The suicide questions in every drug trial were written with public money, and a seventy-company centre runs them
The C-SSRS was built by Columbia, Penn and Pittsburgh with NIMH support and is free to clinics. The FDA names it in its trial guidance. Its validation paper discloses support to the centre from more than seventy companies.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: The disclosure describes support to the centre that runs the scale for sponsors who must use it, not payment for the scale's creation; the studies themselves were publicly funded. The FDA document is a draft and nonbinding on paper.
Significant findings
The Columbia-Suicide Severity Rating Scale is the set of questions about suicidal thoughts and behaviour that sits in nearly every psychiatric drug trial and in a great many clinics. Its validation paper pooled three multisite studies: a treatment study of 124 adolescent suicide attempters, a medication efficacy trial in depressed adolescents, and an adult emergency-department study.
The scale's own site says it was developed by Columbia University, the University of Pennsylvania and the University of Pittsburgh "supported by the National Institute of Mental Health (NIMH)", and that the protocol and training "are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research."
The FDA's 2012 draft guidance on assessing suicidal ideation and behaviour in drug trials calls it "one of several available suicidal ideation and behavior instruments" and says it "would be acceptable for the purpose of these studies." The document is marked "Contains Nonbinding Recommendations." In practice it is what sponsors use.
The paper's disclosure is the part to read slowly. The studies were funded by NIMH cooperative agreements and the American Foundation for Suicide Prevention. "The data for the analysis of the escitalopram trial (study 2) were provided by Forest Laboratories, which did not participate in the data analysis, interpretation of results, or review or contribute to this article." The lead author "is the director of the Center for Suicide Risk Assessment, which, as part of an effort to help execute the U.S. Food and Drug Administration's suicidality classification mandates, has received support from" a list of more than seventy companies, including Abbott, AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Johnson & Johnson, Lilly USA, Lundbeck, Merck, Novartis, Otsuka, Pfizer, Roche, Sanofi-Aventis, Shire, Takeda and Wyeth. Three authors "receive royalty payments for the electronic self-rated versions" from ERT, Inc.
Worth asking
That is not payment for inventing the scale. It is what happens when a regulator names an instrument: every sponsor who must use it pays the centre that runs it. The scale is free. The market around it is not. If a clinic asks you these questions, the honest thing to know is that they were written with public money, and that answering them is what starts a conversation, not what ends one.
Source
The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults — Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. (2011)
Read the source: https://doi.org/10.1176/appi.ajp.2011.10111704
DOI: 10.1176/appi.ajp.2011.10111704
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
We have not finished checking this source, so there is no scoring to show yet. “We have not checked this yet” and “this is disputed” are different statements, so no scored band is shown rather than a low one.
Read the full scoring rubric, including what it can't tell you.
Published September 17, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: The disclosure describes support to the centre that runs the scale for sponsors who must use it, not payment for the scale's creation; the studies themselves were publicly funded. The FDA document is a draft and nonbinding on paper. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults — Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. (2011). DOI: 10.1176/appi.ajp.2011.10111704. The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.