Designing a Model of Suicidal Beliefs Based on Emotional Expressivity with the Mediating Role of Fear of Negative Evaluation in Individuals with Gender Dysphoria

Authors

    Behnush Nikkhah Department of Psychology, Ar.C., Islamic Azad University, Arak, Iran.
    Mohammad Mehdi Jahangiri * Department of Psychology, Ar.C., Islamic Azad University, Arak, Iran. mm.jahangiri@iau.ac.ir
    Davood Taghvaei Department of Psychology, Ar.C., Islamic Azad University, Arak, Iran.

Keywords:

emotional expression, fear of negative evaluation, gender dysphoria, suicidal ideations

Abstract

Individuals with gender dysphoria report higher levels of harmful thoughts and beliefs compared to the general population. This highlights the importance of identifying factors that increase this group’s vulnerability to suicidal thoughts and beliefs.  The present study aimed to investigate the mediating effect of fear of negative evaluation in the relationship between emotional expressivity and suicidal beliefs in individuals with gender dysphoria. This study employed a correlational design and structural equation modeling. The study population consisted of all men and women with gender dysphoria in Tehran from March to September 2024. Of these, 267 individuals were selected as the sample using convenience sampling and based on the research criteria. Data collection instruments included the Beck Suicide Ideation Scale (Beck et al., 1988), the Emotional Expressivity Questionnaire (King & Emmons, 1990), and the Fear of Negative Evaluation Scale (Leary, 1983). Data analysis was conducted using SPSS and AMOS software through structural equation modeling. The results showed that the direct effect of emotional expressivity on suicidal beliefs and fear of negative evaluation was significantly negative (p < .001). The direct path from fear of negative evaluation to suicidal beliefs was significantly positive (p < .001). Examination of the indirect coefficients indicated that fear of negative evaluation played a mediating role in the relationship between emotional expressivity and suicidal beliefs (p < .001). Overall, the findings of this study indicate that emotional expressivity, through the mediating role of fear of negative evaluation, affects suicidal beliefs in individuals with gender dysphoria.

Downloads

Download data is not yet available.

References

Chen, D., Shen, Y., Zhou, X., Ying, J., Zhang, J., Zhan, S., & You, J. (2024). The bidirectional longitudinal associations between fear of negative evaluation and suicidal ideation among Chinese adolescents: The mediating role of interpersonal needs factors. Journal of affective disorders, 361, 59-66. https://doi.org/10.1016/j.jad.2024.05.151

Dryman, M. T., & Heimberg, R. G. (2018). Emotion regulation in social anxiety and depression: A systematic review of expressive suppression and cognitive reappraisal. Clinical psychology review, 65, 17-42. https://doi.org/10.1016/j.cpr.2018.07.004

Dyar, C., Herry, E., & Pirog, S. (2024). Emotion regulation strategies and coping self-efficacy as moderators of daily associations between transgender and gender diverse (TGD) enacted stigma and affect among TGD young adults assigned female at birth. Social Science & Medicine, 358, 117261. https://doi.org/10.1016/j.socscimed.2024.117261

Everaert, J., Bronstein, M. V., Castro, A. A., Cannon, T. D., & Joormann, J. (2020). When negative interpretations persist, positive emotions don't! Inflexible negative interpretations encourage depression and social anxiety by dampening positive emotions. Behaviour Research and Therapy, 124, 103510. https://doi.org/10.1016/j.brat.2019.103510

Faruki, F., Patel, A., Jaka, S., Kaur, M., Sejdiu, A., Bajwa, A., & Patel, R. S. (2023). Gender dysphoria in pediatric and transitional-aged youth hospitalized for suicidal behaviors: a cross-national inpatient study. The Primary Care Companion for CNS Disorders, 25(2), 46284. https://doi.org/10.4088/PCC.22m03352

Ghiasi, Z., Khazaei, F., Khosravi, M., & Rezaee, N. (2024). Physical and psychosocial challenges of people with gender dysphoria: a content analysis study. BMC public health, 24(1), 16. https://doi.org/10.1186/s12889-023-17537-z

Huang, T., & Wang, W. (2024). Relationship between fear of evaluation, ambivalence over emotional expression, and self-compassion among university students. BMC psychology, 12(1), 128. https://doi.org/10.1186/s40359-024-01629-5

Hunter, J., Butler, C., & Cooper, K. (2021). Gender minority stress in trans and gender diverse adolescents and young people. Clinical Child Psychology and Psychiatry, 26(4), 1182-1195. https://doi.org/10.1177/13591045211033187

Kassing, F., Dodd, C. G., Palmer, L. E., & Hill, R. M. (2022). Comfort expressing emotions and suicide ideation: evidence of indirect effects via perceived burdensomeness and thwarted belongingness. Archives of Suicide Research, 26(2), 886-895. https://doi.org/10.1080/13811118.2020.1841053

Klinger, D., Oehlke, S. M., Riedl, S., Eschbaum, K., Zesch, H. E., Karwautz, A., & Kothgassner, O. D. (2024). Mental health of non-binary youth: a systematic review and meta-analysis. Child and adolescent psychiatry and mental health, 18(1), 126. https://doi.org/10.1186/s13034-024-00822-z

Kohnepoushi, P., Nikouei, M., Cheraghi, M., Hasanabadi, P., Rahmani, H., Moradi, M., Moradi, G., Moradpour, F., & Moradi, Y. (2023). Prevalence of suicidal thoughts and attempts in the transgender population of the world: a systematic review and meta-analysis. Annals of General Psychiatry, 22(1), 28. https://doi.org/10.1186/s12991-023-00460-3

Lewis, J. E., Patterson, A. R., Effirim, M. A., Patel, M. M., Lim, S. E., Cuello, V. A., & Lee, W. C. (2025). Examining gender-specific mental health risks after gender-affirming surgery: a national database study. The Journal of Sexual Medicine, qdaf026. https://doi.org/10.1093/jsxmed/qdaf026

Lindquist, E. G., Villarosa-Hurlocker, M. C., Raposa, E. B., Pearson, M. R., Bravo, A. J., & Protective Strategies Study, T. (2023). Fear of negative evaluation and suicidal ideation among college students: the moderating role of impulsivity-like traits. Journal of American College Health, 71(2), 396-402. https://doi.org/10.1080/07448481.2021.1891919

Liu, A., Wang, W., & Wu, X. (2020). Understanding the relation between self-compassion and suicide risk among adolescents in a post-disaster context: Mediating roles of gratitude and posttraumatic stress disorder. Frontiers in psychology, 11, 1541. https://doi.org/10.3389/fpsyg.2020.01541

Marconi, E., Monti, L., Marfoli, A., Kotzalidis, G. D., Janiri, D., Cianfriglia, C., & Chieffo, D. P. R. (2023). A systematic review on gender dysphoria in adolescents and young adults: focus on suicidal and self-harming ideation and behaviours. Child and adolescent psychiatry and mental health, 17(1), 110. https://doi.org/10.1186/s13034-023-00654-3

Narang, P., Sarai, S. K., Aldrin, S., & Lippmann, S. (2018). Suicide among transgender and gender-nonconforming people. The Primary Care Companion for CNS Disorders, 20(3), 26899. https://doi.org/10.4088/pcc.18nr02273

Polanco-Roman, L., Ahmad, K., Tigershtrom, A., Jacobson, C., & Miranda, R. (2024). Emotion expressivity, suicidal ideation, and explanatory factors: Differences by Asian American subgroups compared with White emerging adults. Cultural diversity & ethnic minority psychology, 30(1), 11-21. https://doi.org/10.1037/cdp0000313

Prades-Caballero, V., Navarro-Pérez, J. J., & Carbonell, Á. (2025). Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model. Community Mental Health Journal, 61(4), 612-628. https://doi.org/10.1007/s10597-024-01368-2

Rogante, E., Cifrodelli, M., Sarubbi, S., Costanza, A., Erbuto, D., Berardelli, I., & Pompili, M. (2024). The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature. Healthcare (Basel, Switzerland), 12(2), 169. https://doi.org/10.3390/healthcare12020169

Shin, K. E., Baroni, A., Gerson, R. S., Bell, K. A., Pollak, O. H., Tezanos, K., & Cha, C. B. (2024). Using behavioral measures to assess suicide risk in the psychiatric emergency department for youth. Child Psychiatry & Human Development, 55(6), 1475-1486. https://doi.org/10.1007/s10578-023-01507-y

Sun, C. F., Xie, H., Metsutnan, V., Draeger, J. H., Lin, Y., Hankey, M. S., & Kablinger, A. S. (2023). The mean age of gender dysphoria diagnosis is decreasing. General Psychiatry, 36(3), e100972. https://doi.org/10.1136/gpsych-2022-100972

Thompson, L., Sarovic, D., Wilson, P., Sämfjord, A., & Gillberg, C. (2022). A PRISMA systematic review of adolescent gender dysphoria literature: 1) epidemiology. Plos Global Public Health, 2(3), e0000245. https://doi.org/10.1371/journal.pgph.0000426

Tsarpalis-Fragkoulidis, A., Tran, U. S., & Zemp, M. (2024). Fears of positive and negative evaluation and their within-person associations with emotion regulation in adolescence: A longitudinal analysis. Development and Psychopathology, 1-13. https://doi.org/10.1017/S0954579424001366

Villacura-Herrera, C., Ávalos-Tejeda, M., Gaete, J., Robinson, J., & Núñez, D. (2025). The underlying dynamics of a suicidal ideation latent network model: The role of hopelessness, psychopathology, emotion regulation, and behavioral coping skills in adolescents from the general population. Journal of affective disorders, 379, 540-548. https://doi.org/10.1016/j.jad.2025.02.101

Wastler, H. M., & Núñez, D. (2022). Psychotic experiences, emotion regulation, and suicidal ideation among Chilean adolescents in the general population. Frontiers in Psychiatry, 13, 983250. https://doi.org/10.3389/fpsyt.2022.983250

Wyman Battalen, A., Mereish, E., Putney, J., Sellers, C. M., Gushwa, M., & McManama O'Brien, K. H. (2021). Associations of discrimination, suicide ideation severity and attempts, and depressive symptoms among sexual and gender minority youth. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 42(4), 301. https://doi.org/10.1027/0227-5910/a000718

Additional Files

Published

2025-09-10

Submitted

2025-06-11

Revised

2025-08-28

Accepted

2025-09-05

Issue

Section

Clinical Psychology

Categories

How to Cite

Nikkhah, B., Jahangiri, M. M., & Taghvaei, D. (2025). Designing a Model of Suicidal Beliefs Based on Emotional Expressivity with the Mediating Role of Fear of Negative Evaluation in Individuals with Gender Dysphoria. KMAN Counseling & Psychology Nexus, 3, 1-10. https://www.journals.kmanpub.com/index.php/psychnexus/article/view/4450