Difficulty Identifying Feelings as a Predictor of Suicidal Ideation Severity in Mexican Psychiatric Inpatients

Difficulty Identifying Feelings as a Predictor of Suicidal Ideation Severity in Mexican Psychiatric Inpatients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Difficulty Identifying Feelings as a Predictor of Suicidal Ideation Severity in Mexican Psychiatric Inpatients Odeth Monserrat Yáñez-Sandoval, Raúl Sampieri-Cabrera, Joaquín Ricardo Gutiérrez-Soriano This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7437464/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective This study examined whether difficulty identifying feelings (DIF), a central component of alexithymia, predicts the severity of suicidal ideation among psychiatric inpatients in Mexico. By focusing on a culturally underrepresented population, we aimed to clarify the dimensional role of emotional processing deficits in acute suicide risk. Method A cross-sectional design was applied to 84 inpatients hospitalized for suicide-related crises at a public psychiatric hospital in Mexico City. Participants completed the 20-item Toronto Alexithymia Scale (TAS-20) and the Beck Scale for Suicide Ideation (SSI) within 72 hours of admission. Severe ideation was defined as SSI ≥ 20. Logistic regression adjusted for age, depression, and anxiety. Cluster analysis explored emotion–symptom subgroups. Results Patients with severe ideation had higher TAS-20 scores (M = 67.42) than those with mild/moderate ideation (M = 56.24), p < .001. DIF emerged as the strongest subscale predictor. Logistic regression confirmed that alexithymia significantly increased the odds of severe ideation (OR = 1.09, p < .001), while depression showed an inverse association (OR = 0.20, p = .026). Cluster analysis identified a high-risk subgroup characterized by elevated DIF, severe ideation, and prior suicide attempts. Conclusions DIF may function as an independent and clinically meaningful marker of suicide risk in acute psychiatric care, beyond categorical diagnoses. Integrating emotion-focused screening tools into routine assessments may improve detection of high-risk patients in Latin American settings. alexithymia suicidal ideation psychiatric inpatients emotional dysregulation Mexican psychiatry Figures Figure 1 Introduction Suicide is a pressing public health concern, responsible for over 700,000 deaths annually and ranking among the leading causes of death in young people worldwide (WHO, 2021). In Mexico, suicide mortality has increased by nearly 20% over the past decade, reflecting both structural inequalities and insufficient access to specialized care (INEGI, 2021; Borges et al., 2010 ; Dávila-Cervantes & Luna-Contreras, 2024 ). Research within Latin American psychiatry has largely focused on categorical diagnoses such as depression, yet international evidence demonstrates that suicidal ideation is a transdiagnostic phenomenon that cuts across psychiatric conditions, often linked to emotional dysregulation and interpersonal stressors (Klonsky et al., 2016 ; Franklin et al., 2017 ). Despite this, culturally grounded studies remain scarce, and the dimensional markers of risk are not systematically incorporated into clinical assessments in the region. Alexithymia, defined as a difficulty in identifying and describing emotions, has emerged as a robust marker of vulnerability across psychiatric disorders (Sifneos, 1973 ; Bagby et al., 1994 ; Taylor et al., 2024 ). Among its dimensions, difficulty identifying feelings (DIF) shows the strongest and most consistent association with suicidal ideation and behavior (Hintikka et al., 2001 ; Hemming et al., 2019 ; Mohamed & Ahmed, 2022 ). Evidence from international studies suggests that DIF independently predicts suicide risk beyond depression and anxiety, highlighting its relevance as a transdiagnostic mechanism (De Berardis et al., 2017 ). However, little is known about the role of alexithymia in Latin American psychiatric contexts, where sociocultural norms of stoicism and stigma surrounding emotional expression may further obscure risk detection (Oliffe et al., 2015 ; Mascayano et al., 2016 ; Juárez-Domínguez et al., 2024 ). To address this gap, the present study examined whether DIF predicts suicidal ideation severity among Mexican psychiatric inpatients. We hypothesized that higher alexithymia scores, particularly DIF, would be associated with more severe suicidal ideation after adjusting for depression and anxiety, and that cluster analysis would identify clinically distinct high-risk subgroups. Methods Design and Setting We conducted a cross-sectional study at Hospital de Psiquiatría Morelos, a tertiary psychiatric facility of the Mexican Social Security Institute (IMSS) in Mexico City. Data were collected between July and September 2023 as part of routine clinical intake procedures. Participants The sample comprised 84 adults (18–65 years) consecutively admitted for suicide-related crises, including recent attempts or acute suicidal ideation. Inclusion criteria required clinical stability within 72 hours of admission, defined as absence of active psychosis, catatonia, or disorganized behavior, and capacity to provide informed consent. Patients with major neurocognitive disorders, intellectual disability, or severe medical instability were excluded. Measures Alexithymia. Alexithymia was assessed with the Spanish version of the 20-item Toronto Alexithymia Scale (TAS-20; Bagby et al., 1994 ; Fernández-Jiménez et al., 2013 ). The instrument evaluates three dimensions—difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT). Items are rated on a 5-point scale (range 20–100); scores ≥ 60 indicate clinically significant alexithymia. Internal consistency in this sample was high (α = .84). Suicidal ideation. The Beck Scale for Suicide Ideation (SSI; Beck et al., 1979 ; Osnaya & Pérez, 2012 ) was used to measure suicidal thoughts and intent over the past week. The clinician-administered 19-item scale ranges from 0 to 38; scores ≥ 20 indicated severe ideation, consistent with prior research in Latin American populations. Internal consistency was excellent (α = .91). Clinical variables. Diagnoses of depressive and anxiety disorders were established via structured clinical interviews (DSM-5/ICD-10 criteria), corroborated with medical records. Sociodemographic data included age, sex, education, and history of suicide attempts. Procedures Within 72 hours of admission, eligible patients provided informed consent and completed the TAS-20 and SSI under the supervision of trained clinicians. Instruments were administered in separate sessions to reduce fatigue. The TAS-20 was self-reported with assistance available for clarification of abstract terms, while the SSI was clinician-administered as part of standard suicide risk protocols. Statistical Analysis Analyses were conducted using R (v. 4.3.1). Descriptive statistics summarized sample characteristics. Group comparisons between severe (SSI ≥ 20) and mild/moderate ideation (SSI < 20) were examined using t -tests and chi-square tests. Logistic regression assessed whether alexithymia predicted severe ideation, adjusting for age, depressive disorder, and anxiety disorder. Odds ratios (OR) with 95% confidence intervals (CI) were reported. Model fit was evaluated with the Hosmer–Lemeshow test, and variance explained with Nagelkerke’s R². To explore clinical subgroups, k -means cluster analysis was performed on standardized TAS-20 and SSI scores, with cluster validity checked using elbow and silhouette methods. Significance was set at p < .05 (two-tailed). Ethics The protocol was approved by the institutional Research Ethics Committee (HPM-CEI-23-007). All participants provided written informed consent in accordance with the Declaration of Helsinki (1964 and later amendments). Results Sample Characteristics The analytic sample included 84 psychiatric inpatients (M age = 29.7 years, SD = 11.2); two-thirds were women (66.7%), and most were single (73.8%). Depressive disorders were the most prevalent diagnosis (79.8%), followed by anxiety (48.8%), personality (34.5%), and substance use disorders (25.0%). Prior suicide attempts were reported by 65.5% of participants. Overall, 60.7% met criteria for clinically significant alexithymia (TAS-20 ≥ 60), and 59.5% presented with severe suicidal ideation (SSI ≥ 20). Table 1 summarizes the main sociodemographic and clinical characteristics. Table 1 Sociodemographic and clinical characteristics of psychiatric inpatients admitted for suicide-related crises (N = 84). Variable Value Age, mean (SD) 29.7 (11.2) Female (%) 66.7% Single (%) 73.8% High school or higher (%) 84.5% Depressive disorder (%) 79.8% Anxiety disorder (%) 48.8% Personality disorder (%) 34.5% Substance use disorder (%) 25.0% Prior suicide attempt (%) 65.5% Severe suicidal ideation (%) 59.5% Clinically significant alexithymia (%) 60.7% TAS-20 total score, mean (SD) 62.5 (13.1) More than half of the sample met criteria for clinically significant alexithymia (TAS-20 ≥ 60) and severe suicidal ideation (SSI ≥ 20), highlighting the high-risk profile of this inpatient population. Bivariate Comparisons Patients with severe ideation (SSI ≥ 20) had significantly higher TAS-20 scores (M = 67.42, SD = 10.71) compared with those with mild/moderate ideation (M = 56.24, SD = 12.12), t (82) = − 4.45, p < .001, Cohen’s d = 0.98. Differences were consistent across all subscales, with DIF showing the strongest effect, p = .001. Clinically significant alexithymia was more frequent among the severe group (78.0%) than the mild/moderate group (38.2%), χ²(1) = 15.66, p < .001. Logistic Regression In logistic regression adjusting for age, depression, and anxiety, TAS-20 total score was the only independent predictor of severe ideation (OR = 1.09, 95% CI [1.04, 1.14], p < .001). Depression showed an inverse association with ideation severity (OR = 0.20, 95% CI [0.05, 0.82], p = .026). Model fit was adequate (Hosmer–Lemeshow χ² = 6.78, p = .560), explaining 42% of the variance. Cluster Analysis K -means clustering identified a distinct high-risk subgroup (n = 20, 24%) characterized by elevated TAS-20 scores (M = 72.65, SD = 6.39), severe suicidal ideation (M = 28.42, SD = 3.32), and the highest prevalence of prior attempts (92.0%). Figure 1 illustrates the distribution of clusters across TAS-20 and SSI scores. Discussion This study demonstrates that difficulty identifying feelings (DIF), a central component of alexithymia, is independently associated with the severity of suicidal ideation in Mexican psychiatric inpatients. Beyond depression and anxiety, DIF emerged as a robust transdiagnostic marker, and cluster analysis revealed a subgroup defined by elevated alexithymia, severe ideation, and prior suicide attempts. These findings reinforce dimensional frameworks of suicide risk that highlight emotion regulation as a core explanatory process (Hemming et al., 2019 ; O’Connor & Kirtley, 2018 ). Since the seminal description by Sifneos ( 1973 ), alexithymia has been recognized as a transversal vulnerability factor across psychiatric disorders. Meta-analyses confirm its stronger association with suicidal ideation than with suicide attempts (Hemming et al., 2019 ), a pattern replicated in our data. This suggests that alexithymia plays a more central role in the formation of suicidal thoughts than in the transition to action, a process likely influenced by additional moderators such as impulsivity or access to means (Klonsky et al., 2016 ). Recent studies, including Shi et al. (2025), further underscore the universality of DIF as a suicide risk marker across cultural contexts. A clinical summary of these findings and their implications is presented in the Supplementary Infographic. An unexpected finding was the inverse association between diagnosed depression and suicidal ideation. In high-alexithymia populations, deficits in emotional recognition may obscure the salience of depressive symptoms, consistent with models that emphasize emotion dysregulation and interpersonal stress over categorical diagnoses (May & Klonsky, 2016). Neurobiological evidence supports this interpretation: alexithymia has been linked to hypoactivation in the amygdala, insula, and anterior cingulate cortex, circuits also implicated in suicidal behaviors (Taylor et al., 2024 ). These overlaps suggest that DIF reflects a neurocognitive pathway to suicidality. Cultural factors also deserve attention. In Mexican contexts, stoicism and stigma may reinforce alexithymic traits, manifested in common expressions such as “I feel bad” or “I don’t know what I feel” (Fernández-Jiménez et al., 2013 ). These linguistic markers illustrate how emotional inhibition intersects with clinical risk. Thus, prevention strategies should incorporate emotional literacy and regulation training. Evidence-based interventions such as DBT and ACT have proven effective in reducing suicidal ideation (Linehan, 2015 ; Ducasse et al., 2018 ) and could be culturally adapted for Latin America. Limitations include the cross-sectional design, reliance on self-report measures, and restricted generalizability beyond an urban psychiatric setting. Nonetheless, the inclusion of Latin American data contributes novel evidence to an underrepresented region in global suicide research. Future studies should employ longitudinal designs and examine gendered pathways, given that cultural norms of masculinity may intensify alexithymia and hinder help-seeking (Oliffe et al., 2015 ). Conclusion Difficulty identifying feelings (DIF) was independently associated with the severity of suicidal ideation among Mexican psychiatric inpatients. These findings suggest that alexithymia represents a dimensional, transdiagnostic marker of suicide vulnerability, particularly relevant in contexts where cultural norms and structural barriers complicate risk detection. Incorporating brief emotion-focused screening tools into psychiatric assessments may enhance early identification of high-risk patients and inform culturally responsive suicide prevention strategies. (Watch Supplementary Figure). Declarations Ethics Statement This study was approved by the Research Ethics Committee of Hospital de Psiquiatría Morelos (protocol no. HPM-CEI-23-007). Written informed consent was obtained from all participants. All procedures complied with the Declaration of Helsinki (1964 and subsequent amendments). Author Contributions O. M. Y. S. collected the data, conducted preliminary analysis, and drafted the initial manuscript. R. S. C. drafted and critically revised the manuscript. J. R. G. S. supervised the study design, performed the statistical analyses, and drafted and critically revised the manuscript. All authors approved the final version. Funding No external funding was received for this study. Clinical Trial Number Clinical trial number: not applicable. Consent to Publish Consent to Publish declaration: not applicable. Conflict of Interest The authors declare no commercial or financial conflicts of interest. Data Availability Statement The anonymized data supporting the findings of this study are available from the corresponding author upon reasonable request, subject to institutional approval and compliance with national data protection regulations. AI Disclosure No AI tools were employed in study design, data analysis, or interpretation of results. All outputs were critically reviewed and approved by the authors. Acknowledgments The authors thank Dr. Miguel Palomar Baena for his early contributions to the conceptualization of the study, and Drs. Claudia Fouilloux Morales, Virginia Barragán Pérez, and Silvia Aracely Tafoya Ramos (UNAM) for their academic mentorship. Special appreciation is extended to the clinical staff of Hospital de Psiquiatría Morelos for their collaboration and commitment to ethical data collection. References Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23–32. https://doi.org/10.1016/0022-3999(94)90005-1 . Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: The Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343–52. https://doi.org/10.1037/0022-006X.47.2.343 . Borges G, Orozco R, Medina-Mora ME, Borges C. Suicidio y conductas suicidas en México: retrospectiva y situación actual. Salud pública de México. 2010;52(4):292–304. http://www.scielo.org.mx/scielo.php?script=sci_abstract&pid=S0036-36342010000400005 . Dávila-Cervantes CA, Luna-Contreras M. 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Mascayano F, Tapia T, Schilling S, Alvarado R, Tapia E, Lips W, Yang LH. Stigma toward mental illness in Latin America and the Caribbean: A systematic review. Brazilian J Psychiatry. 2016;38(1):73–85. https://doi.org/10.1590/1516-4446-2015-1652 . Mohamed BES, Ahmed MGAE. Emotional intelligence, alexithymia and suicidal ideation among depressive patients. Arch Psychiatr Nurs. 2022;37:33–8. https://doi.org/10.1016/j.apnu.2021.12.002 . O’Connor RC, Kirtley OJ. The integrated motivational–volitional model of suicidal behaviour. Philosophical Trans Royal Soc B: Biol Sci. 2018;373(1754):20170268. https://doi.org/10.1098/rstb.2017.0268 . Oliffe JL, Han CSE, Drummond M, Sta. Maria E, Bottorff JL, Kelly MT. Men, masculinities, and murder-suicide. Am J Men’s Health. 2015;9(6):473–85. https://doi.org/10.1177/1557988314551359 . Osnaya MC, Pérez JCR. Confiabilidad y validez de constructo de la escala de ideación suicida de Beck en estudiantes mexicanos de educación media superior. 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09:56:13","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":89085,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7437464/v1/d1c96e63ba28d186a88f0a4d.html"},{"id":91841630,"identity":"c9c8ccef-6503-4d79-9f5a-5633e80d2b41","added_by":"auto","created_at":"2025-09-22 09:56:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82671,"visible":true,"origin":"","legend":"\u003cp\u003eCluster 2 (High Risk) shows the highest levels of alexithymia (TAS-20), suicidal ideation severity (SSI), and prior suicide attempts compared to Cluster 0 (Moderate Risk) and Cluster 1 (Lower Risk). This profile illustrates the existence of a clinically distinct subgroup defined by emotional dysregulation and elevated suicide risk, independent of diagnostic categories.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7437464/v1/ee782b188be4c71c73d38243.png"},{"id":91845523,"identity":"32d09533-4488-4a74-9608-f87977a873ab","added_by":"auto","created_at":"2025-09-22 10:12:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":618570,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7437464/v1/c545dad8-c122-487d-a488-95cf2c870eff.pdf"},{"id":91845519,"identity":"0c013b5e-b1c3-491d-9290-6bac66213e85","added_by":"auto","created_at":"2025-09-22 10:12:13","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":895447,"visible":true,"origin":"","legend":"","description":"","filename":"infographic.png","url":"https://assets-eu.researchsquare.com/files/rs-7437464/v1/c10291a937a7c8e4fa55a0f8.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Difficulty Identifying Feelings as a Predictor of Suicidal Ideation Severity in Mexican Psychiatric Inpatients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuicide is a pressing public health concern, responsible for over 700,000 deaths annually and ranking among the leading causes of death in young people worldwide (WHO, 2021). In Mexico, suicide mortality has increased by nearly 20% over the past decade, reflecting both structural inequalities and insufficient access to specialized care (INEGI, 2021; Borges et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; D\u0026aacute;vila-Cervantes \u0026amp; Luna-Contreras, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Research within Latin American psychiatry has largely focused on categorical diagnoses such as depression, yet international evidence demonstrates that suicidal ideation is a transdiagnostic phenomenon that cuts across psychiatric conditions, often linked to emotional dysregulation and interpersonal stressors (Klonsky et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Franklin et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Despite this, culturally grounded studies remain scarce, and the dimensional markers of risk are not systematically incorporated into clinical assessments in the region.\u003c/p\u003e\u003cp\u003eAlexithymia, defined as a difficulty in identifying and describing emotions, has emerged as a robust marker of vulnerability across psychiatric disorders (Sifneos, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1973\u003c/span\u003e; Bagby et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1994\u003c/span\u003e; Taylor et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Among its dimensions, difficulty identifying feelings (DIF) shows the strongest and most consistent association with suicidal ideation and behavior (Hintikka et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Hemming et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Mohamed \u0026amp; Ahmed, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Evidence from international studies suggests that DIF independently predicts suicide risk beyond depression and anxiety, highlighting its relevance as a transdiagnostic mechanism (De Berardis et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, little is known about the role of alexithymia in Latin American psychiatric contexts, where sociocultural norms of stoicism and stigma surrounding emotional expression may further obscure risk detection (Oliffe et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Mascayano et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Ju\u0026aacute;rez-Dom\u0026iacute;nguez et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). To address this gap, the present study examined whether DIF predicts suicidal ideation severity among Mexican psychiatric inpatients. We hypothesized that higher alexithymia scores, particularly DIF, would be associated with more severe suicidal ideation after adjusting for depression and anxiety, and that cluster analysis would identify clinically distinct high-risk subgroups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign and Setting\u003c/h2\u003e\u003cp\u003eWe conducted a cross-sectional study at Hospital de Psiquiatr\u0026iacute;a Morelos, a tertiary psychiatric facility of the Mexican Social Security Institute (IMSS) in Mexico City. Data were collected between July and September 2023 as part of routine clinical intake procedures.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe sample comprised 84 adults (18\u0026ndash;65 years) consecutively admitted for suicide-related crises, including recent attempts or acute suicidal ideation. Inclusion criteria required clinical stability within 72 hours of admission, defined as absence of active psychosis, catatonia, or disorganized behavior, and capacity to provide informed consent. Patients with major neurocognitive disorders, intellectual disability, or severe medical instability were excluded.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eAlexithymia.\u003c/b\u003e Alexithymia was assessed with the Spanish version of the 20-item Toronto Alexithymia Scale (TAS-20; Bagby et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1994\u003c/span\u003e; Fern\u0026aacute;ndez-Jim\u0026eacute;nez et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The instrument evaluates three dimensions\u0026mdash;difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT). Items are rated on a 5-point scale (range 20\u0026ndash;100); scores\u0026thinsp;\u0026ge;\u0026thinsp;60 indicate clinically significant alexithymia. Internal consistency in this sample was high (α\u0026thinsp;=\u0026thinsp;.84).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSuicidal ideation.\u003c/b\u003e The Beck Scale for Suicide Ideation (SSI; Beck et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1979\u003c/span\u003e; Osnaya \u0026amp; P\u0026eacute;rez, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) was used to measure suicidal thoughts and intent over the past week. The clinician-administered 19-item scale ranges from 0 to 38; scores\u0026thinsp;\u0026ge;\u0026thinsp;20 indicated severe ideation, consistent with prior research in Latin American populations. Internal consistency was excellent (α\u0026thinsp;=\u0026thinsp;.91).\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical variables.\u003c/b\u003e Diagnoses of depressive and anxiety disorders were established via structured clinical interviews (DSM-5/ICD-10 criteria), corroborated with medical records. Sociodemographic data included age, sex, education, and history of suicide attempts.\u003c/p\u003e\n\u003ch3\u003eProcedures\u003c/h3\u003e\n\u003cp\u003e Within 72 hours of admission, eligible patients provided informed consent and completed the TAS-20 and SSI under the supervision of trained clinicians. Instruments were administered in separate sessions to reduce fatigue. The TAS-20 was self-reported with assistance available for clarification of abstract terms, while the SSI was clinician-administered as part of standard suicide risk protocols.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAnalyses were conducted using R (v. 4.3.1). Descriptive statistics summarized sample characteristics. Group comparisons between severe (SSI\u0026thinsp;\u0026ge;\u0026thinsp;20) and mild/moderate ideation (SSI\u0026thinsp;\u0026lt;\u0026thinsp;20) were examined using \u003cem\u003et\u003c/em\u003e-tests and chi-square tests. Logistic regression assessed whether alexithymia predicted severe ideation, adjusting for age, depressive disorder, and anxiety disorder. Odds ratios (OR) with 95% confidence intervals (CI) were reported. Model fit was evaluated with the Hosmer\u0026ndash;Lemeshow test, and variance explained with Nagelkerke\u0026rsquo;s R\u0026sup2;. To explore clinical subgroups, \u003cem\u003ek\u003c/em\u003e-means cluster analysis was performed on standardized TAS-20 and SSI scores, with cluster validity checked using elbow and silhouette methods. Significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05 (two-tailed).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthics\u003c/h2\u003e\u003cp\u003eThe protocol was approved by the institutional Research Ethics Committee (HPM-CEI-23-007). All participants provided written informed consent in accordance with the Declaration of Helsinki (1964 and later amendments).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eSample Characteristics\u003c/h2\u003e\u003cp\u003eThe analytic sample included 84 psychiatric inpatients (M age\u0026thinsp;=\u0026thinsp;29.7 years, SD\u0026thinsp;=\u0026thinsp;11.2); two-thirds were women (66.7%), and most were single (73.8%). Depressive disorders were the most prevalent diagnosis (79.8%), followed by anxiety (48.8%), personality (34.5%), and substance use disorders (25.0%). Prior suicide attempts were reported by 65.5% of participants. Overall, 60.7% met criteria for clinically significant alexithymia (TAS-20\u0026thinsp;\u0026ge;\u0026thinsp;60), and 59.5% presented with severe suicidal ideation (SSI\u0026thinsp;\u0026ge;\u0026thinsp;20). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the main sociodemographic and clinical characteristics.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and clinical characteristics of psychiatric inpatients admitted for suicide-related crises (N\u0026thinsp;=\u0026thinsp;84).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29.7 (11.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school or higher (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressive disorder (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e79.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety disorder (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonality disorder (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubstance use disorder (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior suicide attempt (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere suicidal ideation (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinically significant alexithymia (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTAS-20 total score, mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62.5 (13.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMore than half of the sample met criteria for clinically significant alexithymia (TAS-20\u0026thinsp;\u0026ge;\u0026thinsp;60) and severe suicidal ideation (SSI\u0026thinsp;\u0026ge;\u0026thinsp;20), highlighting the high-risk profile of this inpatient population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eBivariate Comparisons\u003c/h2\u003e\u003cp\u003ePatients with severe ideation (SSI\u0026thinsp;\u0026ge;\u0026thinsp;20) had significantly higher TAS-20 scores (M\u0026thinsp;=\u0026thinsp;67.42, SD\u0026thinsp;=\u0026thinsp;10.71) compared with those with mild/moderate ideation (M\u0026thinsp;=\u0026thinsp;56.24, SD\u0026thinsp;=\u0026thinsp;12.12), \u003cem\u003et\u003c/em\u003e(82) = \u0026minus;\u0026thinsp;4.45, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.98. Differences were consistent across all subscales, with DIF showing the strongest effect, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001. Clinically significant alexithymia was more frequent among the severe group (78.0%) than the mild/moderate group (38.2%), χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;15.66, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eLogistic Regression\u003c/h2\u003e\u003cp\u003eIn logistic regression adjusting for age, depression, and anxiety, TAS-20 total score was the only independent predictor of severe ideation (OR\u0026thinsp;=\u0026thinsp;1.09, 95% CI [1.04, 1.14], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Depression showed an inverse association with ideation severity (OR\u0026thinsp;=\u0026thinsp;0.20, 95% CI [0.05, 0.82], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.026). Model fit was adequate (Hosmer\u0026ndash;Lemeshow χ\u0026sup2; = 6.78, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.560), explaining 42% of the variance.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCluster Analysis\u003c/h2\u003e\u003cp\u003e\u003cem\u003eK\u003c/em\u003e-means clustering identified a distinct high-risk subgroup (n\u0026thinsp;=\u0026thinsp;20, 24%) characterized by elevated TAS-20 scores (M\u0026thinsp;=\u0026thinsp;72.65, SD\u0026thinsp;=\u0026thinsp;6.39), severe suicidal ideation (M\u0026thinsp;=\u0026thinsp;28.42, SD\u0026thinsp;=\u0026thinsp;3.32), and the highest prevalence of prior attempts (92.0%). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the distribution of clusters across TAS-20 and SSI scores.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that difficulty identifying feelings (DIF), a central component of alexithymia, is independently associated with the severity of suicidal ideation in Mexican psychiatric inpatients. Beyond depression and anxiety, DIF emerged as a robust transdiagnostic marker, and cluster analysis revealed a subgroup defined by elevated alexithymia, severe ideation, and prior suicide attempts. These findings reinforce dimensional frameworks of suicide risk that highlight emotion regulation as a core explanatory process (Hemming et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; O\u0026rsquo;Connor \u0026amp; Kirtley, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince the seminal description by Sifneos (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1973\u003c/span\u003e), alexithymia has been recognized as a transversal vulnerability factor across psychiatric disorders. Meta-analyses confirm its stronger association with suicidal ideation than with suicide attempts (Hemming et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), a pattern replicated in our data. This suggests that alexithymia plays a more central role in the formation of suicidal thoughts than in the transition to action, a process likely influenced by additional moderators such as impulsivity or access to means (Klonsky et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Recent studies, including Shi et al. (2025), further underscore the universality of DIF as a suicide risk marker across cultural contexts. A clinical summary of these findings and their implications is presented in the \u003cem\u003eSupplementary Infographic.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAn unexpected finding was the inverse association between diagnosed depression and suicidal ideation. In high-alexithymia populations, deficits in emotional recognition may obscure the salience of depressive symptoms, consistent with models that emphasize emotion dysregulation and interpersonal stress over categorical diagnoses (May \u0026amp; Klonsky, 2016). Neurobiological evidence supports this interpretation: alexithymia has been linked to hypoactivation in the amygdala, insula, and anterior cingulate cortex, circuits also implicated in suicidal behaviors (Taylor et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These overlaps suggest that DIF reflects a neurocognitive pathway to suicidality.\u003c/p\u003e\u003cp\u003eCultural factors also deserve attention. In Mexican contexts, stoicism and stigma may reinforce alexithymic traits, manifested in common expressions such as \u0026ldquo;I feel bad\u0026rdquo; or \u0026ldquo;I don\u0026rsquo;t know what I feel\u0026rdquo; (Fern\u0026aacute;ndez-Jim\u0026eacute;nez et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). These linguistic markers illustrate how emotional inhibition intersects with clinical risk. Thus, prevention strategies should incorporate emotional literacy and regulation training. Evidence-based interventions such as DBT and ACT have proven effective in reducing suicidal ideation (Linehan, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Ducasse et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and could be culturally adapted for Latin America.\u003c/p\u003e\u003cp\u003eLimitations include the cross-sectional design, reliance on self-report measures, and restricted generalizability beyond an urban psychiatric setting. Nonetheless, the inclusion of Latin American data contributes novel evidence to an underrepresented region in global suicide research. Future studies should employ longitudinal designs and examine gendered pathways, given that cultural norms of masculinity may intensify alexithymia and hinder help-seeking (Oliffe et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDifficulty identifying feelings (DIF) was independently associated with the severity of suicidal ideation among Mexican psychiatric inpatients. These findings suggest that alexithymia represents a dimensional, transdiagnostic marker of suicide vulnerability, particularly relevant in contexts where cultural norms and structural barriers complicate risk detection. Incorporating brief emotion-focused screening tools into psychiatric assessments may enhance early identification of high-risk patients and inform culturally responsive suicide prevention strategies. (Watch \u003cem\u003eSupplementary Figure).\u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of Hospital de Psiquiatr\u0026iacute;a Morelos (protocol no. HPM-CEI-23-007). Written informed consent was obtained from all participants. All procedures complied with the Declaration of Helsinki (1964 and subsequent amendments).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eO. M. Y. S.\u0026nbsp;\u003c/strong\u003ecollected the data, conducted preliminary analysis, and drafted the initial manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eR. S. C.\u0026nbsp;\u003c/strong\u003edrafted and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJ. R. G. S.\u0026nbsp;\u003c/strong\u003esupervised the study design, performed the statistical analyses, and drafted and critically revised the manuscript. All authors approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to Publish declaration: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no commercial or financial conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe anonymized data supporting the findings of this study are available from the corresponding author upon reasonable request, subject to institutional approval and compliance with national data protection regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI Disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo AI tools were employed in study design, data analysis, or interpretation of results. All outputs were critically reviewed and approved by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Dr. Miguel Palomar Baena for his early contributions to the conceptualization of the study, and Drs. Claudia Fouilloux Morales, Virginia Barrag\u0026aacute;n P\u0026eacute;rez, and Silvia Aracely Tafoya Ramos (UNAM) for their academic mentorship. Special appreciation is extended to the clinical staff of Hospital de Psiquiatr\u0026iacute;a Morelos for their collaboration and commitment to ethical data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale\u0026mdash;I. Item selection and cross-validation of the factor structure. 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(2021). \u003cem\u003eSuicide worldwide in 2019: Global health estimates\u003c/em\u003e (1st ed.). WHO. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240026643\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240026643\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"alexithymia, suicidal ideation, psychiatric inpatients, emotional dysregulation, Mexican psychiatry","lastPublishedDoi":"10.21203/rs.3.rs-7437464/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7437464/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study examined whether difficulty identifying feelings (DIF), a central component of alexithymia, predicts the severity of suicidal ideation among psychiatric inpatients in Mexico. By focusing on a culturally underrepresented population, we aimed to clarify the dimensional role of emotional processing deficits in acute suicide risk.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA cross-sectional design was applied to 84 inpatients hospitalized for suicide-related crises at a public psychiatric hospital in Mexico City. Participants completed the 20-item Toronto Alexithymia Scale (TAS-20) and the Beck Scale for Suicide Ideation (SSI) within 72 hours of admission. Severe ideation was defined as SSI\u0026thinsp;\u0026ge;\u0026thinsp;20. Logistic regression adjusted for age, depression, and anxiety. Cluster analysis explored emotion\u0026ndash;symptom subgroups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePatients with severe ideation had higher TAS-20 scores (M\u0026thinsp;=\u0026thinsp;67.42) than those with mild/moderate ideation (M\u0026thinsp;=\u0026thinsp;56.24), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001. DIF emerged as the strongest subscale predictor. Logistic regression confirmed that alexithymia significantly increased the odds of severe ideation (OR\u0026thinsp;=\u0026thinsp;1.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), while depression showed an inverse association (OR\u0026thinsp;=\u0026thinsp;0.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.026). Cluster analysis identified a high-risk subgroup characterized by elevated DIF, severe ideation, and prior suicide attempts.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eDIF may function as an independent and clinically meaningful marker of suicide risk in acute psychiatric care, beyond categorical diagnoses. Integrating emotion-focused screening tools into routine assessments may improve detection of high-risk patients in Latin American settings.\u003c/p\u003e","manuscriptTitle":"Difficulty Identifying Feelings as a Predictor of Suicidal Ideation Severity in Mexican Psychiatric Inpatients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:56:08","doi":"10.21203/rs.3.rs-7437464/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-15T11:46:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T21:21:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295113018379692045709179074898763486621","date":"2025-09-26T10:23:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T07:51:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212071632450087279156179115611177845105","date":"2025-09-13T15:09:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-11T15:06:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T13:54:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-26T00:02:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Psychology","date":"2025-08-26T00:00:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92f9e0cb-497e-49ba-9d87-e5df7d954cae","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-04T18:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 09:56:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7437464","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7437464","identity":"rs-7437464","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}