Which are the two initial questions used to assess suicidal ideation according to the C-SSRS?

The initial questions used to assess suicidal ideation according to the Columbia – Suicide Severity Rating Scale (C-SSRS) focus on directly assessing the individual's thoughts about death and self-harm. The question "Have you wished you were dead?" is foundational because it explicitly inquires about the person's desire for death, making it clear and direct in evaluating suicidal ideation.

This specific phrasing helps to gauge the intensity and nature of their thoughts related to suicide. It not only captures a moment of ideation but also serves as a precursor to understanding deeper suicidal thoughts and feelings. By starting with this type of question, clinicians can establish a baseline level of risk which is essential for effective assessment and intervention.

In contrast, the other options, while relevant to understanding a person's mental state, do not directly target suicidal thoughts in a straightforward manner. For instance, asking about future thoughts or feelings of hopelessness can indicate broader mental health issues but may not specifically reveal suicidal intent. Self-harm inquiries, while significant, are more about behaviors than current ideation. Thus, they do not fit the primary objective of direct suicidal ideation assessment in the initial questions of the C-SSRS.