The C-SSRS screener result is determined by the highest-numbered question answered 'Yes,' reflecting the most severe level of suicidal ideation or behavior endorsed. If only Question 1 is positive (wish to be dead), this indicates passive suicidal ideation and warrants further monitoring and clinical follow-up. If Question 2 is positive (thoughts of killing yourself), active suicidal ideation is present and requires a more thorough risk assessment.

Positive responses to Questions 3 through 5 indicate progressively more severe active suicidal ideation: Question 3 positive means the person has thought about a method, Question 4 positive means there is some intent to act, and Question 5 positive means there is a specific plan with intent. These escalating levels of ideation require increasingly urgent clinical intervention, safety planning, and consideration of higher levels of care.

A positive response to Question 6 indicates suicidal behavior — the person has made a prior attempt, started to carry out a plan, or made preparations. This is the highest risk category on the screener and warrants immediate safety assessment, means restriction counseling, and determination of the appropriate level of care. Any positive response on the C-SSRS should trigger a comprehensive clinical evaluation and documentation of the safety plan.

The C-SSRS screener should be used whenever there is a clinical need to assess for suicidal ideation and behavior. It is appropriate for universal screening in emergency departments, inpatient psychiatric admissions, primary care visits where depression or risk factors are identified, and as part of intake assessments in mental health settings. Many health systems now mandate universal suicide screening using the C-SSRS or similar validated tools.

This tool is also indicated when a patient presents with depression, hopelessness, recent psychosocial stressors, substance use, or any clinical concern for self-harm. It can be used by non-clinical staff after brief training, making it suitable for schools, crisis hotlines, military settings, and community organizations. The C-SSRS screener is designed for rapid administration and can be completed in one to two minutes.

The C-SSRS screener is a brief screening version and does not capture the full detail of the complete C-SSRS clinical assessment, which includes intensity ratings for ideation (frequency, duration, controllability, deterrents, reasons) and detailed behavior assessment. A positive screener should prompt a more comprehensive evaluation by a qualified clinician.

Like all suicide risk assessment tools, the C-SSRS cannot predict with certainty whether an individual will attempt suicide. Suicide risk is dynamic and can change rapidly based on circumstances, access to means, and protective factors. A negative screen does not eliminate risk, and clinical judgment must always be applied alongside structured screening.

The screener relies on honest self-disclosure, and individuals who are determined to conceal suicidal ideation may deny symptoms. Cultural factors, stigma, and the clinical environment can all influence willingness to disclose. The C-SSRS should be administered in a private, supportive setting and should be considered one component of a comprehensive risk assessment rather than a standalone decision-making tool.