Examining the Relationship Between Ambivalence Over Emotional Expressiveness and Suicidal Ideation in Veterans: The Mediating Role of PTSD Symptoms
Keywords:
ambivalence over emotional expressiveness, posttraumatic stress disorder, suicidal ideation, veterans, mediationAbstract
Purpose: This study aimed to examine the relationship between ambivalence over emotional expressiveness and suicidal ideation in veterans, with posttraumatic stress disorder (PTSD) symptoms considered as a mediating variable.
Methods and Materials: This descriptive-correlational, cross-sectional study included 100 Iran–Iraq War veterans hospitalized at Fajr Hospital who were recruited through convenience sampling. Participants completed the Ambivalence over Emotional Expressiveness Questionnaire, the Beck Scale for Suicide Ideation, and the Mississippi Scale for Combat-Related PTSD. Pearson’s correlation was used to examine relationships among the variables. Structural equation modeling with maximum likelihood estimation was conducted in Mplus version 8 to test the mediation model. Normality was assessed using skewness and kurtosis, and multicollinearity was evaluated through variance inflation factors. Model fit was assessed using the chi-square-to-degrees-of-freedom ratio, comparative fit index, Tucker–Lewis index, and root-mean-square error of approximation. Bootstrapping was used to test the indirect effect.
Findings: Suicidal ideation was significantly correlated with ambivalence over emotional expressiveness and PTSD symptoms. Ambivalence over emotional expressiveness significantly predicted suicidal ideation in the model without the mediator. In the mediation model, ambivalence over emotional expressiveness significantly predicted PTSD symptoms, and PTSD symptoms significantly predicted suicidal ideation. However, the direct path from ambivalence over emotional expressiveness to suicidal ideation was not statistically significant after PTSD symptoms were entered into the model. The indirect effect of ambivalence over emotional expressiveness on suicidal ideation through PTSD symptoms was statistically significant. The structural model demonstrated acceptable fit to the data.
Conclusion: PTSD symptoms fully mediated the relationship between ambivalence over emotional expressiveness and suicidal ideation, suggesting that interventions targeting emotional-expression conflicts and trauma-related symptoms may help reduce suicidal ideation among veterans.
Downloads
References
Baek, J., Lee, J., Park, W., & Kim, D. (2026). The effectiveness of emotion regulation-focused interventions on non-suicidal self-injury: A meta-analysis. Cognitive therapy and research, 1-15. https://doi.org/10.1007/s10608-026-10726-1
Blain, R. C., Martin, C. E., Ehlinger, C. C., & Chard, K. M. (2023). Evidence Based Treatment for Posttraumatic Stress Disorder Decreases Suicidal Ideation by Reducing Perceived Burdensomeness Among Veterans in an Outpatient Program. Journal of Traumatic Stress, 36(6), 1138-1150. https://doi.org/10.1002/jts.23004
Bryant-Genevier, J., Rao, C. Y., Lopes-Cardozo, B., Kone, A., Rose, C., Thomas, I., & Byrkit, R. (2021). Symptoms of depression, anxiety, post-traumatic stress disorder, and suicidal ideation among state, tribal, local, and territorial public health workers during the COVID-19 pandemic: United States, March-April 2021. Morbidity and Mortality Weekly Report, 70(26), 947.
Fox, V., Dalman, C., Dal, H., Hollander, A. C., Kirkbride, J. B., & Pitman, A. (2021). Suicide risk in people with post-traumatic stress disorder: A cohort study of 3.1 million people in Sweden. Journal of affective disorders, 279, 609-616.
Gomes, K. D., Collette, T. L., Schlenk, M., Judkins, J., Sanchez-Cardona, I., Channer, B., & Moore, B. A. (2024). Posttraumatic Stress Disorder, Suicidal Ideation, and Stress: The Moderating Role of Dysfunctional and Recovery Cognitions. Archives of Suicide Research, 28(2), 569-584. https://doi.org/10.1080/13811118.2023.2199798
Khalifian, C. E., Knopp, K., Wilks, C. R., Wooldridge, J., Sohn, M. J., Thomas, D., & Morland, L. A. (2020). The association between sexual functioning and suicide risk in US military veteran couples seeking treatment for post-traumatic stress disorder. Archives of Sexual Behavior, 49(5), 1601-1613.
Lake, S., Kerr, T., Buxton, J., Walsh, Z., Marshall, B. D., Wood, E., & Milloy, M. J. (2020). Does cannabis use modify the effect of post-traumatic stress disorder on severe depression and suicidal ideation? Evidence from a population-based cross-sectional study of Canadians. Journal of Psychopharmacology, 34(2), 181-188.
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. https://doi.org/10.3389/fpsyg.2020.01541
Liu, H., Ho, G. W. K., Karatzias, T., Shevlin, M., Wong, K. H., & Hyland, P. (2024). Self-Harm, Suicide, and ICD-11 Complex Posttraumatic Stress Disorder in Treatment-Seeking Adolescents With Major Depression. Journal of Child & Adolescent Trauma, 17(4), 1057-1066. https://doi.org/10.1007/s40653-024-00655-0
Otto, A., Jacob, R., Jarvers, I., Kandsperger, S., & Brunner, R. (2026). Relationship between Emotional Competence, Dissociative Symptoms and Borderline Personality Disorder Traits in Female Adolescents Engaging in Non-Suicidal Self-Injury. Child and adolescent psychiatry and mental health. https://doi.org/10.1186/s13034-026-01067-8
Saccaro, L. F., Giff, A. E., Parincu, Z., Piguet, C., Greiner, C., & Prada, P. (2026). Emotion regulation-targeted interventions initiated during hospitalization for suicidal crisis: a systematic review and exploratory meta-analysis. Journal of affective disorders, 121375. https://doi.org/10.1016/j.jad.2026.121375
Smith, D. G., Giugni, M., Gulliver, A., Fitzpatrick, S. J., Lamb, H., Ellis, L. A., & Banfield, M. (2026). Peer-Led Models Focussed on Emotional Distress and Suicide Prevention: A Scoping Review. International journal of environmental research and public health, 23(2), 273. https://doi.org/10.3390/ijerph23020273
Stanley, I. H., Boffa, J. W., Tran, J. K., Schmidt, N. B., Joiner, T. E., & Vujanovic, A. A. (2019). Posttraumatic Stress Disorder Symptoms and Mindfulness Facets in Relation to Suicide Risk Among Firefighters. Journal of Clinical Psychology, 75(4), 696-709. https://doi.org/10.1002/jclp.22748
Wang, Y., Bai, R., Liu, J., Xu, S., & Liu, X. (2026). Latent transition analysis of non-suicidal self-injury comorbidity patterns among adolescents: Predictive roles of impulsivity, emotional dysregulation, and core self-evaluations. International Journal of Clinical and Health Psychology, 26(2), 100708. https://doi.org/10.1016/j.ijchp.2026.100708
Whitley, R., & Saucier, A. M. (2022). Media coverage of Canadian veterans, with a focus on post-traumatic stress disorder and suicide. BMC psychiatry, 22(1), 1-11.
Willis, D. N., Dowling, A. P. C., Deehan, T., & O'Reilly, P. G. (2023). Exploring the Impact of Trauma and the Role of Compassion Before and After a Phase-orientated Intervention for Complex Trauma. European Journal of Trauma & Dissociation, 7(1), 100308. https://www.sciencedirect.com/science/article/pii/S2468749922000503
Wu, J., Wang, C., Zheng, Y., Han, X., Guo, J., Cui, Y., Hu, J., Lin, M. P., & You, J. (2025). Intolerance of Uncertainty Predicts Suicidal Ideation Among Adolescents Through Maladaptive Cognitive Emotion Regulation Strategies and Psychache. Suicide and Life-Threatening Behavior, 55(2). https://doi.org/10.1111/sltb.70001
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Rasoul Heshmati; Sepideh Sadat Moosavi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
