Multi-Attitude Suicide Tendency Scale (MAST)

Abstract

The Multi-Attitude Suicide Tendency Scale (MAST), developed by Orbach and colleagues in 1991, is a crucial self-report instrument designed to capture the complex, multidimensional nature of suicide tendency. It moves beyond traditional scales that focus narrowly on ideation or intent by evaluating four distinct, often conflicting, attitudes related to life and death: Attraction to Life, Repulsion by Life, Attraction to Death, and Repulsion by Death. This framework posits that suicidal risk arises from the dynamic interaction of these attitudes. Initially validated for use with adolescents, the MAST has demonstrated utility across various age groups, offering a significantly nuanced perspective for psychological assessment in both clinical and research environments.

Keywords

Multi-Attitude Suicide Tendency Scale, MAST, suicidality, suicide risk assessment, attitudes toward life and death, psychopathology, clinical psychology, self-report instrument.

Authors

Israel Orbach, Itzhak Milstein, Dvora Har-Even, Alan Apter, Shimon Tiano, Amiram Elizur.

Purpose

The central purpose of the MAST is to generate a comprehensive, multidimensional profile of an individual’s psychological orientation concerning life and death, particularly in the context of suicidal behavior. Most conventional measures tend to focus only on the negative aspects, such as suicidal intent or generalized depression. The MAST uniquely addresses the inherent ambivalence often experienced by suicidal individuals by simultaneously measuring both life-affirming and death-attracting motivations.

This detailed assessment is invaluable for clinicians as it helps pinpoint specific attitudinal targets for therapeutic intervention, based on which of the four subscales exhibits the highest intensity. Academically, the scale is fundamental to research that tests the theoretical model asserting that suicidal action stems from a dynamic interplay among these four opposing attitudes. For instance, a profile characterized by high scores on Attraction to Death combined with high scores on Repulsion by Life, especially when Attraction to Life scores are low, indicates a particularly elevated and complex risk profile.

Construct

The MAST operationalizes and measures the psychological construct of suicide tendency through four distinct yet interrelated attitudinal dimensions. This theoretical model posits that suicidal motivation is not monolithic but rather a product of a complex motivational matrix involving simultaneous attraction and repulsion toward both existence and cessation.

The four core constructs measured by the 30-item scale are:

• Attraction to Life (AL): Reflects positive feelings toward life, hopefulness regarding the future, and general enjoyment of daily activities and relationships.
• Repulsion by Life (RL): Captures negative evaluations of existence, including feelings of hopelessness, dissatisfaction with personal relationships, and perceived burdensomeness.
• Attraction to Death (AD): Measures positive cognitions associated with death, often viewing it as a solution to problems, a relief from suffering, or a pathway to spiritual peace.
• Repulsion by Death (RD): Assesses fear and anxiety specifically related to the process and consequences of death, such as fear of bodily decay, loss of identity, termination of consciousness, and separation from loved ones.

By including both positive and negative orientations toward both life and death, the MAST provides a significantly more fine-grained analysis of the internal conflict central to suicidal crises compared to simpler screening instruments.

Validity

Extensive research across diverse populations, including both Israeli and American samples, supports the robust validity of the MAST. Studies have confirmed its strong concurrent and predictive validity. Specifically, subscales such as Repulsion by Life and Attraction to Death consistently demonstrate significant positive correlations with other established measures of hopelessness and suicidal ideation, confirming their relevance to the core outcome.

Furthermore, the scale exhibits powerful discriminant validity. It successfully distinguishes between three key groups: non-suicidal individuals, individuals with psychiatric diagnoses who lack a history of suicide attempts, and those who have previously attempted suicide. This ability to differentiate risk levels based on the relative intensity of the four attitudinal components provides unique diagnostic information that is not fully captured by generalized measures of anxiety or depression, thereby confirming that the MAST measures the specific construct of suicide tendency.

Reliability

The internal consistency of the MAST subscales is consistently reported as acceptable to high across various validation studies. The original 1991 study by Orbach et al. reported Cronbach’s alpha coefficients ranging from .70 to .89 within their adolescent sample. Typically, the Repulsion by Life and Attraction to Death subscales demonstrate the highest levels of reliability.

Subsequent international studies, such as those conducted by Osman et al. (1993) using American college student populations, have replicated these high reliability coefficients, confirming that the scale consistently measures the intended constructs across culturally diverse groups. Additionally, test-retest reliability has been established, indicating the stability of these measured attitudes over time. This temporal stability is a critical requirement for any effective clinical screening instrument used in the field of psychometrics.

Factor Analysis

The structural integrity of the MAST has been rigorously assessed using statistical methods, primarily Factor Analysis. The initial exploratory factor analysis (EFA) performed by the scale developers strongly supported the hypothesized four-factor structure: Attraction to Life, Repulsion by Life, Attraction to Death, and Repulsion by Death. This empirical finding aligns perfectly with the complex theoretical model of suicidal motivation conceived by Orbach and colleagues.

Further structural validation was provided by subsequent confirmatory factor analysis (CFA), notably conducted by Hagstrom and Gutierrez (1998). These studies consistently confirmed that the four-factor model provides a good fit to the collected data. While minor instances of item cross-loading have been observed occasionally, the robust factor structure confirms the scale’s multidimensionality and its unique ability to differentiate between the four proposed attitudes toward life and death, supporting its application in detailed clinical and research assessment.

Instrument

Test Type: Self-report questionnaire, screening instrument.

Format: 30 items scored on a 5-point Likert scale.

Language Available: Primarily English (validated in American samples) and Hebrew (original development language).

Population Group: Clinical and non-clinical samples.

Age Group: Adolescents (initially intended) and adults (college students and general population).

Population Details: The scale was originally validated on Israeli adolescents. Later validation studies expanded its application to include American college students and various groups of psychiatric patients, broadening its clinical utility.

Test Methodology: Respondents are required to rate their level of agreement with each statement using a 5-point scale. The scale ranges from 1 (Strongly disagree) to 5 (Strongly Agree). Four separate subscale scores are calculated by summing the item scores corresponding to each factor, providing a profile of the individual’s four core attitudes.

Keywords

Attraction to Life, Repulsion by Life, Attraction to Death, Repulsion by Death, clinical psychology, psychometric instrument, suicide assessment tool.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The Multi-Attitude Suicide Tendency Scale (MAST) was first published in 1991 by Orbach et al. The scale is widely recognized and frequently cited in academic literature and sourcebooks, suggesting its common use for non-commercial research purposes without prohibitive fee requirements. Specific licensing or royalty information, particularly for high-volume commercial or clinical implementation, should be obtained directly from the primary authors or the original publishing source, Psychological Assessment: A Journal of Consulting and Clinical Psychology.

Reference’s

• Fischer, Joel. & Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY: Oxford University Pr. Vol. 1, Page(s): 563-565.
• Orbach, I., Milstein, I., Har-Even, D., Apter, A., Tiano, S., & Elizur, A. (1991). A Multi-Attitude Suicide Tendency Scale for adolescents. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3(3), 398-404.
• Osman, A., Barrios, F.X., Grittmann, L. R., & Osman, J. R. (1993). The Multi-Attitude Suicide Tendency Scale: psychometric characteristics in an American sample. Journal of Clinical Psychol, 49(5):701-708.
• Hagstrom, Anne H. & Gutierrez, Peter M. (1998). Confirmatory Factor Analysis of the Multi-Attitude Suicide Tendency Scale. Journal of Psychopathology and Behavioral Assessment, 20(2), 173–186.
• Orbach, I., Milstein, I., Har-Even, D., Apter, A., Tiano, S., & Elizur, A. (1991). A Multi-Attitude Suicide Tendency Scale. In Fischer, Joel. & Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY: Oxford University Pr. Vol. 1, Page(s): 563-565.

Items of the Multi-Attitude Suicide Tendency Scale (MAST)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Most of the time I feel happy.
2. Life seems to be one long and difficult struggle.
3. I fear the idea that there is no return from death.
4. I fear death because all my mental and spiritual activity will stop.
5. Even though things may be tough at times I think it’s worth living.
6. I feel that close people make me feel good.
7. I fear death because my identity will disappear.
8. I know people who have died and I believe I will meet them when I die.
9. I don’t ask for help even when things are very tough for me.
10. Thinking about death gives me the shivers.
11. I am afraid of death because my body will rot.
12. I fear death because it means that I will not be able to experience and think anymore.
13. I can see myself as being very successful in the future.
14. I feel that I am not important to my family.
15. Sometimes I feel that my family will be better off without me.
16. Sometimes I feel that my problems can’t be solved.
17. Death can change things for the better.
18. I like to do many things.
19. Death is actually eternal life.
20. The thought that one day I will die frightens me.
21. I don’t like to spend time with my family.
22. Many problems can be solved by death only.
23. I believe death can bring a great relief for suffering.
24. I fear death because all my plans will come to an end.
25. I am very hopeful.
26. In some situations it is better to die than to go on living.
27. Death can be a state of rest and calm.
28. I enjoy many things in life.
29. Death frightens me more than anything else.
30. No one really loves me.

Scoring Schema:

• 1 = Strongly disagree
• 2 = Don’t agree
• 3 = Sometimes agree, Sometimes disagree
• 4 = Agree
• 5 = Strongly Agree

Subscale Item Groupings (as per source):

• Attraction to life (AL): Items 1, 5, 6, 13, 18, 25, and 28.
• Repulsion by life (RL): Items 2, 9, 14, 15, 16, 21, and 30.
• Attraction to death (AD): Items 8, 17, 18, 22, 23, 26, and 27.
• Repulsion by death (RD): Items 3, 4, 7, 10, 11, 12, 20, 24, and 29.