Trait Anger, Anger Expression, and Suicide Attempts Among Adolescents and Young Adults: A Prospective Study

Abstract

Previous studies of the relationship between anger, anger expression, and suicidal behavior have been largely cross-sectional and have yielded mixed findings. In a prospective, naturalistic study, we examined how trait anger and anger expression influenced the likelihood of suicide attempts among 180 adolescents followed for up to 13.3 years after discharge from an inpatient psychiatry unit. Results showed that higher trait anger and anger expressed outwardly over the follow-up was related to increased likelihood of suicide attempts among boys. For girls, trait anger and both the inward and outward expression of anger moderated the risk for suicide attempts associated with major depression. These results are interpreted in light of theory regarding behavioral activation and behavioral inhibition systems.

Notes

Note. Major depressive disorder (MDD), substance use disorder (SUD), and prior (prehospitalization) suicide attempts assessed with the Interview Schedule for Children and Adolescents and the Follow-Up Interview Schedule for Adults (Sherrill & Kovacs, 2000); Trait Anger, Anger In, and Anger Out assessed with the State Trait Anger Expression Inventory (Spielberger, 1988); based on 180 participants and 1,831 observations.

∗p < .001.

Note. MDD = major depressive disorder; SUD = substance use disorder.

^a Interaction terms that were not statistically significant (p > .05) were not retained in final models.

^b The main effects (and Hazard Ratios) of major depressive disorder and the anger variables for women cannot be interpreted in isolation from the significant interaction term between these variables.

Note. Low Trait Anger, Anger In, and Anger Out defined as T scores <50 on the State Trait Anger Expression Inventory (STAXI). High Trait Anger, Anger In, and Anger Out defined as T scores ≥50 on the STAXI. MDD = major depressive disorder.