A 34-year-old male with major depressive disorder presents to the emergency department with suicidal ideation. He reports passive death wishes for the past 2 weeks and denies current intent or plan. On mental status examination, he appears depressed with psychomotor retardation. Which investigation is most appropriate to objectively assess his current suicide risk and guide immediate management?

Explanation

## Suicide Risk Assessment Investigations ### The Columbia-Suicide Severity Rating Scale (C-SSRS) **Key Point:** The C-SSRS is a gold-standard, validated instrument for assessing suicide risk in clinical and research settings. It is recommended by the FDA and widely used in psychiatric emergency departments. **High-Yield:** The C-SSRS evaluates both ideation (frequency, intensity, duration) and behaviour (actual attempts, interrupted attempts, aborted attempts, preparatory behaviour). It provides a structured, objective measurement of suicide severity. ### Why C-SSRS is the Investigation of Choice 1. **Structured assessment:** Provides quantifiable data on suicidal ideation and behaviour across multiple dimensions 2. **Clinical utility:** Directly informs risk stratification (low, intermediate, high) and admission decisions 3. **Evidence-based:** Extensively validated in diverse populations and recommended by psychiatric guidelines 4. **Immediate applicability:** Can be administered in the emergency setting within minutes ### Other Investigations in Suicide Risk Assessment | Investigation | Role in Suicide Risk | Limitation | |---|---|---| | **C-SSRS** | Direct, validated measurement of ideation and behaviour | Gold standard | | **Serum cortisol** | Marker of HPA axis dysfunction in depression | Non-specific; does not assess suicide risk directly | | **EEG** | May show abnormalities in mood disorders | Not used for suicide risk assessment | | **DST** | Historical test for depression severity | Outdated; poor predictive value for suicide | **Clinical Pearl:** While biological markers (cortisol, inflammatory cytokines) may be elevated in depressed patients with suicidal ideation, they lack specificity and sensitivity for suicide risk prediction. Structured clinical assessment tools remain the gold standard. **Warning:** Do not confuse biomarkers of depression severity with instruments that assess suicide risk. A patient with abnormal DST or elevated cortisol is not necessarily at higher suicide risk.