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_v2 | N | text | - | - | - | |
| 1. Wish to be dead - Since Last Visit <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_v2 | N | radio | 1, Yes | 0, No | - | - | |
| 2. Non-Specific Active Suicidal Thoughts - Since Last Visit <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_v2 | N | radio | 1, Yes | 0, No | - | - | |
| 3. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act - Since Last Visit<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_v2 | N | radio | 1, Yes | 0, No | - | - | |
| 4. Active Suicidal Ideation with Some Intent to Act, without Specific Plan - Since Last Visit<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_v2 | N | radio | 1, Yes | 0, No | - | - | |
| 5. Active Suicidal Ideation with Specific Plan and Intent - Since Last Visit<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_v2 | N | radio | 1, Yes | 0, No | - | - | |
| If answered yes to 1, describe: | cssrs_1_desc_v2 | Y | notes | - | - | - | |
| If answered yes to 2, describe: | cssrs_2_desc_v2 | Y | notes | - | - | - | |
| If answered yes to 3, describe: | cssrs_3_desc_v2 | Y | notes | - | - | - | |
| If answered yes to 4, describe: | cssrs_4_desc_v2 | Y | notes | - | - | - | |
| If answered yes to 5, describe: | cssrs_5_desc_v2 | 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_v2 | N | descriptive | - | - | - | |
| Most severe ideation (Type# 1-5) | ioi_mostsevere_v2 | N | text | - | - | - | |
| Describe: | ioi_mostsevere_dtl_v2 | Y | text | - | - | - | |
| Most Severe: How many times have you had these thoughts? | freq_a_v2 | N | radio | 1, Less than once a week | 2, Once a week | 3, 2-5 times a week | 4, Daily or almost daily | 5, Many times a day | - | - | |
| Most Severe: | dur_a_v2 | 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 | - | - | |
| Most Severe: | cssrs_control_a_v2 | 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 | - | - | |
| Most Severe: | deter_a_v2 | 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 | - | - | |
| Most Severe: | reason_a_v2 | 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_v2 | N | descriptive | - | - | - | |
| Since last visit: | aa_a_v2 | N | radio | 1, Yes | 0, No | - | - | |
| Since last visit: Total # of Attempts | cssrs_total_attempts_v2 | N | text | - | - | - | |
| Since last visit: 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_v2 | Y | notes | - | - | - | |
| Since last visit: <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) | cssrs_sb_b_v2 | Y | notes | - | - | - | |
| Since last visit: Has subject engaged in Non-Suicidal Self-Injurious Behavior? | cssrs_c2_v2 | 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_v2 | N | descriptive | - | - | - | |
| Since last visit: | interrupted_a_v2 | N | radio | 1, Yes | 0, No | - | - | |
| Since last visit: Total # of Interrupted Attempts | cssrs_inter_total_v2 | N | text | - | - | - | |
| Describe: | cssrs_ia_a_v2 | 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_v2 | N | descriptive | - | - | - | |
| Since last visit: | cssrs_ab_a_v2 | N | radio | 1, Yes | 0, No | - | - | |
| Since last visit: Total # of Aborted Attempts | cssrs_ab_total_v2 | N | text | - | - | - | |
| Describe: | cssrs_ab_a_desc_v2 | Y | notes | - | - | - | |
| Since last visit: | cssrs_prep_a_v2 | N | radio | 1, Yes | 0, No | - | - | |
| Detail (Preparatory Acts of Behavior) | sb_prepactbeh_dtl_v2 | Y | notes | - | - | - | |
| Since last visit: | cssrs_sb_as_a_v2 | N | radio | 1, Yes | 0, No | - | - | |
| Most Lethal Attempt Date | cssrs_mlad_v2 | N | text | - | - | - | |
| Most Lethal Attempt | cssrs_mla_v2 | 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_mlap_v2 | 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_v2 | Y | notes | - | - | - |