Sociodemographic and Clinical Determinants of Suicidal Ideation: An Analysis in a Peruvian Consultation-Liaison Psychiatry Unit

doi:10.21203/rs.3.rs-4273086/v1

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Sociodemographic and Clinical Determinants of Suicidal Ideation: An Analysis in a Peruvian Consultation-Liaison Psychiatry Unit

https://doi.org/10.21203/rs.3.rs-4273086/v1

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Background

Suicidal ideation (SI) poses a significant global health concern, particularly among hospitalized individuals, with gaps in understanding its contributing factors in low and middle-income countries like Peru.

Methods

Utilizing a cross-sectional design, this study examined 940 patients evaluated by the Consultation-Liaison Psychiatry Unit at a major Peruvian general hospital. Sociodemographic and clinical characteristics were assessed, employing standardized instruments such as the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15), and Clinical Global Impressions (CGI). The prevalence of SI and its associations were explored through bivariate and multivariate analyses.

Results

The prevalence of SI was 19.7%, with notable associations found in patients experiencing moderate-to-severe depression (36.8%) and those rated as moderately to severely ill on CGI (33.2%). Multivariate analysis confirmed these associations, emphasizing the impact of retirement (aPR = 1.53, 95% CI = 1.04–2.26, p = 0.032), clinical severity (aPR = 1.41, 95% CI = 1.22–1.63, p < 0.0001), and depressive symptoms (aPR = 2.98, 95% CI = 2.13–4.17, p < 0.0001) on SI.

Conclusion

This study provides essential insights into SI factors among hospitalized patients. Identifying risk factors, like retirement and clinical severity, underscores the importance of targeted interventions in the Peruvian general hospital context.

Suicidal ideation

hospitalized patients

Consultation-Liaison Psychiatry

depression

mental health

Peru

In 2019, as per the World Health Organization (WHO) data, it is estimated that 703,000 individuals worldwide died by suicide (1). These statistics underscore the global scale of the suicide issue (1). Suicidal ideation (SI), ranging from general thoughts of suicide to detailed plans for self-harm (2), exhibits a moderate association with actual suicide (3).

Hospitalized patients represent a high-risk population for SI (4). For instance, two studies conducted in India reported the prevalence of SI in psychiatric unit patients to be 13.3% and 16.4% (5, 6). Furthermore, the prevalence of SI in patients hospitalized for non-psychiatric illnesses ranges from 2.3–21.6% (7–10). Factors associated with SI in hospitalized patients include depression, being young (18–35 years), alcoholism, smoking, prior suicide attempts, irritability, feelings of inferiority, anxiety, and lack of social support (7–10).

Despite advancements in the understanding of SI and its associations, significant gaps in our comprehension of this phenomenon persist (11), particularly in the context of hospitalized patients in general hospitals. While some risk factors have been identified, the complexity of the interplay between clinical, psychosocial, and environmental variables necessitates further exploration (12). Existing literature emphasizes the heterogeneity of the hospitalized population and the diversity of factors that can influence SI. An example of this is the study conducted by Cai H and colleagues in hospitalized patients with major depressive disorder, which suggests various preventive measures targeting the associated factors in this population. However, it also warns us about the potential biases that may result from generalizing the results (13). SI in patients hospitalized in a general hospital setting has been associated with mental disorders, poor functional status, high stress, pain, palliative care, prior suicide attempts, insufficient social support, specific medical conditions, sociodemographic factors, quality of life, desire for death, cognitive impairment, low self-esteem, low self-efficacy, length of hospital stay, history of traumatic events (10, 14).

In the context of Peru, a country with unique socio-economic and cultural characteristics, there is a paucity of research on SI among hospitalized patients in general hospitals. Investigating SI in low and middle-income countries, such as Peru, is of paramount importance. These regions often grapple with numerous challenges, including limited healthcare resources, inadequate access to mental health services, and socioeconomic disparities (15, 16). Exploring SI in general hospitals within such resource-constrained environments is imperative as it illuminates the specific issues and risk factors faced by patients. The Consultation-Liaison Psychiatry Unit, embedded within the general hospital setting, serves as a pivotal bridge between psychiatric and medical care. This unit not only addresses the unique challenges encountered by patients but also provides a comprehensive perspective on their needs, making it representative of the broader healthcare landscape.

This study aims to comprehensively profile sociodemographic and clinical characteristics in patients evaluated by the Consultation-Liaison Psychiatry Unit at a Peruvian general hospital, investigate the prevalence of SI within this patient population, identify factors associated with SI, and calculate adjusted prevalence ratios (aPR) to better understand the relationships between these variables and SI.

Study design

We conducted a secondary analysis using data from a larger research study with the objective to determine the sensitivity and specificity of different versions of the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder Scale (GAD-7) in a Peruvian hospital population (17). The study follows a cross-sectional design, conducting a one-time assessment of sociodemographic and clinical characteristics in patients evaluated by the Consultation-Liaison Psychiatry Unit at a Peruvian general hospital.

Setting

The research was conducted at the Guillermo Almenara Irigoyen National Hospital (HNGAI), situated in Lima, Peru's capital city. HNGAI represents a prominent healthcare institution, characterized by its high complexity. It ranks among the top three largest hospitals within the Peruvian Social Security system, boasting a substantial capacity of 960 hospital beds. Furthermore, HNGAI serves as a crucial tertiary referral center catering to a comprehensive spectrum of medical disciplines, inclusive of the field of psychiatry (http://www.essalud.gob.pe/estadistica-institucional/). It delivers healthcare services to a population of 1,547,840 beneficiaries under social insurance coverage.

The Liaison Psychiatry Unit at HNGAI is tasked with addressing consultation requests from various clinical-surgical departments within the hospital (18). In the evaluation of each patient, alongside clinical interviews and psychiatric diagnoses, standardized assessments like PHQ-9 and GAD-7 are employed for thorough monitoring and treatment response assessment. Beginning in September 2020, the services offered by the Liaison Unit have been documented using a Google Form to enhance patient tracking.

Participants

The study included a total of 940 participants who were patients evaluated by the Consultation-Liaison Psychiatry Unit at a large Peruvian general hospital. The participants were part of routine clinical assessments, and their data were collected between September 2020 and June 2022.

Instruments

Sociodemographic characteristics

We used the sociodemographic characteristics in the database generated by (17). Dichotomous or polytomous data were obtained about age, sex, marital status, education level, employment status, religion, cohabitants, previous mental health diagnosis and/or treatment (17). All these characteristics were included in the secondary analysis.

Depressive symptoms: For the evaluation of depressive symptoms, the PHQ-9 was used (19). As it is known, PHQ-9 is also a self-administered scale consisting of 9 items, rated on a Likert scale ranging from 0 (“not at all”) to 3 (“almost every day”). The PHQ-9 score reflects five categories of severity of depressive disorders: None (0–4), Mild (5–9), Moderate (10–14), Moderately severe (15–19), and Severe (20–27). In studies carried out in Latin America, PHQ-9 has been proven to be a valid and reliable tool for detecting depressive symptoms in various types of population (20, 21). The PHQ-9 has been validated in Peruvian patients hospitalized in general hospitals (17), demonstrated favorable psychometric characteristics, aligning well with a one-dimensional model (CFI = .936, RMSEA = .089) and displaying sufficient internal consistency (ω = .87) (22). In our study, the internal consistency of this test was high (Cronbach’s alpha = 0.842).

Suicidal ideation (SI): SI was assessed using question 9 of the PHQ-9 (19). This question has been employed in prior studies to ascertain the presence of SI (23–26). Participants were asked if, in the past 2 weeks, they had had thoughts that they would be better off dead. Their responses were assessed on a four-point scale: 0 (Not at all), 1 (Several days), 2 (More than half the days), and 3 (Nearly every day). A score of 1 or higher was considered indicative of the presence of SI.

Anxiety symptoms

The GAD-7 is a Likert-type rating scale adhering to DSM-IV criteria. It gauges anxious symptoms experienced in the preceding two weeks, employing a range of response options from 0 (not at all) to 3 (almost every day) (27). The GAD-7, featuring its original seven items, yielded scores ranging from 0 to 21. In the Peruvian context, the GAD-7 demonstrated favorable psychometric characteristics, aligning well with a one-dimensional model (CFI = .995, TLI = .992, RMSEA = .056), displaying sufficient internal consistency (ω = .89), and exhibiting invariance with respect to gender (ΔCFI ≤ .01) (28). The internal consistency was 0.815 (Cronbach’s alpha) in our research.

Somatic symptoms

The Patient Health Questionnaire-15 (PHQ-15), comprised of 15 items designed to measure the severity of somatic symptoms. It evaluates 15 somatic symptoms or symptom clusters that collectively encompass over 90% of physical complaints reported by outpatients, except for upper respiratory tract symptoms. Each symptom scored from 0 (“not bothered at all”) to 2 (“bothered a lot”) (29). The Spanish version of the PHQ-15 questionnaire has demonstrated feasibility, reliability, and validity in assessing somatic symptoms (30). This demonstrated acceptable internal consistency (Cronbach’s alpha = 0.790).

Clinical Global Impressions (CGI): The CGI-Severity (CGI-S) is a single-question assessment where the clinician evaluates the patient's current mental illness based on their overall clinical experience with this specific population. It employs a seven-point scale as follows: 1 = Normal (not sick); 2 = Dubiously ill, 3 = Slightly ill, 4 = Moderately ill, 5 = Markedly ill, 6 = Severely ill, 7 = Among the most extremely ill patients. This rating considers observed and reported symptoms, behavior, and functioning over the past seven days. While symptoms and behavior may vary during the week, the score is intended to represent the average severity level across those seven days (31).

Analysis plan

Data analysis was performed in four phases. The first phase included the descriptive analysis, the qualitative variables, using frequency and percentage for qualitative variables, and means and standard deviations for quantitative variables. In the second phase, we recategorized some variables before inferential analysis (Supplementary Table S1). The outcome variables of mental health were dichotomized according to their clinical relevance (19, 32). The SI variable was dichotomized concerning the participant’s response to item 9 of the PHQ-9: absence (“Not at all”) and presence (“Several days,” “More than half of the days” and “Nearly every day”). Depression, anxiety, and somatization, as clinically non-significant (none and mild) or clinically significant (moderate to severe). Other variables (marital status, education level, employment, living arrangement, CGI – initial and psychiatric history) were also re-categorized to maintain a proper number of patients in each cell.

In the third phase, the Chi-square test was performed to explore the association between SI and covariates. In the last phase, we selected variables that presented a p < 0.25 (gender, age, education level, employment, CGI – initial, psychiatric history, depression, anxiety, and somatic symptoms) in the univariate analysis for the robust Poisson regression model. The variable psychiatric diagnosis was not considered due to the small number of participants in a reference category cell. We verified that the excluded variables (marital status and living arrangement) did not make a significant contribution to the multivariate analysis in the presence of the other variables following the recommendations of (33). The degree of association was represented by a prevalence ratio (PR) with its respective 95% CI. Values of p < 0.05 were considered as significant. These data analysis was performed using IBM SPSS Statistics 24.0 version for Window.

Ethics

The Hospital Nacional Guillermo Almenara Irigoyen’s Institutional Review Board approved the original study (Nota N°52 CIEI-OIyD-GRPA-Essalud-2023) and the current analysis (N° 0498-2024-CIEI-UPSJB), which was also approved by the Ethics Committee of the Universidad Privada San Juan Bautista. Throughout the study, the researchers did not have access to any identifying information about the participants. In addition, participants gave informed consent. All participants were users of the hospital's Liaison Psychiatry Unit, so all received psychological or psychiatric care as needed.

The mean age of the patients was 54.85 (SD = 16.71). The sample was composed of women (59.5%), married or cohabiting individuals (58.3%), with a university education (34.9%), engaged in formal work (44.5%), and living with a partner and children (70.5%). The other sociodemographic characteristics are detailed in Table 1.

Table 1

Sociodemographic and clinical characteristics in a sample of patients evaluated by the Consultation-Liaison Psychiatry Unit (n = 940).
Sociodemographic	n	%
Gender
Male	381	40.5
Female	559	59.5
Age (years)	54.85 (± 16.71) [19–95]
Under 60 years	538	57.2
60 years or older	402	42.8
Marital Status
Single	224	23.8
Married/Cohabitant	548	58.3
Separated	84	8.9
Widowed	77	8.2
Lost data	7	0.7
Education Level
None	6	0.6
Primary	102	10.9
Secondary	329	35
Technical	164	17.4
University	328	34.9
Lost data	11	1.2
Employment
Unemployed	223	23.7
Unpaid work	39	4.1
Informal work	77	8.2
Formal work	418	44.5
Retired	166	17.7
Lost data	17	1.8
Living Arrangement
Alone	69	7.3
Partner with children	663	70.5
Parents/family	189	20.1
Work colleagues	4	0.4
Caregiver	5	0.5
Lost data	10	1.1
Clinical	n	%
Psychiatric History
Organic Mental Disorders (F0X)	11	1.2
Mental Disorders due to Substance Use (F1X)	4	0.4
Schizophrenia Spectrum Disorders (F2X)	8	0.9
Mood Disorders (F3X)	133	14.1
Anxiety, Stress, and Somatoform Disorders (F4X)	83	8.8
Syndromes Associated with Physiological Disturbances (F5X)	5	0.5
Personality Disorders (F6X)	5	0.5
Childhood and/or Adolescent Disorders (F9X)	1	0.1
None	657	69.9
Lost data	33	33.5
Psychiatric Diagnosis
Organic Mental Disorders (F0X)	39	4.1
Mental Disorders due to Substance Use (F1X)	3	0.3
Schizophrenia Spectrum Disorders (F2X)	9	1.0
Mood Disorders (F3X)	283	30.1
Anxiety, Stress, and Somatoform Disorders (F4X)	474	50.4
Syndromes Associated with Physiological Disturbances (F5X)	11	1.2
Personality Disorders (F6X)	6	0.6
None	115	12.2
CGI - Initial
Not evaluated	4	.4
Normal (not sick)	83	8.8
Dubiously ill	67	7.1
Slightly ill	381	40.5
Moderately ill	333	35.4
Markedly ill	49	5.2
Severely ill	9	1.0
Among the most extremely ill patients	0	0
Lost	14	1.5
Depression (PHQ-9)
Normal	430	45.7
Mild	291	31
Moderate	143	15.2
Moderate-Severe	51	5.4
Severe	25	2.7
Anxiety (GAD-7)
Normal	499	53.1
Mild	318	33.8
Moderate	92	9.8
Severe	31	3.3
Somatic symptoms (PHQ-15)
Normal	457	48.6
Mild	310	34
Moderate	116	12.3
Severe	47	5
Suicidal ideation
Presence	185	19.7
Absence	755	80.3
PHQ-9: Patient Health Questionnaire-9; GAD-7: General Anxiety Disorder-7; PHQ-15: Patient Health Questionnaire-15

Additionally, 23.3% of the participants showed clinically significant depression, 13.1% showed clinically significant anxiety, and 17.3% showed clinically significant somatic symptoms. We found that 19.7% of the participants experienced SI.

Regarding the bivariate analysis (Table 2), a significantly lower proportion of patients with a university education exhibited SI compared to those with a lower educational background (15.2% vs. 24.4%, p = 0.031). Patients with a CGI-Initial rating of “Normal, slightly, or doubtfully ill” demonstrated a lower prevalence of SI in comparison to those with a “Moderately to severely ill” rating (< 0.0001). Moreover, the absence of a psychiatric diagnosis was associated with a lower incidence of SI, with only 1.7% of patients reporting this, whereas patients with various psychiatric diagnoses had notably higher rates (up to 36%). Additionally, significant associations were observed between the severity of depression, anxiety, and somatic symptom burdens (as assessed by PHQ-9, GAD-7, and PHQ-15 scores) and SI, with patients experiencing moderate to severe symptoms showing higher rates of SI.

Table 2

Bivariate analysis of baseline clinical characteristics and suicidal ideation in a sample of patients evaluated by the Consultation-Liaison Psychiatry Unit (n = 940).
Characteristic	Suicidal ideation n(%)
Characteristic	No	Yes	p
Gender
Male	315 (82.7)	66 (17.3)	0.133
Female	440 (78.7)	119 (21.3)
Age
Under 60 years	424 (78.8)	114 (21.2)	0.178
60 years or older	331 (82.3)	71 (17.7)
Marital Status
Single	180 (80.4)	44 (19.6)	0.376
Married/cohabiting	446 (81.3)	102 (18.6)
Separated/widowed	123 (76.4)	38 (23.6)
Education Level			0.031
University	278 (84.8)	50 (15.2)
Technical	124 (75.6)	40 (24.4)
School/None	345 (78.9)	92 (21.1)
Employment			0.076
Formal work	349 (83.5)	69 (16.5)
Unemployed/unpaid work	201 (76.7)	61 (23.3)
Informal work	57 (74)	20 (26)
Retired	135 (81.3)	31 (18.7)
Living Arrangement			0.303
Alone	53 (76.8)	16 (23.2)
With partner or children	541 (81.6)	122 (18.4)
With parents or relatives or others	153 (77.3)	45 (22.7)
CGI - Initial			< 0.0001
Normal, mild, or slightly ill	513 (93.4)	36 (6.6)
Moderately to severely ill	242 (61.9)	149 (38.1)
Psychiatric History			0.025
None	539 (82.2)	11 (17.8)
Anxiety, stress, and somatoform disorders	107 (79.3)	28 (20.7)
Mood disorders	60 (73.2)	22 (26.8)
Other	22 (64.7)	12 (35.3)
Psychiatric Diagnosis			< 0.0001
None	113 (98.3)	2 (1.7)
Anxiety, stress, and somatoform disorders	405 (85.4)	69 (14.6)
Mood disorders	181 (64)	102 (36.0)
Other	56 (82.4)	12 (17.6)
Depression (PHQ-9)			< 0.0001
Normal/mild	652 (90.4)	69 (9.6)
Moderate-to-severe	103 (47)	116 (53.0)
Anxiety (GAD-7)			< 0.0001
Normal/mild	685 (83.8)	132 (16.2)
Moderate-to-severe	70 (56.9)	53 (43.1)
Somatic symptoms (PHQ-15)			< 0.0001
Normal/mild	652 (83.9)	125 (16.1)
Moderate-to-severe	103 (63.2)	60 (36.8)
PHQ-9: Patient Health Questionnaire-9; GAD-7: General Anxiety Disorder-7; PHQ-15: Patient Health Questionnaire-15

In our multivariate analysis (Table 3), patients who were retired exhibited a higher prevalence of SI (aPR = 1.53, 95% CI = 1.04–2.26, p = 0.032) compared to those employed in formal work. Additionally, patients with an initial CGI rating of “Moderately to severely ill” had a significantly elevated prevalence of SI (aPR = 1.41, 95% CI = 1.22–1.63, p < 0.0001). Furthermore, patients with moderate-to-severe symptoms of depression, as assessed by the PHQ-9, demonstrated a substantially increased prevalence of SI (aPR = 2.98, 95% CI = 2.13–4.17, p < 0.0001) in comparison to those with normal or mild symptoms. The comprehensive results of the multivariate analysis are described in Supplementary Table S2.

Table 3

Multivariate analysis of baseline clinical characteristics and suicidal ideation in a sample of patients evaluated by the Consultation-Liaison Psychiatry Unit (n = 940).
	Presence of Suicidal Ideation
	p valor	aPR	CI 95%
Employment
Formal work		Ref.
Unemployed/unpaid work	0.464	1.12	0.82–1.52
Informal work	0.388	1.2	0.79–1.84
Retired	0.032	1.53	1.04–2.26
CGI - Initial
Normal, mild, or slightly ill		Ref.
Moderately to severely ill	< 0.0001	1.41	1.22–1.63
Depression (PHQ-9)
Normal/mild		Ref.
Moderate-to-severe	< 0.0001	2.98	2.13–4.17
PHQ-9: Patient Health Questionnaire-9; aPR: adjusted prevalence ratio

SI has been identified as a high-risk factor for suicide (3). This study holds significant relevance in elucidating factors associated with SI within the hospital setting. The findings from this investigation unveil a predominantly adult population with a mean age of 54 years. The predominance of females (59.5%) and the high proportion of married or cohabiting participants (58.3%) underscore the importance of considering gender differences and family context when addressing mental health in Peru. Previous studies demonstrate parallels in sociodemographic characteristics with our sample (14). In a study conducted on cancer patients in China, a mean age of 59.7 years, female predominance, and a majority of married participants were reported. This study found a prevalence of SI of 12.9% in men and 17.6% in women (14). Another study reported a mean age of 52.7 years, predominantly male (58.1%), with higher education and mostly married. No significant gender-related SI data were reported (9). In Peru, a study revealed a female predominance in its sample, married or cohabiting individuals (68.2%), with a higher prevalence of SI in patients with a secondary education or higher and in young hospitalized patients (34). Furthermore, the majority of studies suggest that depressive symptoms, anxiety, and a history of psychiatric illnesses are the most relevant factors associated with SI.

Labor transitions, such as retirement, impact mental health and are considered risk factors for SI. Information from other studies suggests that retirement encompasses a spectrum of impacts on psychological well-being, ranging from potentially positive changes to detriments such as depressive symptoms and suicidal ideation (35). Although retirement may induce stress through the disruption of relationships and routines, it concurrently offers augmented free time, mitigating risks associated with work-related stressors. This proves notably advantageous for mental health in occupations demanding higher levels of engagement, facilitating enhanced social interactions, and promoting engagement in healthful activities (35). Prior research suggests that expectations regarding future employment, identified here as the likelihood of maintaining full-time employment at the age of 62, have a longitudinal relationship with the manifestation of SI in older adults (36). In another study, it was revealed that individuals who retired early were 3.1 times more likely to experience SI compared to those with at least part-time employment (37). Further investigation, examining mental health outcomes across labor transitions and key sociodemographic factors, observed that unmet expectations, especially among those aspiring to continue working, were associated with the manifestation of elevated depressive symptoms, including SI (38). The link between expectations and mental health is rooted in theoretical reasons, as expectations represent subjective assessments of the likelihood of future events and are intrinsically linked to hopelessness and anxiety. The latter are recognized as risk factors for the development of depression and a propensity for suicidal behaviors (36). In the Peruvian context, the reality of retirees can be a crucial factor influencing their mental health and suicidal ideation during hospitalization. The transition to retirement in Peru may be marked by economic, social, and adaptational challenges to significant changes in daily routines (39). The availability and accessibility of social security systems, as well as post-retirement socio-economic conditions, could play a fundamental role in retirees' mental health. The lack of social support and the perception of loss of status and social connection may contribute to psychological stress (40).

The presence of increased SI has been observed in patients with elevated CGI scores in previous studies. For instance, in a study involving hospitalized patients with mood disorders, those with high scores on both PHQ-9 and the highest CGI exhibited a greater tendency towards SI (OR = 4.70, p = 0.0005) (41). Another study documented a correlation between SI and psychopathology in the CGI (OR = 1.85) in patients with blepharospasm, along with more severe symptoms of anxiety and depression (42). This finding suggests that the severity of symptoms and clinical burden may play a crucial role in the escalation of SI in hospitalized patients. Several explanations exist for this phenomenon. Firstly, the presence of more severe symptoms and a higher clinical burden can engender a sense of hopelessness and despair in patients, thereby increasing the likelihood of considering suicide as an option (43, 44). Additionally, patients with higher CGI scores generally experience greater interference in their daily functioning and a decrease in quality of life, contributing to feelings of hopelessness and a desire to escape their current situation (31, 43).

In our investigation, we delineate a robust association between moderate to severe depression and SI among hospitalized patients, a relationship that maintains statistical significance in multivariate analysis. A study conducted in a general hospital in Brazil identified a noteworthy association between depression and SI (OR = 9.1, p < 0.001) (8). Another study revealed depression as a predictive variable for SI (OR = 8.474, p < 0.001) (7). Within the hospital setting, physical pain attributable to severe medical conditions, chronic treatments, and the aftermath of hospitalization may heighten the co-occurrence of depressive disorders and the likelihood of SI in depressed patients (8). Consequently, we underscore the pivotal importance of recognizing and addressing depressive symptoms, given their association with an augmented risk of hospitalization, prolonged stays, heightened reentry risk, and the presence of SI (45, 46).

The presented findings underscore the immediate imperative to address this issue and pose the challenge of implementing a comprehensive approach through a series of measures. These measures should not only encompass the identification of high-risk areas but also delve into the analysis of related factors, particularly mental health issues, sociodemographic characteristics, and aspects pertaining to the quality of the hospital stay, as they significantly impact suicidal behavior (47). There is a pressing need to expand knowledge in these cases due to potential implications for preventive actions (48).

Within the Peruvian context, the reduction of the gap in mental health services should pivot towards identifying and supporting mental health care-seeking behavior in individuals recognizing a substantial need for care. Such identification holds the potential to double the rate of mental health care access (16). Simultaneously, it is crucial to work on increasing awareness of mental disorders to foster greater self-evaluation of unrecognized mental morbidities among those who could benefit from care (16).

Moreover, given the scarcity of studies focusing on the issue of SI within the Peruvian context, this work not only addresses a conspicuous gap in existing literature but also holds significant theoretical value. By expanding our understanding of factors associated with SI in Peru, we not only fulfill an immediate need to comprehend and address this phenomenon but also lay the groundwork for future investigations. The insights generated by this study can serve as a starting point for more detailed and specific research, providing a valuable resource for formulating prevention and intervention strategies in the realm of mental health in the country.

The study should be interpreted within the context of its methodological limitations. Despite the valuable insights provided by the research, its single-center design and cross-sectional approach may restrict the generalizability of findings and hinder the establishment of causal relationships. The data for this study were derived from a secondary analysis of a larger research project. Although this approach can be efficient, it may introduce the risk of uncontrolled confounding factors and missing data. Additionally, the study's reliance on self-reported measures and its specific cultural context in Peru should be considered when applying the results to other populations or healthcare settings. These limitations underscore the need for caution when drawing conclusions.

However, despite these limitations, the present study boasts several strengths. The inclusion of a substantial sample size and the use of well-validated assessment tools enhance the reliability and statistical power of the findings. The comprehensive data collection, encompassing a wide range of sociodemographic and clinical variables, provides a thorough understanding of factors related to SI. Furthermore, the application of a robust multivariate analysis allows for a more in-depth exploration of the complex interplay of these factors. While acknowledging its limitations, this study contributes valuable insights to the field of psychiatric research, emphasizing the need for further investigations to build upon these strengths and address its methodological constraints.

In conclusion, this study sheds light on the factors associated with SI among patients evaluated by the Consultation-Liaison Psychiatry Unit at a Peruvian general hospital. While recognizing its methodological limitations, the research highlights the importance of considering sociodemographic and clinical characteristics, including initial clinical severity, and severity of depressive symptoms.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work the authors used ChatGPT3.5/OpenAI in order to enhance the clarity, coherence, and structure of the manuscript. After using this tool, the authors reviewed and edited the content as needed and takes full responsibility for the content of the publication.

Ethics approval and consent to participate

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Availability of data and materials

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

Acknowledgements

We would like to extend our heartfelt gratitude to all the dedicated members of the Consultation-Liaison Psychiatry Unit at the Guillermo Almenara Irigoyen National Hospital (HNGAI) who tirelessly provided care to the patients. Their unwavering commitment and hard work were instrumental in making this research possible.

Authors’ contributions

JHV contributed to the conceptualizing the study, designing the methodology, developing software tools, validating the results, conducting investigations, managing resources, curating data, project administration responsibilities, and participated in reviewing and editing the manuscript. JSC contributed to the formal analysis, performed investigations, and aided in visualizing the findings. MC, MP and KB participated in the investigation phase and contributed to the initial drafting of the manuscript, provided critical input for the manuscript in the review and editing stages, and played a supervisory role.

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Sociodemographic and Clinical Determinants of Suicidal Ideation: An Analysis in a Peruvian Consultation-Liaison Psychiatry Unit

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