Columbia Classification Algorithm for Suicide Assessment (C-CASA)

Last reviewed 01/2018

Columbia Classification Algorithm for Suicide Assessment (C-CASA)

C-CASA has described eight categories that differentiate suicidal events from nonsuicidal events and indeterminate or potentially suicidal events:

• suicidal events
  
  
• completed suicide  - a self-injurious behaviour that resulted in fatality and was associated with at least some intent to die as a result of the act
  
  
• suicide attempt - a potentially self-injurious behaviour, associated with at least some intent to die, as a result of the act. Evidence that the individual intended to kill him/ herself, at least to some degree, can be explicit or inferred from the behaviour or circumstance. A suicide attempt may or may not result in actual injury
  
  
• preparatory acts toward imminent suicidal behaviour - the individual takes steps to injure him- or herself, but is stopped by self or others from starting the self-injurious act before the potential for harm has begun
  
  
• suicidal ideation - passive thoughts about wanting to be dead or active thoughts about killing oneself, not accompanied by preparatory behaviour
  
  
• indeterminate or potentially suicidal events
  
  
• self-injurious behaviour where associated intent to die is unknown and cannot be inferred. The injury or potential for injury is clear, but why the individual engaged in that behaviour is unclear
  
  
• not enough information - insufficient information to determine whether the event involved deliberate suicidal behaviour or ideation. There is reason to suspect the possibility of suicidality but not enough to be confident that the event was not something other, such as an accident or psychiatric symptom. An injury sustained on a place on the body consistent with deliberate self-harm or suicidal behaviour (e.g., wrists), with- out any information as to how the injury was received, would warrant placement in this category
  
  
• nonsuicidal events, self-injurious behaviour
  
  
• self-injurious behaviour associated with no intent to die - the behaviour is intended purely for other reasons, either to relieve distress (often referred to as “self-mutilation,” e.g., superficial cuts or scratches, hitting/banging, or burns) or to effect change in others or the environment
  
  
• other, no deliberate self-harm - no evidence of any suicidality or deliberate self-injurious behaviour associated with the event. The event is characterized as an accidental injury, psychiatric or behavioural symptoms only, or medical symptoms or procedure only

Reference:

• (1) Posner K et al. Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007 Jul; 164(7): 1035–1043.