Difficulty identifying feelings as a predictor of suicidal ideation severity in Mexican psychiatric inpatients

Abstract

Objective: This study examined whether difficulty in identifying feelings (DIF), a core dimension of alexithymia, predicted the severity of suicidal ideation among psychiatric inpatients in Mexico. This study aimed to clarify the independent predictive value of emotional processing deficits and their clinical utility in acute suicide risk. Method: Eighty-four inpatients hospitalized for suicide-related crises at a public psychiatric hospital in Mexico City completed the 20-item Toronto Alexithymia Scale (TAS-20) and Beck Scale for Suicide Ideation (SSI) within 72 h of admission. Severe ideation was defined as an SSI ≥ 20. Logistic regression adjusted for age, depression, and anxiety was used to estimate the independent contribution of DIF. Cluster analysis explored emotion–symptom configurations. Results: Patients with severe ideation exhibited higher TAS-20 total scores (M = 67.42) than those with mild or moderate ideation (M = 56.24; p <.001). DIF subscale was the strongest predictor. Adjusted analysis confirmed DIF as an independent predictor of severe ideation (OR = 1.09, p <.001), while depressive symptoms showed an inverse association (OR = 0.20, p =.026). Cluster analysis identified a clinically distinct subgroup marked by elevated DIF, severe ideation, and prior suicide attempts. Conclusions: DIF independently predicted severe suicidal ideation, underscoring the transdiagnostic value of alexithymia as a practical clinical marker. Incorporating emotion-focused screening into routine assessment may refine triage accuracy and support brief, targeted interventions in acute psychiatric care in Latin American settings.