The Role of Self-Reassurance in the Relation Between Internalized Gender Stigma, Self-Criticism, and Depression Among Transgender and Nonbinary Patients

Purpose: This cross-sectional study investigated self-reassurance as a protective factor in mitigating depression related to internalized gender stigma and enhancing overall well-being among transgender and nonbinary (TNB) individuals during the first step of the gender-affirmation process. Methods: The study included 101 TNB individuals (mean age = 26.42, standard deviation = 8.83) accessing the “Be as You Are” Clinical and Research Center at Sapienza University of Rome, Italy, which offers psychological support for individuals undergoing gender-affirmation processes, from 2021 to 2024. Participants completed the Gender Minority Stress and Resilience Scale to assess internalized gender stigma; the Self-Criticizing/Attacking and Self-Reassuring Scale to evaluate self-criticism (i.e., hated-self and inadequate-self), and self-reassurance; and the Symptom Checklist-90 to measure depressive symptoms. Mediation and moderated mediation models were tested. Results: Mediation models indicated that inadequate-self significantly mediated the relationship between internalized gender stigma and depressive symptoms. The moderated mediation analysis revealed a complex pattern: higher levels of self-reassurance were associated with a more pronounced mediating effect of inadequate-self, suggesting that self-reassurance may facilitate awareness and processing of self-critical thoughts rather than simply buffer their impact. These findings suggest that self-reassurance is a complex psychological resource that may facilitate recognizing self-critical processes and contribute to emotional regulation during the gender-affirming process. Conclusion: These results underscore the dynamic role of self-reassurance in the initial stages of the gender-affirming process. Clinical approaches such as compassion-focused therapy may help foster self-reassurance and alleviate the psychological burden of minority stress, particularly during the vulnerable period of accessing gender-affirming care.