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

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.