Abstract
BACKGROUND: The Columbia-Suicide Severity Rating Scale (C-SSRS) screener is a brief scale widely used to assess suicidal risk. In Chile, its psychometric properties have not been examined in a university population. OBJECTIVE: to examine the psychometric properties of the C-SSRS screener in university students in Chile. METHODS: 2,547 university students (61.7% female; mean age: 20.6 years) participated in an online survey that included the six-item self-report C-SSRS screen version, instruments to measure symptoms of depression, generalized anxiety, well-being, and sociodemographic variables. Confirmatory factor analysis was used to examine the factor structure of the scale, its reliability was assessed, and validity based on the relationship with other variables was estimated. RESULTS: the single-factor structure of the C-SSRS showed acceptable fit and adequate internal consistency (α = 0.78 and ω = 0.83). Weak to strong positive correlations were observed with measures of depression, suicidal ideation and/or self-injury, and with generalized anxiety (ρ between 0.38 to 0.75; p < 0.001), as well as a moderate negative correlation with the well-being measure (ρ = -0.41; p < 0.001). CONCLUSIONS: the results support the use of the C-SSRS screener in the university population.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4a ed.). APA.
Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469-480. https://doi.org/10.1037/0003-066X.55.5.469
Arnett, J. J., Žukauskienė, R. y Sugimura, K. (2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569-576. https://doi.org/10.1016/S2215-0366(14)00080-7
Austria-Corrales, F., Jiménez-Tapia, A., Astudillo-García, C. I., Arenas-Landgrave, P., Xochihua-Tlecuitl, T., Cruz-Cruz, C., Rivera-Rivera, L., Gómez-García, J. A., Palacios-Hernández, B., Pérez-Amezcua, B., Toledano-Toledano, F., Richards, J. y Galynker, I. (2023). The Columbia-Suicide Severity Rating Scale: Validity and psychometric properties of an online Spanish-language version in a Mexican population sample. Frontiers in Public Health, 11, 1157581. https://doi.org/10.3389/fpubh.2023.1157581
Bjureberg, J., Dahlin, M., Carlborg, A., Edberg, H., Haglund, A. y Runeson, B. (2022). Columbia-Suicide Severity Rating Scale Screen Version: Initial screening for suicide risk in a psychiatric emergency department. Psychological Medicine, 52(16), 3904-3912. https://doi.org/10.1017/S0033291721000751
Borghero, F., Martinez, V., Zitko, P., Vohringer, P. A., Cavada, G. y Rojas, G. (2018). Screening depressive episodes in adolescents. Validation of the Patient Health Questionnaire-9 (PHQ-9). Revista Médica de Chile, 146(4), 479-486. https://doi.org/10.4067/s0034-98872018000400479
Busby, D. R., Hughes, J. L., Walters, M., Ihediwa, A., Adeniran, M., Goodman, L. y Mayes, T. L. (2023). Measurement choices for youth suicidality. Child Psychiatry and Human Development. https://doi.org/10.1007/s10578-023-01627-5
Carvajal, D., Aboaja, A. y Rubén, A. (2015). Validación de la escala de bienestar mental de Warwick-Edimburgo en Chile. Revista de Salud Pública, 19(1), 13-21. https://doi.org/10.31052/1853.1180.v19.n1.11822
Crockett, M. A., Martínez, V. y Ordóñez-Carrasco, J. L. (2022). Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents. Revista Médica de Chile, 150(4), 458-464. https://doi.org/10.4067/S0034-98872022000400458
Crockett, M. A., Martínez-Nahuel, V., Mac-Ginty, S., Núñez, D., Langer, Á. I. y Gaete, J. (2024). Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-024-02683-5
Danielsen, S., Strandberg-Larsen, K., Orri, M., Nordentoft, M., Erlangsen, A. y Madsen, T. (2024). Mental health, risk behaviors, and social life factors in relation to adolescents’ suicide ideation, plans and attempt. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-024-02616-2
Davis Weaver, N., Bertolacci, G. J., Rosenblad, E., Ghoba, S., Cunningham, M., Ikuta, K. S., Moberg, M. E., Mougin, V., Han, C., Wool, E. E., Abate, Y. H., Adewuyi, H. O., Adnani, Q. E. S., Adzigbli, L. A., Afolabi, A. A., Agampodi, S. B., Ahinkorah, B. O., Ahmad, A., Ahmad, D., … Naghavi, M. (2025). Global, regional, and national burden of suicide, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Public Health, 10(3), e189-e202. https://doi.org/10.1016/S2468-2667(25)00006-4
Flora, D. B. y Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for Confirmatory Factor Analysis with ordinal data. Psychological Methods, 9(4), 466-491. https://doi.org/10.1037/1082-989X.9.4.466
Forero, C. G., Maydeu-Olivares, A. y Gallardo-Pujol, D. (2009). Factor analysis with ordinal indicators: A Monte Carlo study comparing DWLS and ULS estimation. Structural Equation Modeling, 16(4), 625-641. https://doi.org/10.1080/10705510903203573
Galán-Muros, V., Roser-Chinchilla, R. y Hsiung, N. (2024). Supporting the mental health and well-being of higher education students. SDG briefs series. Goal 3. UNESCO IESALC. https://unesdoc.unesco.org/ark:/48223/pf0000391501
Germanaud, E., Callahan, S., Revranche, M., Biscond, M., Pic, O. y Husky, M. (2025). Mental disorders and suicidality by sexual orientation status among first-year college students in France. Journal of Homosexuality, 72(3), 462-477. https://doi.org/10.1080/00918369.2024.2322606
Hu, L. y Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1-55. https://doi.org/10.1080/10705519909540118
Hyseni Duraku, Z., Davis, H., Arënliu, A., Uka, F. y Behluli, V. (2024). Overcoming mental health challenges in higher education: A narrative review. Frontiers in Psychology, 15, 1466060. https://doi.org/10.3389/fpsyg.2024.1466060
Jiménez Molina, Á., Duarte Vásquez, F., Vargas Gallegos, B., Riquelme Bórquez, A. y Martínez Nahuel, V. (2024). Recomendaciones para la actualización del programa nacional de prevención del suicidio. Integrando participación territorial y evidencia [Policy brief]. Ministerio de Salud. https://tinyurl.com/3erfxcph
Krause, K. R., Chung, S., Adewuya, A. O., Albano, A. M., Babins-Wagner, R., Birkinshaw, L., Brann, P., Creswell, C., Delaney, K., Falissard, B., Forrest, C. B., Hudson, J. L., Ishikawa, S., Khatwani, M., Kieling, C., Krause, J., Malik, K., Martínez, V., Mughal, F., … Wolpert, M. (2021). International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. The Lancet Psychiatry, 8(1), 76-86. https://doi.org/10.1016/s2215-0366(20)30356-4
Kroenke, K., Spitzer, R. L. y Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Li, C.-H. (2016). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods, 48(3), 936-949. https://doi.org/10.3758/s13428-015-0619-7
Mason, A., Rapsey, C., Sampson, N., Lee, S., Albor, Y., Al-Hadi, A. N., Alonso, J., Al-Saud, N., Altwaijri, Y., Andersson, C., Atwoli, L., Auerbach, R. P., Ayuya, C., Báez-Mansur, P. M., Ballester, L., Bantjes, J., Baumeister, H., Bendtsen, M., Benjet, C., … Van der Heijde, C. (2025). Prevalence, age-of-onset, and course of mental disorders among 72,288 first-year university students from 18 countries in the World Mental Health International College Student initiative. Journal of Psychiatric Research, 183, 225-236. https://doi.org/10.1016/j.jpsychires.2025.02.016
Mendez-Bustos, P., Mellado, C., Lopez-Castroman, J. y Arellano-Faúndez, O. (2024). Suicide risk stratification in adolescents with psychiatric disorders. Cogent Psychology, 11(1). https://doi.org/10.1080/23311908.2024.2339570
Ministerio de Salud. (2019). Recomendaciones para la prevención de la conducta suicida en establecimientos educacionales. Desarrollo de estrategias preventivas para comunidades escolares. Programa Nacional de Prevención del Suicidio. Ministerio de Salud. https://bibliotecadigital.mineduc.cl/handle/20.500.12365/18426
Mokros, Ł., Rawska-Kabacińska, A., Świtaj, P., Wieczorek, Ł., Jabłońska, A. y Anczewska, M. (2024). Adaptation and validation of the Columbia-Suicide Severity Rating Scale (C-SSRS) screen version. Psychiatria Polska, 1-18. https://doi.org/10.12740/PP/OnlineFirst/174591
Mortier, P., Cuijpers, P., Kiekens, G., Auerbach, R. P., Demyttenaere, K., Green, J. G., Kessler, R. C., Nock, M. K. y Bruffaerts, R. (2018). The prevalence of suicidal thoughts and behaviours among college students: A meta-analysis. Psychological Medicine, 48(4), 554-565. https://doi.org/10.1017/S0033291717002215
Mortier, P., Yang, X., Altwaijri, Y. A., Holdcraft, J. A., Lee, S., Sampson, N. A., Albor, Y., Alhadi, A. N., Alonso, J., Al-Saud, N. K., Andersson, C., Atwoli, L., Auerbach, R. P., Muaka, C. A., Báez-Mansur, P. M., Ballester, L., Bantjes, J., Baumeister, H., Bendtsen, M., … Kessler, R. C. (2025). The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors: Results from the World Mental Health International College Student Initiative. Psychiatry Research, 350, 116555. https://doi.org/10.1016/j.psychres.2025.116555
Nam, S., Um, B., Jeong, J., Rodriguez, M. y Lardier, D. (2024). Score reliability generalization of the Columbia-Suicide Severity Rating Scale (C-SSRS): A meta-analysis. Measurement and Evaluation in Counseling and Development, 57(2), 173-185. https://doi.org/10.1080/07481756.2023.2301285
Núñez, D., Arias, V., Méndez-Bustos, P. y Fresno, A. (2019). Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents? Comprehensive Psychiatry, 88, 39-48. https://doi.org/10.1016/j.comppsych.2018.11.002
Padilla, M. (2019). A primer on reliability via coefficient alpha and omega. Archives of Psychology, 3(8), 1-15. https://doi.org/10.31296/aop.v3i8.125
Porru, F., Schuring, M., Bültmann, U., Portoghese, I., Burdorf, A. y Robroek, S. J. W. (2022). Associations of university student life challenges with mental health and self-rated health: A longitudinal study with six months follow-up. Journal of Affective Disorders, 296, 250-257. https://doi.org/10.1016/j.jad.2021.09.057
Posner, K. (2017). Columbia-Escala de Severidad Suicida (C-SSRS). Versión para Chile: Pesquisa con puntos para triage. https://tinyurl.com/ptu9rmw8
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S. y Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Simpson, S. A., Goans, C., Loh, R., Ryall, K., Middleton, M. C. A. y Dalton, A. (2021). Suicidal ideation is insensitive to suicide risk after emergency department discharge: Performance characteristics of the Columbia-Suicide Severity Rating Scale screener. Academic Emergency Medicine, 28(6), 621-629. https://doi.org/10.1111/acem.14198
Slimmen, S., Timmermans, O., Mikolajczak-Degrauwe, K. y Oenema, A. (2022). How stress-related factors affect mental wellbeing of university students: A cross-sectional study exploring the associations between stressors, perceived stress, and mental wellbeing. PLOS ONE, 17(11), e0275925. https://doi.org/10.1371/journal.pone.0275925
Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar De Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U. y Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281-295. https://doi.org/10.1038/s41380-021-01161-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W. y Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092. https://doi.org/10.1001/archinte.166.10.1092
Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J. y Weich, S. (2009). Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): A Rasch analysis using data from the Scottish Health Education Population Survey. Health and Quality of Life Outcomes, 7(1), 15. https://doi.org/10.1186/1477-7525-7-15
Subsecretaría de Educación Superior y Subsecretaría de Salud Pública. (2023). Recomendaciones y orientaciones del consejo asesor en salud mental para la educación superior. Propuesta elaborada por el Consejo Asesor en materia de Bienestar y Salud Mental en el Sistema de Educación Superior 2023. Subsecretaría de Educación Superior y Subsecretaría de Salud Pública. https://tinyurl.com/yp2wz637
The Columbia Lighthouse Project. (2016a). FAQ. https://tinyurl.com/32sh9dfz
The Columbia Lighthouse Project. (2016b). The Columbia Suicide Severity Rating Scale (C-SSRS): Psychometric evidence. https://tinyurl.com/3yk2dpes
The Columbia Lighthouse Project. (2016c). Translations. https://tinyurl.com/5n7p32k5
The Columbia Lighthouse Project. (2016d). Triage and risk identification. https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/risk-identification/
World Health Organization. (2021a). Live life: An implementation guide for suicide prevention in countries. World Health Organization.
World Health Organization. (2021b). Suicide worldwide in 2019: Global health estimates. World Health Organization.
Zakhour, M., Haddad, C., Sacre, H., Fares, K., Akel, M., Obeid, S., Salameh, P. y Hallit, S. (2021). Suicidal ideation among Lebanese adults: Scale validation and correlates. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03111-7