PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| <i style="background-color:#0272A6">Past Months</i> | past_months | N | text | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i> Years | past_year | N | text | - | - | - | |
| 1a. Wish to be dead - <i style="background-color:#DA70D6"><i style="background-color:#DA70D6">Lifetime:</i> Time He/She Felt Most Suicidal<br><h6>(Subject endorses thoughts about a wish to be dead or not alive anymore, or wish to fall asleep and not wake up.) Have you wished you were dead or wished you could not go to sleep and not wake up? </h6> | cssrs_1a | N | radio | 1, Yes | 0, No | - | - | |
| 1b. Wish to be dead - <i style="background-color:#0272A6">Past Months</i> <br><h6>(Subject endorses thoughts about a wish to be dead or not alive anymore, or wish to fall asleep and not wake up.) Have you wished you were dead or wished you could not go to sleep and not wake up? | cssrs_1b | N | radio | 1, Yes | 0, No | - | - | |
| 2a. Non-Specific Active Suicidal Thoughts - <i style="background-color:#DA70D6"><i style="background-color:#DA70D6">Lifetime:</i> Time He/She Felt Most Suicidal <br><h6>(General, non-specific thoughts of wanting to end one's life / commit suicide (e.g.., "I've thought about killng myself") without thoughts of ways to kill oneself/associated methods, intent, or plan during the assessment period.) Have you actually had any thoughts of killing yourself? | cssrs_2a | N | radio | 1, Yes | 0, No | - | - | |
| 2b. Non-Specific Active Suicidal Thoughts - <i style="background-color:#0272A6">Past Months</i> <br><h6>(General, non-specific thoughts of wanting to end one's life / commit suicide (e.g.., "I've thought about killng myself") without thoughts of ways to kill oneself/associated methods, intent, or plan during the assessment period.) Have you actually had any thoughts of killing yourself? | cssrs_2b | N | radio | 1, Yes | 0, No | - | - | |
| 3a. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act - <i style="background-color:#DA70D6"><i style="background-color:#DA70D6">Lifetime:</i> Time He/She Felt Most Suicidal <br><h6>( Subject endorses thoughts of suicide and has thoughts of at least one method during assessment period. This is different than a specific plan with time, place or method details worked out (e.g. thoughts of method to kill self but not a specific plan.) Includes person who would say, "I thought about taking an overdose but I never made a specific plan as to when, where or how I would actually do it..and I would never go through with it") Have you been thinking about how you might do this? | cssrs_3a | N | radio | 1, Yes | 0, No | - | - | |
| 3b. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act - <i style="background-color:#0272A6">Past Month</i> <br><h6>( Subject endorses thoughts of suicide and has thoughts of at least one method during assessment period. This is different than a specific plan with time, place or method details worked out (e.g. thoughts of method to kill self but not a specific plan.) Includes person who would say, "I thought about taking an overdose but I never made a specific plan as to when, where or how I would actually do it..and I would never go through with it") Have you been thinking about how you might do this? | cssrs_3b | N | radio | 1, Yes | 0, No | - | - | |
| 4a. Active Suicidal Ideation with Some Intent to Act, without Specific Plan - <i style="background-color:#DA70D6"><i style="background-color:#DA70D6">Lifetime:</i> Time He/She Felt Most Suicidal <br><h6>(Active suicidal thoughts of killing oneself and subject reports having some intent to act on such thoughts as opposed to "I have thoughts but I definitely will not do anything about them.") Have you had these thoughts and had some intentions of acting on them? | cssrs_4a | N | radio | 1, Yes | 0, No | - | - | |
| 4b. Active Suicidal Ideation with Some Intent to Act, without Specific Plan - <i style="background-color:#0272A6">Past Months</i> <br><h6>(Active suicidal thoughts of killing oneself and subject reports having some intent to act on such thoughts as opposed to "I have thoughts but I definitely will not do anything about them.") Have you had these thoughts and had some intentions of acting on them? | cssrs_4b | N | radio | 1, Yes | 0, No | - | - | |
| 5a. Active Suicidal Ideation with Specific Plan and Intent - <i style="background-color:#DA70D6"><i style="background-color:#DA70D6">Lifetime:</i> Time He/She Felt Most Suicidal <br><h6>(Thoughts of killing oneself with details of plan fully or partially worked out and subject has some intent to carry it out.) Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan? | cssrs_5a | N | radio | 1, Yes | 0, No | - | - | |
| 5b. Active Suicidal Ideation with Specific Plan and Intent - <i style="background-color:#0272A6">Past Months</i> <br><h6>(Thoughts of killing oneself with details of plan fully or partially worked out and subject has some intent to carry it out.) Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan? | cssrs_5b | N | radio | 1, Yes | 0, No | - | - | |
| If answered yes to 1a/1b, describe: | cssrs_1_desc | Y | notes | - | - | - | |
| If answered yes to 2a/2b, describe: | cssrs_2_desc | Y | notes | - | - | - | |
| If answered yes to 3a/3b, describe: | cssrs_3_desc | Y | notes | - | - | - | |
| If answered yes to 4a/4b, describe: | cssrs_4_desc | Y | notes | - | - | - | |
| If answered yes to 5a/5b, describe: | cssrs_5_desc | Y | notes | - | - | - | |
| <u>INTENSITY OF IDEATION</u> The following features should be rated with respect to the most severe type of ideation (i.e. 1-5 from above, with 1 being the least severe and 5 being the most severe). | cssrs_intensity | N | descriptive | - | - | - | |
| Most Severe Ideation - <i style="background-color:#DA70D6">Lifetime:</i> (Type # 1-5) | ioi_mostsevere | N | text | - | - | - | |
| Describe the most severe ideation: | ioi_mostsevere_dtl | Y | notes | - | - | - | |
| Most Severe Ideation in the <i style="background-color:#0272A6">past month</i> (Type # 1-5) | ioi_pxm_mostsevere | N | text | - | - | - | |
| Describe the most severe ideation: | ioi_pxm_mostsevere_dtl | Y | notes | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: How many times have you had these thoughts? | freq_a | N | radio | 1, Less than a week | 2, Once a week | 3, 2-5 times a week | 4, Daily or almost daily | 5, Many times a day | - | - | |
| <i style="background-color:#0272A6">Past Months</i>: How many times have you had these thoughts? | freq_b | N | radio | 1, Less than a week | 2, Once a week | 3, 2-5 times a week | 4, Daily or almost daily | 5, Many times a day | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | dur_a | N | radio | 1, Fleeting - few seconds or minutes | 2, Less than 1 hour/some of the time | 3, 1-4 hours/a lot of time | 4, 4-8 hours/most of day | 5, More than 8 hours/ persistent or continuous | - | - | |
| <i style="background-color:#0272A6">Past Months</i>: | dur_b | N | radio | 1, Fleeting - few seconds or minutes | 2, Less than 1 hour/some of the time | 3, 1-4 hours/a lot of time | 4, 4-8 hours/most of day | 5, More than 8 hours/ persistent or continuous | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | cssrs_control_a | N | radio | 1, Easily able to control thoughts | 2, Can control thoughts with little difficulty | 3, Can control thoughts with some difficulty | 4, Can control thoughts with a lot of difficulty | 5, Unable to control thoughts | 0, Does not attempt to control thoughts | - | - | |
| <i style="background-color:#0272A6">Past Months</i>: | cssrs_control_b | N | radio | 1, Easily able to control thoughts | 2, Can control thoughts with little difficulty | 3, Can control thoughts with some difficulty | 4, Can control thoughts with a lot of difficulty | 5, Unable to control thoughts | 0, Does not attempt to control thoughts | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | deter_a | N | radio | 1, Deterrents definitely stopped you from attempting suicide | 2, Deterrents probably stopped you | 3, Uncertain that deterrents stopped you | 4, Deterrents most likely did not stop you | 5, Deterrents definitely did not stop you | 0, Does not apply | - | - | |
| <i style="background-color:#0272A6">Past Months</i>: | deter_b | N | radio | 1, Deterrents definitely stopped you from attempting suicide | 2, Deterrents probably stopped you | 3, Uncertain that deterrents stopped you | 4, Deterrents most likely did not stop you | 5, Deterrents definitely did not stop you | 0, Does not apply | - | - | |
| <i style="background-color:#DA70D6">Lifetime</i>: | reason_a | N | radio | 1, Completely to get attention, revenge or a reaction from others | 2, Mostly to get attention, revenge or a reaction from others | 3, Equally to get attention, revenge or a reaction fro others and to end/stop the pain | 4, Mostly to end or stop the pain (you couldn't go on living with the pain or how you were feeling) | 5, Completely to end or stop the pain (you couldn't go on living with the pain or how you were feeling) | 0, Does not apply | - | - | |
| <i style="background-color:#0272A6">Past Months</i>: | reason_b | N | radio | 1, Completely to get attention, revenge or a reaction from others | 2, Mostly to get attention, revenge or a reaction from others | 3, Equally to get attention, revenge or a reaction fro others and to end/stop the pain | 4, Mostly to end or stop the pain (you couldn't go on living with the pain or how you were feeling) | 5, Completely to end or stop the pain (you couldn't go on living with the pain or how you were feeling) | 0, Does not apply | - | - | |
| SUICIDAL BEHAVIOR (Check all that apply so long as these are separate events, must ask about all types.) | cssrs_aa | N | descriptive | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | aa_a | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#0272A6">Past Month</i> | aa_b | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: Total # of Attempts | cssrs_total_attempts | N | text | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: What did you do? <h6 style="background-color:powderblue;border-left: 6px solid gray;"> Have you made a suicide attempt? Have you done anything to harm yourself? Have you done anything dangerous where you could have died? What did you do? Did you _______________ as a way to end your life? Did you want to die (even a little) when you __________________? Were you trying to end your life when you __________________? Or did you think it was possible you could have died from __________________? </h6> | cssrs_sb_a | Y | notes | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: <h6 style="background-color:powderblue;border-left: 6px solid gray;">Or did you do it purely for other reasons / without ANY intention of killing yourself (like to relieve stress, feel better, get sympathy, or get something else to happen) ? (Self injurious behavior without suicide attempts) </h6> | cssrs_sb_b | Y | notes | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: Has subject engaged in Non-Suicidal Self-Injurious Behavior? | cssrs_c2 | N | yesno | - | - | - | |
| <i style="background-color:#4CBB17">Past Year:</i> Total # of Attempt | cssrs_pastyr_total_attempt | N | text | - | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: Has subject engaged in Non-Suicidal Self-Injurious Behavior? | cssrs_c1 | N | yesno | - | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: What did you do? <h6 style="background-color:powderblue;border-left: 6px solid gray;"> Have you made a suicide attempt? Have you done anything to harm yourself? Have you done anything dangerous where you could have died? What did you do? Did you _______________ as a way to end your life? Did you want to die (even a little) when you __________________? Were you trying to end your life when you __________________? Or did you think it was possible you could have died from __________________? </h6> | cssrs_sb_a2 | Y | notes | - | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: <h6 style="background-color:powderblue;border-left: 6px solid gray;"> Or did you do it purely for other reasons / without ANY intention of killing yourself (like to relieve stress, feel better, get sympathy, or get something else to happen) ? (Self injurious behavior without suicide attempts)</h6> | cssrs_sb_b2 | Y | notes | - | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: Has subject engaged in Non-Suicidal Self-Injurious Behavior? | cssrs_cs2 | Y | notes | - | - | - | |
| <u>INTERRUPTED ATTEMPTS</u> When the person is interrupted (by any outside circumstances) from starting the potentially self injurious act (if not for that, actual attempt would have occurred.) Overdose: Person has pills in hand but is stopped from ingesting. Once they ingest any pills, this becomes an attempt rather than an interrupted attempt. Shooting: Person has gun pointed towards self, gun is taken away by someone else, or is somehow prevented from pulling trigger. Once they pull the trigger, even if the gun fails to fire, it is an attempt. Jumping: Person is poised to jump, is grabbed and taken down from the ledge. Hanging: Person has noose around neck but has not yet started to hang - is stopped from doing so. | cssrs_ia | N | descriptive | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime</i>: | interrupted_a | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#4CBB17">Past Years</i>: | interrupted_b | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: Total # of Interrupted Attempts | cssrs_inter_total | N | text | - | - | - | |
| Describe: | cssrs_ia_a | Y | notes | - | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: Total # of Interrupted Attempts | cssrs_inter_year_total | N | text | - | - | - | |
| Describe: | cssrs_ia_b | Y | notes | - | - | - | |
| <u>ABORTED ATTEMPTS</u> When person begins to take steps towards making a suicide attempt, but stops themselves before they actually have engaged in any self-destructive behavior. Examples are similar to interrupted attempts, except that the individual stops him/herself, instead of being stopped by someone else. | cssrs_ab | N | descriptive | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | cssrs_ab_a | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#4CBB17">Past Years</i>: | cssrs_ab_b | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: Total # of Aborted Attempts | cssrs_ab_total | N | text | - | - | - | |
| Describe: | cssrs_ab_a_desc | Y | notes | - | - | - | |
| <i style="background-color:#4CBB17">Past Years</i>: Total # of Aborted Attempts: | cssrs_ab_b_total | N | text | - | - | - | |
| Describe: | cssrs_ab_b_desc | Y | notes | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | cssrs_prep_a | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: | cssrs_prep_b | N | radio | 1, Yes | 0, No | - | - | |
| Detail (Preparatory Acts or Behavior) | sb_prepactbeh_dtl | Y | notes | - | - | - | |
| <i style="background-color:#DA70D6">Lifetime:</i>: | cssrs_sb_as_a | N | radio | 1, Yes | 0, No | - | - | |
| <i style="background-color:#4CBB17">Past Year</i>: | cssrs_sb_as_b | N | radio | 1, Yes | 0, No | - | - | |
| Most Recent Attempt Date: | cssrs_mrad | N | text | - | - | - | |
| Most Lethal Attempt Date | cssrs_mlad | N | text | - | - | - | |
| Initial/First Attempt Date: | cssrs_mfad | N | text | - | - | - | |
| Most Recent Attempt | cssrs_mra | N | radio | 0, No physical damage or very minor physical damage (e.g., surface scratches) | 1, Minor physical damage (e.g., lethargic speech; first degree burns; mild bleeding, sprains) | 2, Moderate physical damage; medical attention needed (e.g., conscious but sleepy, somewhat responsive; second degree burns; bleeding of major vessel) | 3, Moderately severe physical damage; medical hospitalization and likely intensive care required (e.g., comatose with reflexes intact; third degree burns less than 20% of the body; extensive blood loss but can recover; major fracture) | 4, Severe physical damage; medical hospitalization with intensive care required (e.g., comatose without reflexes; third degree burns over 20% of the body; extensive blood loss with unstable vital signs; major damage to vital area) | 5, Death | - | - | |
| Most Lethal Attempt | cssrs_mla | N | radio | 0, No physical damage or very minor physical damage (e.g., surface scratches) | 1, Minor physical damage (e.g., lethargic speech; first degree burns; mild bleeding, sprains) | 2, Moderate physical damage; medical attention needed (e.g., conscious but sleepy, somewhat responsive; second degree burns; bleeding of major vessel) | 3, Moderately severe physical damage; medical hospitalization and likely intensive care required (e.g., comatose with reflexes intact; third degree burns less than 20% of the body; extensive blood loss but can recover; major fracture) | 4, Severe physical damage; medical hospitalization with intensive care required (e.g., comatose without reflexes; third degree burns over 20% of the body; extensive blood loss with unstable vital signs; major damage to vital area) | 5, Death | - | - | |
| Initial/First Attempt Date | cssrs_mfa | N | radio | 0, No physical damage or very minor physical damage (e.g., surface scratches) | 1, Minor physical damage (e.g., lethargic speech; first degree burns; mild bleeding, sprains) | 2, Moderate physical damage; medical attention needed (e.g., conscious but sleepy, somewhat responsive; second degree burns; bleeding of major vessel) | 3, Moderately severe physical damage; medical hospitalization and likely intensive care required (e.g., comatose with reflexes intact; third degree burns less than 20% of the body; extensive blood loss but can recover; major fracture) | 4, Severe physical damage; medical hospitalization with intensive care required (e.g., comatose without reflexes; third degree burns over 20% of the body; extensive blood loss with unstable vital signs; major damage to vital area) | 5, Death | - | - | |
| Most Recent Attempt | cssrs_mrap | N | radio | 0, Behavior not likely to result in injury | 1, Behavior likely to result in injury but not likely to cause death | 2, Behavior likely to result in death despite available medical care | - | - | |
| Most Lethal Attempt | cssrs_mlap | N | radio | 0, Behavior not likely to result in injury | 1, Behavior likely to result in injury but not likely to cause death | 2, Behavior likely to result in death despite available medical care | - | - | |
| Initial/First Attempt Date | cssrs_mfap | N | radio | 0, Behavior not likely to result in injury | 1, Behavior likely to result in injury but not likely to cause death | 2, Behavior likely to result in death despite available medical care | - | - | |
| Note | cssrs_note | Y | notes | - | - | - |