Previous taxometric studies have yielded inconsistent findings regarding the empirical support for the common clinical practice of categorizing patients into discrete suicide risk groups (low versus high risk). Furthermore, potential sex differences in these latent structures have not been adequately explored. This study aimed to investigate the latent structure of suicide risk based on motivational and volitional phase symptoms from the ideation-to-action framework, and to explore potential sex differences in these latent structures, in order to determine whether the clinical practice of categorizing patients into low versus high suicide risk categories is empirically valid.

We employed taxometric procedures to examine whether suicide risk should be understood as dimensional or categorical. Our analysis distinctly evaluated motivational and volitional phase symptoms across separate samples of male and female outpatients with mood disorders.

Our research revealed significant sex differences in the latent structure of suicide risk. For motivational phase symptoms, an ambiguous structure was revealed in the male group, whereas a clearly dimensional latent structure was observed in the female group. For volitional phase symptoms, a categorical structure emerged in males, while a dimensional structure was found in females.

Given the ‘gender paradox’ in suicidal behavior, which highlights higher rates of fatal suicide attempts among males, early identification of the high-volitional-risk group and focused allocation of intervention resources are particularly crucial for males. Our findings underscore the necessity for sex-specific approaches to suicide risk assessments, research applying the ideation-to-action framework, and targeted intervention development.