The Reading Hospital and Medical Center Sixth Avenue and Spruce Street, West Reading, PA 19611
SUICIDE IDEATION DEFINITIONS AND PROMPTS:
Ask questions that are bolded and underlined. The remaining information is for staff only.
Yes No
Ask questions 1 and 2
1) Wish to be Dead:
Person endorses thoughts about a wish to be dead or not alive anymore, or wish to fall asleep and not wake up.
In the past week, have you wished you
were
dead,
or
wished you could go
to
sleep and not wake up?
2) Suicidal Thoughts:
General non-specific thoughts of wanting to end one's life/commit suicide, "I've thought about killing myself"
without general thoughts of ways to kill oneself/associated methods, intent or plan.
In the past week. have you had any actual thoughts of killing yourself?
If YES to 2: Ask Question 3.
3) Suicidal Thoughts with method (without Specific Plan or Intent to Act):
Person endorses thoughts of suicide and has thought of at least one method during the assessment period.
This is different than a specific plan with time, place, or method details worked out. "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. "
In the past week, have you been thinking about how you might do this?
If NO to 2 or NO to 3, skip to Question 6 and stop there
If YES to Question 3, ask Question 4 and 5, Do NOT ask Question 6
4) Suicidal Intent (without specific plan):
Active suicidal thoughts of killing oneself and patient reports having some intent to act on such thoughts, as
opposed to "I have the thoughts but I definitely will not do anything about them."
In the past week, have you had these thoughts and had some intention of acting on them?
5) Suicidal Intent With Specific Plan:
Thoughts of killing oneself with details of plan fully or partially worked out, and person has some intent to carry it
out.
In the past week, have you started
to
work out
or
worked out the details of how
to
kill yourself? Do you
intend
to
carry out this plan?
PT #:
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AS0580
COLUMBIA-SUICIDE SEVERITY
RATING SCREEN VERSION
RH2311 Revised 11.09 1 of 2
