Assessing suicidal motivations: bridging research and clinical practice with a clinician-report tool

Introduction: Given the challenge of understanding and explaining suicide through to a universally valid casual law, MIS-A was developed to bridge the gap in risk assessment by shifting the focus from risk factors to the motivational contents that shape psychache, ideation and eventual suicidal solution. MIS- A has demonstrated strong associations between its motivational categories and key psychopathological and personality conditions recognized as suicide risk factors. It also distinguishes individuals at higher risk of acting on suicidal thoughts. The need to establish the construct validity of MIS-A and to facilitate risk assessment led to the development of a clinician-report instrument. Methods: Item formulation followed two key principles: (1) comprehensiveness guided the integration of contemporary perspectives on the subjective experience of psychic pain beyond personality dimensions, capturing implicit processes that may play a role in the suicidal process, such as aloneness, mind-body dissociation, conscious and unconscious fantasies, and cognitive rigidity; (2) phenomenological adherence aimed to create ‘experience-near’ descriptors, minimizing theoretical distortion aligning closely with the patient’s subjective experience, reducing clinician bias - mitigating idiosyncratic interpretations - and strengthening the link between interview content and motivational categories. Consequently, items undergo a Q-sort evaluation by experts in suicidal risk management, followed by a Q-factor analysis to validate the MIS-A categories. Results: The evaluation process guides the selection of items for the clinician-report questionnaire. This instrument enables clinicians to rate, on a 7-point Likert scale, the extent to which each item reflects the patient’s suicidal state of mind, supporting a rapid and effective assessment of the motivational sources of psychache and suicidal crisis. The clinician is required to use clinical expertise to identify the implicit subtexts and unconscious drivers of suicidality, not always aligned with explicit patient reports. Discussion: The instrument enhances both risk assessment and clinical intervention, improving the validity and clinical relevance. In fact, it makes otherwise inaccessible psychological material more detectable and treatable, and its flexibility allows it to be applied across various clinical settings, where rapid assessment and early intervention are crucial, making it an essential tool for clinicians working with individuals at different stages of suicidal ideation and behavior.