Attitudes and Practices of Ibero-American Neurosurgeons Toward Psychiatric Comorbidity: A Multicenter Cross-Sectional Study.

Introduction Psychiatric comorbidity, particularly anxiety and depression, is associated with worse surgical outcomes across multiple specialties. In Ibero-America, no systematic evidence is available regarding the attitudes and practices of neurosurgeons toward this comorbidity. The present study characterizes such attitudes and self-reported practices and explores their associations with demographic, training-related, and institutional variables. Methods We conducted an observational, cross-sectional, multicenter study based on an ad hoc digital questionnaire deployed on LimeSurvey, with parallel Spanish and Portuguese versions, distributed through national neurosurgical societies and digital professional networks between November 2025 and April 2026. The instrument, with content validated qualitatively by a five-expert panel, comprised 37 items organized into four domains: sociodemographic characteristics, attitudes toward mental health, clinical practices and care integration, and professional training and adoption of technological tools. Statistical analysis was performed in Python and included chi-square goodness-of-fit and independence tests, Fisher's exact test, Spearman's correlation, and 95% confidence intervals computed using the Wilson method. Results Sixty-three complete responses were obtained from 12 countries (74.6% male; mean age 46.9 ± 9.8 years; median 13 years of practice in the specialty). Of the respondents, 95.2% acknowledged worse surgical outcomes in patients with untreated psychiatric comorbidity, and 90.5% endorsed a level of care equivalent to that afforded to somatic disease; nevertheless, behavior in an equivalent clinical scenario differed significantly (p = 0.002), and the required preoperative psychiatric stabilization time was the only questionnaire item whose distribution did not differ from uniform (p = 0.149). Specific training during residency was absent in 58.7% of participants, and 96.8% were receptive to further education. Institutional availability of neuropsychology units showed a significant regional gradient (χ²₍₄₎ = 15.79; p = 0.003), with the Southern Cone at 8% versus 50-67% in other regions. Acceptance of artificial intelligence and telemedicine tools was high (74.6% and 71.4%, respectively) and was inversely associated with respondent age (ρ = -0.28; p = 0.040 and ρ = -0.30; p = 0.020). Conclusions A gap exists between the recognition of the prognostic impact of mental health and the heterogeneity of clinical practice in Ibero-American neurosurgery. This gap is not explained by isolated individual variables but rather by modifiable structural factors. Incorporating dedicated training into residency programs, adopting brief preoperative screening protocols, integrating neuropsychology teams within neurosurgical services, and leveraging digital tools constitute concrete lines of action. Multicenter longitudinal studies with formal instrument validation will allow these findings to be confirmed and extended.