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This study described the levels of anger, anger expression, and suicidal ideation in Korean adolescents. Data from 18,752 adolescents were collected using a self-report questionnaire. Anger, anger expression, and suicidal ideation exhibited significant differences according to school level and gender. The group with higher anger and anger expression showed a higher average suicidal ideation score than that of the group with lower anger and anger expression, suggesting that school-based programs which alleviate anger may be needed to decrease suicidal ideation among Korean adolescents.

ADOLESCENT SUICIDE IS a significant health and social problem worldwide (Catallozzi et al., 2001, Hesketh et al., 2002 and van Heerington, 2001). International comparisons have shown considerable cross-national differences in suicide rates. Across Europe, annual suicide rates among young people vary from 0.6/100,000 in young Greek females to 35.2/100,000 in young Finnish males (Cantor, 2000 and Tomori et al., 2001). In Korea, annual suicide rates of young people are 6.5/100,000 among adolescents (Korean National Statistical Office, 2006). Although youth suicide rates vary, they do appear to be increasing across the nations (Cantor, 2000). In Korea, similar to other countries (Bloch, 1999 and Catallozzi et al., 2001), suicide is the second leading cause of death among 10- to 19-year-olds and the leading cause of death among 20- to 24-year-olds (Korean National Statistical Office, 2006). Although suicidal thoughts do not always precede the act, suicidal ideation has been confirmed to be a significant risk factor for eventual suicide in recent studies (Brown et al., 2000 and Lewinsohn et al., 1994). Anger also contributes synergistically to the suicide risk in combination with strong impulsivity which is the characteristic of the adolescent period (Horesh et al., 1997). The experience and expression of anger are common throughout the adolescent period (Reyes, Meininger, Liehr, Chan, & Mueller, 2003). Anger is one of the most difficult emotions for adolescents to deal with and may be inherent in behaviors associated with juvenile delinquency, such as drug abuse (Boergers et al., 1998 and Lee & Cho, 1999). It potentially harms their physical and mental health (Park, Han, Shin, Kang, & Moon, 2004) and has long been considered crucial in the development of suicidal ideation and behaviors (Goldney, Winefield, Saebel, Winefield, & Tiggeman, 1997). Suicide is viewed as the result of anger misdirected toward the self: Suicidal behavior is an aggressive act and hateful rage misdirected toward a psychological aspect of interfused self–other (Goldney et al., 1997). Despite the importance of the prevention of suicidal behaviors and anger in adolescents, most of the previous studies have suggested only depression or poor self-esteem as important factors for suicidal ideation (De Man, 1999, Kim et al., 2006 and Sun et al., 2006). Few studies have examined the experience and expression of anger in combination with suicidal ideation (Yarcheski, Mahon, & Yarcheski, 2002), especially among Asian adolescents. The purpose of this study was to explore the levels of anger, anger expression, and suicidal ideation in Korean adolescents and identify the differences in anger, anger expression, and suicidal ideation according to school level and gender. The specific aims were (a) to test the differences in the levels of anger and anger expression between middle school and high school students and between male and female students, (b) to test the differences in the levels of suicidal ideation between middle school and high school students and between male and female students, and (c) to test the differences in the levels of anger and anger expression between two groups based on the suicidal ideation scores (students above cut-off scores and those below cut-off scores). To test the differences between the two groups, we used the cutoff threshold of Sokero et al. (2003) for clinically significant suicidal ideation. Thus, we classified the participants with suicidal ideation scores of 6 or more into a high-risk group and the participants with the scores less than 6 into a low-risk group of suicidal ideation. Relevant literature Suicidal ideation is defined as recurrent thoughts about ending one's own life (van Heeringen, 2001). Over the past 25 years, suicidal behaviors such as suicidal ideation, suicide attempts, and completed suicide have become a major concern for health services in many countries (Anderson, Standen, Nazir, & Noon, 2000: van Heeringen, 2001). Rates of attempted suicide are highest among young people and are increasing worldwide, particularly among young males (van Heeringen, 2001). The current severity of suicidal ideation has been found to be a significant predictor of eventually committing suicide (Pinninti, Steer, Rissmiller, Nelson, & Beck, 2002). The levels of suicidal ideation in adolescents have been reported not to be high in previous studies, that is, a suicidal ideation score was 13.7 in the possible range of 0–90 (Kim et al., 2006) and 3.5 in the possible range of 0–25 (Lee, Wong, Chow, & McBride-Chang, 2006) but differed according to age, gender, and ethnicity (Jones & Peacock, 1992, Juon et al., 1994, Kessler et al., 1999 and Kim et al., 2006). Female gender has been reported to be a risk factor of suicidal ideation (Kessler et al., 1999). Kim et al. (2006) also reported higher levels of suicidal ideation in females than in males among Korean adolescents in their study. Yet, another study reported higher rate of suicide attempts and suicidal ideation in male than in females adolescents (Juon et al., 1994). McGee, Williams, and Nada-Raja (2001) suggested different pathways to suicidal ideation for males and females in their New Zealand study. Factors that influence suicidal ideation may differ according to the social structure (social institutions and norms embedded into social systems, e.g., cultural background, law, and religion), conceptualization of individual and gender roles, support systems, and conceptualization of death (Novins, Beals, Roberts, & Manson, 1999). Among many factors, the link between anger and suicidal ideation has been recognized in the literature (Field, Diego, & Sanders, 2001). Adolescents who have a wish to die are likely to be more depressed, hopeless, and angry than are adolescents who do not (Boergers et al., 1998). In a previous study, a high level of aggression was found to increase the risk of recidivism in suicidal attempts (Stein, Apter, Ratzoni, Har-Even, & Avidan, 1998). Yet, Prigerson and Slimack (1999) stated that depression and posttraumatic stress disorder were significant for female young adults' suicidality, whereas aggression was the only important factor for that of male young adults. Rice and Howell (2006) reported that a person who had higher trait anger was likely to express anger more outwardly and that anger-control might be more effective than anger-out in reducing anger in students. There are three ways of anger expression: anger-in, anger-out, and anger-control (Reyes et al., 2003 and Yarcheski et al., 2002). Anger-in means suppression or inhibition of angry feelings, and anger-out means expression of anger toward others or objects ( Reyes et al., 2003 and Rice & Howell, 2006). Anger-control is the attempts to modify and control experienced angry feelings ( Reyes et al., 2003 and Rice & Howell, 2006). Previous studies have shown inconsistent results on gender and ethnic differences in anger and anger expression. Reyes et al. (2003) found an absence of significant gender differences in anger and anger expression among adolescents in the United States. They reported significant age differences only for anger-control. Another study in the United States also found an absence of significant gender differences in any anger variables among adolescents (12–14 years old; Yarcheski et al., 2002). However, in another study among Russian adolescents, significant gender differences were found for state anger, anger-in, and anger-control ( Kassinove, Sukhodolsky, Eckhardt, & Tsytsarev, 1997). Jones and Peacock (1992) also stated that anger in American adolescents was significantly different according to gender, race, and school grade. Many studies have revealed cultural variation in emotional phenomena and suggested that Asians are less expressive than are European Americans ( Matsumoto, 1993, Mesquita, 2001 and Roseman et al., 1995). Reyes et al. (2003) also indicated that there were ethnic differences for trait-anger and outward expression of anger. However, other studies reported more cultural similarities than differences in emotional expression ( Tsai, Chentsova-Dutton, Freire-Bebeau, & Przymus, 2002).