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About the S-STS

The S-STS Sheehan-Suicidality Tracking Scale PDF* or Paper available.

The Sheehan-Suicidality Tracking Scale (S-STS) is a short suicidality rating scale for suicide intention and ideation designed to assess and monitor over time the core phenomena of suicidality.  The same version can be used either as a clinician-rated suicidality rating scale or as a patient-rated suicidality rating scale, or both together at the same visit.  The standard version was designed for use in clinical research studies as a safety assessment measure, to detect treatment emergent suicidality, and as a treatment outcome measure that is very sensitive to change. The S-STS is available in 3 age-related, linguistically validated pediatric versions (for 6 to 8 year olds, for 9 to 12 year olds, and for 13 to 17 year olds).

The more expanded S-STS Clinically Meaningful Change Measure version (S-STS CMCM) addresses the needs of those who want to do a more comprehensive suicidality assessment clinically or who want a more comprehensive primary outcome measure when investigating the anti-suicidality treatment effects of medications.  The S-STS CMCM is available in both adult and adolescent versions (see below).

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Adult S-STS
Sheehan-Suicidality Tracking Scale

The standard version of the S-STS Sheehan-Suicidality Tracking Scale has 14 core questions and 9 additional questions contingent on the responses to the core 14.

PDF* or Paper available.

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Child / Adolescent S-STS
Sheehan-Suicidality Tracking Scale

The Child / Adolescent Sheehan-Suicidality Tracking Scale(S-STS) is available in 3 age-related, linguistically validated pediatric versions:  6 to 8 year olds, 9 to 12 year olds, and 13 to 17 year olds.  The S-STS CMCM is available in an adolescent version.

PDF* or Paper available.

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Adult S-STS CMCM
Sheehan-Suicidality Tracking Scale Clinically Meaningful Change Measure

The Adult S-STS CMCM version has 46 risk / protective factors and 20 questions on suicidal compounding features in addition to the standard S-STS. It is designed for use as a primary outcome measure in clinical research studies investigating the efficacy of anti-suicidality medications in adolescents.

 PDF* or Paper available.

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Adolescent S-STS CMCM
Sheehan-Suicidality Tracking Scale Clinically Meaningful Change Measure

The Adolescent S-STS CMCM version for 13 to 17 year-olds has 45 risk / protective factors and 20 questions on suicidal compounding features in addition to the standard S-STS. It is designed for use as a primary outcome measure in clinical research studies investigating the efficacy of anti-suicidality medications in adolescents.

 PDF* or Paper available.

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Adult S-HTS Combined (H+S)
Sheehan-Homicidality + Suicdality Tracking Scale

The S-HTS Combined has the same core questions and phenomena covered as the standard S-HTS.  However, the question for each core phenomenon asks the patient about a combined act of homicidality and suicidality (e.g., murder-suicide or suicide terrorism).  It has 16 core questions and 9 additional questions contingent on the responses to the core 16.

PDF* or Paper available.

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S-STS FAQ

A fully executed license is required for use of the Sheehan-Suicidality Tracking Scale (S-STS) in any language. To license the S-STS directly from Dr. Sheehan, the author and copyright holder, you will need complete his license agreement. Click here to learn more about the S-STS or to download a License for use.

Dr. Sheehan only provides consultation, guidance on regulatory agency questions, and training to those who license the S-STS directly from him. Contact Dr. Sheehan at davidVsheehan@gmail.com for additional information. If you do not see a QR code on the S-STS you are using linking back to this website then you did not get the SDS from the author and Copyright Holder.  Dr. David V. Sheehan is the Copyright Holder, Trademark Holder, and author of the S-STS in all languages.  This copyright for the S-STS has been registered with the US Copyright Office.

CLICK HERE for more information about Sheehan Scales.

The cost of licensing the S-STS is $4 USD for each use, i.e. each administration to a subject and/or each use in training.

Note: Non-profit institutions sometimes incorrectly assume that the license fee does not apply because they are “not-for-profit”. The licensing fee applies to all uses.

The license and license fee applies to all uses.

Dr. Sheehan licenses the S-STS in paper format for distribution as follows: (1) in paper form for any uses, or (2) in fixed-pdf form, paper form, or both for use in clinical or academic research trials or studies.

The S-STS can be used as a systematic means:

  • To assess and monitor suicidality in primary care as well as mental health settings (inpatient and outpatient).
  • To identify and track suicidality as an efficacy outcome measure, adverse event, and/or treatment emergent effect in clinical trials and treatment outcome studies.
  • To provide detailed documentation of suicidality in forensic evaluations.
  • To detect and describe the incidence or prevalence and severity of suicidality in population research including national and international epidemiology studies and community surveys.

The S-STS is unique in the following ways:

  • The S-STS asks about a broader range of suicidality phenomena than other suicidality scales. For example, beyond suicidal ideation and behavior, it has questions about suicidal impulses, suicidal hallucinations, delusional suicidality, and suicidal dreams.
  • Unlike its most used alternative, the C-SSRS, which uses a binary (Yes/No) response format, confirming the presence or absence of suicidality, the S-STS uses a numeric Likert format. A benefit of this format is that it allows raters to make fine distinctions in the seriousness of suicidality symptoms and track changes over time. Also, item and cluster scores can be graphed quantitatively.
  • The S-STS can be mapped closely to FDA classification categories of suicidality.
  • In clinical trials the S-STS has been found to be uniquely sensitive in detecting drug-placebo differences and treatment effects.
  • To our knowledge, the S-STS is the only suicidal assessment scale that has been linguistically validated for children and adolescents.

No minimum qualification is needed to administer the S-STS. What is more critical is that raters be comfortable discussing suicidality with patients and nonjudgment in their approach to suicidality. However, in research settings where precision is required, we do advise training in the use of the S-STS.

This is to ensure that the S-STS is administered and interpreted correctly and to reduce the risk of false positives or false negatives. We leave the final decision of selection and credentialing of raters up to the local sites.

Note: Dr. Sheehan only provides consultation, guidance on regulatory agency questions, and training to those who license the Sheehan-Suicidality Tracking Scale (S-STS) directly from him. Contact Dr. Sheehan at davidVsheehan@gmail.com for additional information.  If you do not see a QR code on the Sheehan-Suicidality Tracking Scale (S-STS) you are using linking back to this website, then you did not get the Sheehan-Suicidality Tracking Scale (S-STS) from the author and Copyright Holder.  Dr. David V. Sheehan is the Copyright Holder, Trademark Holder and author of the Sheehan-Suicidality Tracking Scale (S-STS) in all languages.  This copyright for the S-STS has been registered with the US Copyright Office.

Yes. Dr. Sheehan’s license allows you to administer the S-STS remotely as long as you complete the S-STS on paper as a primary source document. It is up to your protocol to determine how appropriate remote administration is for your patient population. Be sure to review HIPAA and GDPR privacy rules. If you are doing research, you should also review other applicable rules to make sure that remote administration is acceptable to any agency, such as the FDA, who may have oversight of your research.

The standard version of the S-STS for adults meets most needs, most of the time in clinical and research settings.

For children and adolescents, the S-STS is available in 3 age-related, linguistically validated versions (for 6 to 8 year olds, 9 to 10 year olds, and 13 to 17 year olds). The pediatric version (S-STS-P) is useful for all three age groups since it can be parent or clinician rated. We recommend the adolescent version (S-STS-A) for adolescents aged 13-17 since it can be either self-rated by the adolescent or clinician rated.

The average time to administer the S-STS is 8.4 minutes. This administration time is comparable to that for the C-SSRS (8.1 minutes) and shorter than that that for the ISST-Plus (14.5 min).

The S-STS can be patient or clinician rated but should always be clinician reviewed, preferably by someone with clinical mental health experience and training. To ensure that the S-STS is rated and interpreted correctly and to reduce the risk of false positives or false negatives, we recommend training in the use of the S-STS. For more information about training, CLICK HERE.

Yes. Please CLICK HERE for a watermarked preview copy for review only or contact Dr. Sheehan at davidVsheehan@gmail.com.

CLICK HERE for more information about Sheehan Scales.

Yes, Dr. Sheehan can design a customized version of the S-STS to meet the needs of a specific study or clinical setting. Contact Dr. Sheehan at davidVsheehan@gmail.com to discuss a customized version.

Requests to access existing non-English translations or for any new translations should be submitted through MAPI Research Trust’s ePROVIDE COA platform at

https://eprovide.mapi-trust.org/ using the following process:

  1. Go to Submit a request
  2. If you haven't registered yet, you'll be asked to sign up for free
  3. Complete the request form. Please attach a copy of the signed and fully executed license agreement signed by Dr. David V Sheehan.

How to cite the S-STS

Note: The S-STS is a clinical decision support tool to monitor over time the core phenomena of suicidality. The below listed studies the S-STS was rated in paper format as a primary source document. The standard version of the S-STS has been validated in 2 studies against other standardized suicide rating scales (see Sheehan et al. 2014 and Youngstrom et al. 2015 below – The results cannot be generalized to any other conditions or format.  For FDA guidance on CDS or using software in diagnosis: visit the FDA website.

Use the following citations in referencing the Adult Standard S-STS:

  1. Sheehan, D. V., Alphs, L. D., Mao, L., Li, Q., May, R. S., Bruer, E. H., McCullumsmith, C.B., Gray, C.R., Li, X. and Williamson, D. J. (2014). Comparative validation of the S-STS, the ISST-Plus, and the C–SSRS for assessing the suicidal thinking and behavior FDA 2012 suicidality categories. Innovations in clinical neuroscience, 11(9-10), 32.  PDF: http://innovationscns.epubxp.com/i/425963/32
  2. Youngstrom, E.A., Hameed, A., Mitchell, M.A., Van Meter, A.R., Freeman, A.J., Algorta, G.P., White, A.M., Clayton, P.J., Gelenberg, A.J. and Meyer, R.E. (2015). Direct comparison of the psychometric properties of multiple interview and patient-rated assessments of suicidal ideation and behavior in an adult psychiatric inpatient sample. The Journal of clinical psychiatry, 76(12), 1676-1682. DOI: http://dx.doi.org/4088/JCP.14m09353
  3. Sheehan DV, Giddens JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. Nov. 2015 (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-0-1
  4. Sheehan DV, Giddens JM. (2016). Suicidality Assessment and Documentation for Healthcare Providers: A Brief, Practical Guide.(1st ed.). Tampa, FL: Harm Research Press. April 2016. (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-1-8

Use the following citations in referencing the Adult S-STS CMCM:

  1. Sheehan DV, Giddens JM, Sheehan IS. Status Update on the Sheehan Suicidality Tracking Scale (S-STS) 2014. Innov Clin Neurosci. 2014;11(9–10):93–140.  PDF: http://innovationscns.epubxp.com/i/425963/93
  2. Sheehan, D. V., Alphs, L. D., Mao, L., Li, Q., May, R. S., Bruer, E. H., McCullumsmith, C.B., Gray, C.R., Li, X. and Williamson, D. J. (2014). Comparative validation of the S-STS, the ISST-Plus, and the C–SSRS for assessing the suicidal thinking and behavior FDA 2012 suicidality categories. Innovations in clinical neuroscience, 11(9-10), 32. PDF: http://innovationscns.epubxp.com/i/425963/32
  3. Sheehan DV, Giddens JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. Nov. 2015 (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-0-1
  4. Sheehan DV, Giddens JM. (2016). Suicidality Assessment and Documentation for Healthcare Providers: A Brief, Practical Guide.(1st ed.). Tampa, FL: Harm Research Press. April 2016. (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-1-8

Use the following citations in referencing the 3 Child / Adolescent S-STS:

  1. Amado DM, Beamon DA, Sheehan DV. The linguistic validation of the Pediatric versions of the Sheehan-Suicidality Tracking Scale (S-STS). Innov Clin Neurosci 2014;11(9–10):141–163. PDF: http://innovationscns.epubxp.com/i/425963/140
  2. Sheehan DV, Giddens JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. Nov. 2015 (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-0-1
  3. Sheehan DV, Giddens JM. (2016). Suicidality Assessment and Documentation for Healthcare Providers: A Brief, Practical Guide.(1st ed.). Tampa, FL: Harm Research Press. April 2016. (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-1-8

Use the following citations in referencing the Adolescent S-STS CMCM:

  1. Amado DM, Beamon DA, Sheehan DV. The linguistic validation of the Pediatric versions of the Sheehan-Suicidality Tracking Scale (S-STS). Innov Clin Neurosci 2014;11(9–10):141–163. PDF: http://innovationscns.epubxp.com/i/425963/140
  2. Sheehan DV, Giddens JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. Nov. 2015 (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-0-1
  3. Sheehan DV, Giddens JM. (2016). Suicidality Assessment and Documentation for Healthcare Providers: A Brief, Practical Guide.(1st ed.). Tampa, FL: Harm Research Press. April 2016. (Available from: https://HarmResearch.org) ISBN: 978-0-9969729-1-8

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*Looking for the Sheehan-Suicidality Tracking Scale PDF: Dr. Sheehan licenses the instrument in paper format for distribution as follows: (1) in paper form for any uses, or (2) in fixed-pdf form, paper form, or both for use in clinical or academic research trials or studies.