alexithymia in Moroccan psychoactive substances users, and to establish the links between alexithymia and suicidal ideation and behaviors, anxiety and depression in drug-dependent patients. We also aimed to elucidate if alexithymia predicts suicidal thoughts and behaviors in these consumers. The study included 451 consecutively admitted patients with substance use. Consumers were examined with the Toronto alexi - thymia scale (TAS-20), State and Trait Anxiety Inventory (STAI- Y), Beck Depression Inventory (BDI) and The Columbia-Suicide Severity Rating Scale (C-SSRS). Among substance-dependent individuals, 72.7% was identified as a group with alexithymia. Current age and age at first substance use were lower in the alexithymic group (p&lt;0.01). The mean STAI-Y state and C-SSRS scores were higher in the group with alexithymia (p&lt;0.01). There was a statistically significant difference between the groups in terms of mean scores for anxiety traits (p&lt;0.05) and no significant difference in terms of mean scores for depression. All of the scores correlated significantly with. Addicted patients with alexithymia could be targeted at prevent- ing the onset of suicidal thoughts and behaviour. The present study also evokes that whenever an emotional regulation disorder is observed, the possibility of anxio-depressive symptomatology and suicidality (ideation and behavior) needs to be assessed.

High Serum Levels of IL-6 Are Associated with Suicide Attempt but Not with High Lethality Suicide Attempts: A Preliminary Case-Control Study.

Suicide attempts are an emerging health problem around the world. Increased levels of IL-6 have been associated with suicidal behavior. Therefore, the aims of this study were to evaluate the serum levels of IL-6 in individuals with suicide attempts and a comparison group and to associate the IL-6 levels with the lethality of the suicide attempt. Additionally, we associated the rs2228145 polymorphism of the IL6R gene with suicide attempts or with the IL-6 serum levels. Suicide attempts and their lethality were evaluated using the Columbia Suicide Severity Rating Scale. The serum concentrations of IL-6 were measured by the ELISA technique in individuals with suicide attempts and then compared to a control group. The rs2228145 polymorphism of the IL6R gene was analyzed by real-time polymerase chain reaction. We found elevated serum levels of IL-6 in the suicide attempt group when compared to the control group (F = 10.37, p = 0.002). However, we found no differences of the IL-6 levels between high and low lethality. The IL6R gene polymorphism rs2479409 was not associated with suicide attempts. Our data suggest that IL-6 serum is increased in individuals with suicide attempts.

(170) Assessing Suicidal Ideation: Augmenting the Patient Health Questionnaire-9 with the Columbia-Suicide Severity Rating Scale

(170) Assessing Suicidal Ideation: Augmenting the Patient Health Questionnaire-9 with the Columbia-Suicide Severity Rating Scale

Overlapping Patterns of Suicide Attempts and Non-suicidal Self-Injuries in Adults: A Prospective Clinical Cohort Study.

Objective: An overlap of non-suicidal self-injuries (NSSIs) and suicide attempts (SAs) is observed in young cohorts, but there are few robust prospective studies for adults. We compared 1-year outcomes in adults with different self-harm patterns: NSSI only, NSSI + SA, and SA only. Methods: 793 patients (67% women) consecutively presenting with NSSI (17%) or SA (83%) at 3 Swedish hospitals took part in face-to-face interviews. Past and current self-harm was characterized by the Columbia-Suicide Severity Rating Scale. Clinical records and national register data were employed to determine 1-year outcomes. Results: At inclusion, over half of the participants had engaged in both NSSI and SA; 41% had SA only and 5%, NSSI only. During follow-up, non-fatal SAs were observed in approximately one-third of the total group (n = 269). Suicides occurred in 2% of those with NSSI + SA; the same proportion was seen in the SA only group. No suicides were observed in those with NSSI only. In a multiple logistic regression analysis, the NSSI + SA pattern was associated with a more than 3-fold risk of subsequent fatal/non-fatal suicidal behavior compared to “pure” NSSI; risk was not elevated in those with “pure” SA. Neither sex nor age group predicted subsequent suicidal behavior. Conclusions: Switching between behaviors with and without suicidal intent was common in this adult clinical cohort. Risk of subsequent suicidal behavior was tripled in the combined group. Clinicians who assess adults with NSSI must evaluate not only current but also previous episodes when assessing future risk of suicidal behavior.

Psychological and behavioral characterization of suicide ideators and suicide attempters in adolescence.

Suicide is a global cause of death, a chronic disability, and a significant public health problem. Recent works emphasize the importance of differentiating people with suicide ideation (SI) and people with suicidal attempts (SA), so we conducted a clinical cross-sectional study to better characterize the features most associated with SA. We enrolled 88 adolescents (77 females) from 12 to 18 years of age (M = 15.21, SD = 1.63) admitted to Northern Italian Child Neurology and Psychiatry Service who presented SI and/or SA. We conducted an assessment using the Columbia-Suicide Severity Rating Scale, and divided participants into two groups: adolescents with SA, and adolescents with thoughts about killing themselves which may include a plan but no suicidal attempts (SI). We found that the SA group showed greater severity of SI [t(86) = −3.485, p < 0.001], higher levels of subjective depression [t(70) = −2.65, p = 0.01)], and a higher prevalence of personality disorders [ = 8.775, p = 0.032] than the SI group. Both groups presented a prevalence of internalizing problems compared to the externalizing ones in the Youth Self-Report (YSR). Higher scores on YSR internalizing problems correlate positively with the “Repulsion by Life” subscale of the Multi-Attitude Suicide Tendency (MAST) Scale in both SA and SI groups (p = 0.41 and p = 0.67, respectively), while low levels of the MAST “Attraction to Life” subscale appear more often in the SA one (p = −0.71). In conclusion, results showed that some features (e.g., prevalence of personality disorders, SI intensity, and subjective depression) might help clinicians distinguish between patients with SI and those with SA and support the importance of carefully pursuing this distinction in research.

2.20 Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) With Adolescent Patients During the COVID-19 Pandemic at University of Kentucky Healthcare

The objectives of this study were to: 1) examine the impact of the COVID-19 pandemic on adolescent Columbia-Suicide Severity Rating Scale (C-SSRS) scores, psychiatric inpatient admission rates, and the reason for presentation; 2) determine if there is a significant relationship between scores on the C-SSRS, inpatient psychiatric admissions, and the reason for presentation; and 3) expand on the previous study reviewing compliance with the C-SSRS protocol for all adolescent patients at University of Kentucky (UK) HealthCare from September 2019 to February 2021.

3.59 The Relationship Between Risk Factors of Suicidality, Alexithymia, and the Columbia Suicide Severity Rating Scale Scores of ASD vs Typically Developing Adolescents

There is a need for a better understanding of the factors that contribute to suicidality within the ASD population that may be different from typically developing youth as well as an improvement in the ability to effectively screen for it using a standard scale. The aims of this descriptive study were to: 1) compare the presence and number of known suicidality risk factors between adolescents with ASD and those without ASD evaluated in the emergency department and the congruence with the Columbia Suicide Severity Rating Scale (C-SSRS) score; and 2) explore whether specific aspects of alexithymia, a risk factor present in particularly high rates in the ASD population, are individually associated with the C-SSRS score.

The Relationships between Depression, Suicide Risk and Emotional Cognitive Coping

Background and aim: Emotional cognitive coping strategies are closely correlated with depression and suicide risk. The aim of this study is to explore the particular features of cognitive-emotional coping and their impact on depression levels and suicidal ideation. Methods: The study included a total number of 131 participants, 65 with a clinical diagnosis of depression and 66 controls. Instruments used were: Cognitive Emotion Regulation Questionnaire (CERQ), Columbia Suicide Severity Rating Scale (C-SSRS), Depression Anxiety Stress Scale (DASS21R), Montgomery-Asberg Depression Scale (MADRS), in order to assess the differences between depressive and non-depressive individuals in relation to coping strategies. Results and conclusion: The findings, based on the statistical analysis of the scores obtained on the various psychometric scales, showed significant differences between depressive and non-depressive patients. Also, cognitive-emotional strategies could represent a good predictor to be used in the prevention of suicide risk in depressed patients.

A validation study of PHQ-9 suicide item with the Columbia Suicide Severity Rating Scale in outpatients with mood disorders at National Network of Depression Centers

BackgroundIn the United States, suicide is one of the serious public health problems and a major cause of death. Several researchers and clinical settings use the patient health questionnaires (PHQ-9) to gauge depression and psychological distress among adults and to predict suicide and death. This study aimed to assess the sensitivity, specificity, and predictive potential of suicide Q9 of the PHQ-9 compared to the Columbia-suicide severity rating scale (C-SSRS). MethodsAdults aged 19 or older, identified with a primary mood disorder diagnosis during their initial clinic visit between 2012 and 2020 from the National Network of Depression Centers, were included in the study. The accuracy of the PHQ-9 suicide item was compared with the gold standard, the C-SSRS. ResultsOut of 2677 study participants, 31.6 % (n = 846) and 11.65 % (n = 312) had positive responses to the PHQ-9 suicide item and C-SSRS response, respectively. The sensitivity of the PHQ-9 compared to the C-SSR was 74.7 % (95%CI: 69.6 %–79.2 %), specificity 74.1 % (95%CI: 72.3 %–75.8 %), positive predictive value 27.5 % (95%CI: 24.6 %–30.6 %), and negative predictive value 95.7 % (95%CI: 94.7 %–96.5 %). The secondary analysis results showed better validity results of the PHQ-9 suicide item when compared to the suicide ideation item of the C-SSRS. LimitationsThis study is among mood disorder patients so additional research would be necessary among populations with different conditions. ConclusionFor initial suicide screening, the PHQ-9 suicide item would over identify patients as at risk for suicide and the C-SSRS should be used mood disorder clinics to identify suicide risk.