Negative Emotions as Risk Factors for Self-Directed Violence and Intimate Partner Violence in Chinese College Students

Abstract

In this study, we examined the unique contributions of negative emotions (i.e., anger, depression, and shame) for two different types of self-directed violence (i.e., nonsuicidal self-injury [NSSI] and suicidality) and three different types of intimate partner violence perpetration (i.e., physical, sexual, and psychological violence) in a college sample. We investigated the moderating role of gender in any link between the negative emotions and the violent behaviors. We also examined an association between self-directed violence and intimate partner violence perpetration. We collected the survey data from a convenience sample of 752 Chinese college students (408 women and 344 men) ranging from 18 to 23 years of age. The questionnaires were filled out during class time. Analyses revealed that anger was associated with increased intimate partner physical, sexual, and psychological violence perpetration but not self-directed violence, underscoring its relevance for engaging in violence directed toward others. Our analyses also showed that, conversely, shame was associated with increased NSSI and suicidality but not intimate partner violence. Depression was associated with increased risk of engaging in self-directed violence as well as intimate partner physical and psychological violence. Moderation analysis showed that gender moderates the relationship of shame with NSSI. Women appear more susceptible to NSSI influenced by shame. Furthermore, the results found self-directed violence and intimate partner physical violence perpetration to be associated. The findings highlight the importance of targeting negative emotions in treatment with high-risk individuals. Integrated violence prevention programs would make it possible to treat co-occurring violence against self and intimate others in a more effective way.

Keywords

anger depression shame violence

Self-directed violence and intimate partner violence are prevalent and important public health concerns related to a variety of negative consequences (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). These forms of violence are seldom examined simultaneously. One of the most common forms of self-directed violence is suicide. Suicide ranks after road traffic accidents as the second leading cause of death among individuals aged 20 to 34 in both urban and rural areas in China (C. W. Wang, Chan, & Yip, 2014). Another common form of self-directed violence is nonsuicidal self-injury (NSSI), which is defined as the direct, intentional harm to one’s own body without suicidal intent (Nock, 2009). A meta-analysis showed that the estimated lifetime prevalence of NSSI was 17.2% in adolescents, 13.4% in young adults, and 5.5% in adults (Swannell, Martin, Page, Hasking, & St John, 2014). A survey study on NSSI in Chinese adolescents and young adults reported similar results (Tang et al., 2011).

Unlike self-directed violence in which a person inflicts violence upon himself or herself, intimate partner violence is defined as “behavior within an intimate relationship that causes physical, sexual, or psychological harm” (World Health Organization, 2010, p. 11). A study of intimate partner violence perpetration in Chinese college students reported rates of 41.7% of respondents perpetrating physical violence, 61% of respondents perpetrating psychological violence, and 14.4% of respondents perpetrating sexual violence in the prior year (Chan, 2012).

Despite the fact that self-directed violence and intimate partner violence are different types of violence, Murray, Wester, and Paladino (2008) have documented significant positive correlations between the two types among experiences in American college students. Empirical research on the topic of co-occurring self-harm and intimate partner violence perpetration is limited. A possible explanation for the co-occurrence of self- and other-directed violence is that an individual can possess overlapping risk factors associated with both types of violence (Hillbrand, 2001). It is not surprising to note that many factors confer the risk of both self-directed violence and intimate partner violence perpetration—including childhood abuse, personality disorders, and mental problems (Ehrensaft, Cohen, & Johnson, 2006; Harford, Yi, & Grant, 2013; Lang & Sharma-Patel, 2011; Sadeh, Javdani, Finy, & Verona, 2011; Whitfield, Anda, Dube, & Felitti, 2003). The early studies have focused on a range of clinical diagnoses rather than emotional traits (Ehrensaft et al., 2006). Focusing on emotional risk factors, however, can be useful in terms of identifying high-risk individuals in nonclinical populations regardless of mental diagnoses.

The terms negative affect, negative mood, and negative emotion are often used interchangeably. General strain theory suggests that individuals high in negative emotionality are more likely to experience stronger emotional reactions to strains and are more disposed to respond to strains in an aggressive or antisocial manner (Agnew, Brezina, Wright, & Cullen, 2002). The cognitive-neoassociation model suggests that negative emotional reactions to particular external or internal contextual cues are a central driving force in aggressive problem-solving responses and such reactions must be self-regulated if aggressive responses are to be avoided (Berkowitz, 1990). Also, empirical studies have highlighted the prominent role of negative emotions in intimate partner violence perpetration (Birkley & Eckhardt, 2015) and engagement in self-injury or suicidal thoughts and behaviors (Chapman & Dixon-Gordon, 2007; Jacobson, Batejan, Kleinman, & Gould, 2013).

Popular among researchers, negative emotion was conceptualized as a unitary construct (Watson, Clark, & Tellegen, 1988). But, Ekman (1992) suggested that not all emotions are the same. Negative emotions (such as anger, fear, sadness, and shame) have distinctive expressions, physiologies, goals, action tendencies, thoughts, and feelings (Ekman, 1992; Roseman, Wiest, & Swartz, 1994). Previous research have suggested that studying distinct facets of negative emotions rather than a solitary construct would improve understanding of the perpetrating of self-directed violence and interpersonal violence (Sadeh et al., 2011). Based on this literature, we chose to include anger, depressed mood, and shame in the same model to examine their distinct contribution to self-directed violence and intimate partner physical, sexual, and psychological violence. We considered anger, depressed mood, and shame as risk factors because they are more relevant than other emotional factors (e.g., fear) in understanding self-directed violence and intimate partner violence perpetration.

Anger

Spielberger, Jacobs, Russell, and Crane (1983) have defined anger as “an emotional state that consists of feelings that vary in intensity, from mild irritation or annoyance to intense fury and rage” (p. 16). Buss and Perry (1992) suggested that anger and hostility are two related but distinct constructs linked to both self- and other-directed violence. Anger often represents an emotional state, while hostility is often conceptualized as a cognitive construct. Anger has been a major risk factor examined in the intimate partner violence perpetration literature (see Birkley & Eckhardt, 2015, for review). In a study involving female college students, Shorey, Cornelius, and Idema (2011) found that anger was associated with increased psychological perpetration. Chan, Tiwari, Leung, Ho, and Cerulli (2007) showed that anger management was associated with greater odds of physical violence perpetration in a sample of Hong Kong college students. Elkins, Moore, McNulty, Kivisto, and Handsel (2013) showed that anger was associated with greater odds of physical, sexual, and psychological violence perpetration in dating relationships.

As with research on other-directed violence, the literature has indicated that anger is a common antecedent to self-directed violence such as NSSI (Klonsky, 2007) and suicide attempts (Chapman & Dixon-Gordon, 2007). A common function of NSSI is to relieve anger (Laye-Gindhu & Schonert-Reichl, 2005). Consequently, higher levels of anger might increase the risk for self-directed violence.

Depression

Depressed mood is a known risk factor for self-directed violence (Hankin & Abela, 2011; Jacobson et al., 2013). However, as Joiner and Timmons (2002) noted, clinical approaches to the study of depression have overlooked interpersonal perspectives on depression, emphasizing that depression influences interpersonal functioning and interpersonal characteristics, in turn, shape the experiences of depression. Depression is associated with a variety of interpersonal problems, including social skills problems, excessive reassurance seeking, negative feedback seeking, and negative verbal communication behaviors (see Joiner & Timmons, 2002, for review). Given the interpersonal difficulties of depressed people, it is not surprising that the intimate relationships of depressed individuals are troubled. Depressed partners exhibit a higher frequency of negative behaviors such as blame, withdrawal, and verbal aggression, and a lower frequency of positive behaviors such as problem-solving behaviors, self-disclosure, smiling, and eye contact (see Rehman, Gollan, & Mortimer, 2008, for review).

Traditionally, researchers have studied depression as a consequence of intimate partner violence victimization (Campbell, 2002). However, the relationship between depression and intimate partner violence can operate in either direction. According to Coyne’s (1976) interpersonal theory of depression, when depressed people interact with others, they engage in behaviors marked by hostility, control, and alienation. The way depressed people engage with others may increase their depressive symptoms. Findings from a study by Davila, Bradbury, Cohan, and Tochluk (1997) showed that depressed wives expected their partners to be less supportive and exhibited more negative social support behaviors, which created stress in their relationships and led to more depressive symptoms. There is much evidence indicating that depression is a risk factor of perpetrating physical and psychological violence against an intimate partner (see Dutton & Karakanta, 2013, for review). In studies involving college students, depression was associated with physical and psychological violence perpetration toward an intimate partner (Cogan & Fennell, 2007; Riggs & Kaminski, 2010). Kim, Laurent, Capaldi, and Feingold (2008) reported that depressive symptoms in both members of a couple predicted men’s physical and psychological violence perpetration. Although it is unclear whether a relationship exists between depression and intimate partner sexual violence perpetration, there is some evidence in the sexual offending literature to suggest that negative emotions such as depression are antecedents for sexual offending (see McCoy & Fremouw, 2010, for review). Cortoni and Marshall (2001) suggested that sex may be used as a coping strategy by sexual offenders to deal with stressful and difficult situations.

Shame

Shame is a painful experience, and the shamed person views herself or himself as worthless and defective (Hastings, Northman, & Tangney, 2002). Shame is frequently defined as a basic human emotion derived from an innate human need to be seen as socially attractive; it is elicited by negative self-evaluation, perceived devaluation by others, or unfavorable social comparison (Gilbert, 1997; MacDonald & Leary, 2005). Shame is an important concept in Chinese culture (Bedford, 2004; Li, Wang, & Fischer, 2004). The Chinese concept of shame is literally translated as diu lian (loss of face), diu ren (loss of personhood), xiu chi (deep shame or feeling of having a stain on one’s face), xiu kui (feeling of discovering a negative aspect of oneself), and can kui (a mild feeling involving both regret and shame that comes from failing to attain one’s best or the ideal state; Bedford, 2004). There are broad similarities in the Western and Chinese concept of shame. However, the Chinese concept of shame is closely related to lian (face) indicating “an individual’s social position or prestige” (Hu, 1944). Face can be gained from social position and prestige within one’s social network (Hwang, 1987). A feeling of shame may be aroused in Chinese people when someone is fearful of losing face or when face is already lost (Li et al., 2004). There is a well-established relationship between shame and a variety of internalizing problems (Tangney & Dearing, 2003). Shame was found to be associated with suicidal and other self-harming behaviors among women prisoners (Milligan & Andrews, 2005). Self-injurers reported using self-injury as a strategy to alleviate emotional distress including shame (Klonsky, 2007). Compared with anger, shame has received less attention in the literature on interpersonal aggression. However, it may be an important predictor of intimate partner violence perpetration. Elison, Garofalo, and Velotti (2014) argued that many cases of aggression would be better understood as reactions to shame. Only a handful of studies have examined the link between shame and violence in intimate relationships. Hundt and Holohan (2012) found that shame was associated with perpetration of intimate partner physical/psychological violence. In this study, shame significantly contributed in discriminating between perpetrators and nonperpetrators of intimate partner violence. Harper, Austin, Cercone, and Arias (2005) found that shame was positively related to increases in intimate partner psychological violence perpetration. In a study involving Chinese college students, shame predicted accepting attitudes toward perpetrating physical and psychological intimate partner violence (Anderson et al., 2011). Despite the importance of negative emotions in promoting self-directed violence and intimate partner violence, relatively few studies have looked at the distinct facets of negative emotions as risk factors of these violent behaviors, particularly among nonclinical adults. Previous findings build on data from the western population. The findings from the present study would contribute to understanding the relationship between specific negative emotions and different forms of self-directed violence and intimate partner violence. Furthermore, preliminary evidence has suggested that there exist gender differences in the association of negative emotions with violent behaviors. For instance, survey research showed that females were more likely to engage in NSSI caused by feeling upset, whereas for males, the self-injury tends to be caused by feeling angry (Whitlock et al., 2011). Another study found that anger predicted engagement in other-directed violence in men but not in women (Sadeh et al., 2011). Given that relatively few studies have examined gender as a moderator of the negative emotions associated with violence, there is a need for investigating gender differences in the contribution of specific negative emotions for engagement in self-directed violence and intimate partner violence perpetration.

Present Study

The present study aimed to examine the unique contributions of negative emotions (i.e., anger, depression, and shame) for self-directed violence and intimate partner violence perpetration. In particular, our goal was to examine the association of anger, depression, and shame with histories of (a) self-directed violent behavior in the form of NSSI and suicidality, and (b) violent behavior against intimate partners in the form of physical, sexual, and psychological violence. Identifying the role of discrete negative emotion in facilitating different forms of violence enables us to understand different emotional characteristics of each form of violence and may help in identifying intervention strategies that can reduce the risks and consequences for each form of violence. Based on our literature review, it is hypothesized that anger, depression, and shame would be positively related to (a) NSSI, (b) suicidal thoughts and behaviors, (c) intimate partner physical violence perpetration, (d) intimate partner sexual violence perpetration, and (e) intimate partner psychological violence perpetration.

Given preliminary evidence in the existing literature regarding gender differences in emotional risk factors for self-directed violence and intimate partner violence perpetration, we examined the moderating role of gender. A further aim is to explore the association between self-directed violence and intimate partner violence. We hypothesized that self-directed violence is associated with intimate partner violence, even after taking emotional risk factors into account.

Method

Sample

A total of 1,523 students enrolled at seven universities and colleges in Suzhou, an urban city of Mainland China, participated in a study of adverse childhood experiences. The current study used convenience sampling and these study sites were chosen because of easy accessibility.

The majority of the convenience sample was female (n = 883, 58%) and between 18 and 24 years of age. The current study analyzed a subsample of 752 students having dating experience longer than 1 month. The subsample was comprised of 408 female (54%) and 344 male (46%) Chinese college students ranging from 18 to 23 years of age (M = 19.3 years, SD = 1.1). The procedures of the study were approved by the Human Research Ethics Committee for Non-Clinical Faculties, The University of Hong Kong. Prior to data collection, participants were informed about the purpose of the study, the confidentiality of the survey, and their rights to refuse or discontinue participation at any time. The written informed consent was obtained from the participants. The questionnaires were filled out during class time and the duration of the questionnaire administration averaged 30 min. Participants were given a small gift (i.e., a pen) for their involvement in the study.

Table 1 provides the descriptive statistics for the subsample (N = 752), as well as for women (n = 408) and men (n = 344) separately. The subsample included more first-year males than females and more second-year females than males, χ²(3) = 51.6, p < .001. No gender difference was found in age. Female students reported more years of father’s education than male students, t(750) = 2.38, p < .05.

Table 1.

Descriptive Statistics for the Sample and Within Each Gender.

Variable	The Sample (N = 752)		Men (n = 344)		Women (n = 408)		Statistical Difference Test
Variable	M (SD)	Minimum/Maximum	M (SD)	Minimum/Maximum	M (SD)	Minimum/Maximum	Statistical Difference Test
Age, years	19.3 (1.1)	18/23	19.3 (1.2)	18/23	19.2 (1.0)	18/22	t(750) = −0.94
Father’s education	11.2 (3.2)	0/20	10.9 (3.2)	0/20	11.4 (3.2)	6/20	t(750) = 2.38*
Negative emotions
Anger	21.5 (5.5)	10/40	20.8 (5.6)	10/40	22.1 (5.4)	10/40	t(750) = 3.30**
Depression	6.7 (4.1)	0/27	6.6 (4.3)	0/27	6.8 (3.9)	0/25	t(750) = 1.00
Shame	54.1 (13.7)	25/98	53.2 (13.9)	25/98	54.8 (13.5)	25/97	t(750) = 1.66
STB	4.4 (2.3)	3/16	4.0 (1.9)	3/15	4.7 (2.6)	3/16	t(750) = 4.14***
	Frequency	%	Frequency	%	Frequency	%
Grade							χ²(3) = 51.6***
First year	378	50.3	219	63.7	159	39.0
Second year	248	33.0	75	21.8	173	42.4
Third year	101	13.4	44	12.8	57	14.0
Fourth year	25	3.3	6	1.7	19	4.7
Parental divorce	67	8.9	27	7.9	40	9.8	χ²(1) = 0.88
NSSI	247	32.9	112	32.6	135	33.1	χ²(1) = 0.02
IPV perpetration
Physical	142	18.9	46	13.4	96	23.5	χ²(1) = 12.6***
Sexual	44	5.9	36	10.5	8	2.0	χ²(1) = 24.5***
Psychological	440	58.5	187	54.4	253	62.0	χ²(1) = 4.5*

Note. STB = suicidal thoughts and behaviors; NSSI = nonsuicidal self-injury; IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001.

Measures of Self-Directed Violence and Intimate Partner Violence

NSSI

The Deliberate Self-Harm Inventory (DSHI; Gratz, 2001) is a self-report questionnaire that assesses various aspects of NSSI. All items frame questions to participants as Have you ever intentionally (i.e., on purpose) . . . (without intending to kill yourself)? The scale consists of 17 items that measure NSSI, ranging from less severe behaviors (e.g., interference with wound healing) to more severe ones, such as burning oneself, cutting oneself, and breaking one’s own bones. Participants who responded affirmatively to these items were also asked about the frequency of the reported self-harming behavior(s). Research has found that the DSHI has high internal consistency, good test–retest reliability, and adequate construct, convergent, and discriminant validity (Gratz, 2001). A dichotomous variable was created by assigning a score of 1 to participants who reported yes to any of the 17 items (for Item 17 Have you done anything else to hurt yourself that was not asked about in this questionnaire? If yes, what did you do to hurt yourself?, a score of 1 was assigned when the specified behavior was consistent with the conceptual definition of NSSI). The DSHI was translated to Chinese and showed good validity and reliability for the Chinese participants (Lu, 2006). In the present study, the scale demonstrated good internal consistency (α = .77).

Suicidal thoughts and behaviors

The Suicidal Behaviors Questionnaire–Revised (SBQ-R; Osman et al., 2001) is a four-item self-report measure designed to assess suicidal risk. Four items were answered, on a Likert-type scale, as follows: Have you ever thought about or attempted to kill yourself? How often have you thought about killing yourself in the past year? Have you ever told someone that you were going to commit suicide, or that you might do it? and How likely is it that you will attempt suicide someday? The score of SBQ-R ranges from 3 to 18, representing levels of suicidal risk. The SBQ-R’s scale score’s alpha reliability was .76 in the undergraduate sample (Osman et al., 2001). The SBQ-R was translated to Chinese and showed good reliability for Chinese participants (Zhao et al., 2012). In the present study, the scale showed good internal consistency (α = .78).

Intimate partner violence

Intimate partner violence perpetration was measured by the Revised Conflict Tactics Scale (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996), which assesses five aspects of conflict tactics: physical violence, psychological violence, sexual violence, physical injuries, and negotiation. Three subscales (for physical assault, psychological aggression, and sexual coercion) were used to measure the occurrence of intimate partner violence perpetration. For each item, respondents were asked whether they have ever perpetrated abuse against their dating partner, as well as to give an estimate of how many times. Respondents rated on an 8-point scale ranging from This has never happened (0) to More than 20 times in the past year (6). If the respondent did not report any abuse in the past 12 months, but it happened previously, respondents could choose Not in the past year, but it did happen before (7). A dichotomous variable was created by assigning a score of 1 to participants who reported any violence in their lifetimes. The Chinese version of CTS2 has shown good validity and reliability for Chinese participants (Straus, 2004). In this study, internal reliabilities for the physical assault scale (α = .85), psychological aggression scale (α = .76), and sexual coercion scale (α = .83) were good.

Measures of Negative Emotions

Anger

The STAXI-Trait Anger Scale was a 10-item subscale from the Spielberger State-Trait-Anger Expression Inventory–2 (STAXI-2; Spielberger, 1999) and was used in the present study to assess participant’s usual experiences of anger across a variety of situations. Participants were asked how they have felt generally and to rate their answers on a 4-point scale, ranging from almost never (1) to almost always (4), with a higher score representing higher levels of anger. Examples of the scale include I am a generally hotheaded person and I generally feel annoyed when I am not given recognition for doing good work. Scores on the STAXI-Trait Anger Scale range from 10 to 40. The Chinese version of the STAXI-Trait Anger Scale showed good validity and reliability, with Cronbach’s alpha = .76 (Liu & Gao, 2012). The internal reliabilities for the current study were good (α = .85).

Depression

The Patient Health Questionnaire–9 (PHQ-9; Spitzer, Kroenke, Williams, & Patient Health Questionnaire Primary Care Study Group, 1999) was used in the present study to assess levels of depression. All items started by asking participants, Over the last 2 weeks, how often have you been bothered by any of the following problems? The PHQ-9 consists of nine items, and responses are rated on a 4-point scale with the values 0 = (not at all), 1 = (several days), 2 = (more than half the days), and 3 = (nearly every day). Examples of the PHQ-9 items are Little interest or pleasure in doing things and Trouble concentrating on things, such as reading the newspaper or watching television. Scores on the PHQ-9 range from 0 to 27. Kroenke, Spitzer, and Williams (2001) have shown that the questionnaire is a reliable scale with an alpha coefficient ranging from .86 to .89. The Chinese version of the PHQ-9 showed good validity and reliability, with Cronbach’s alpha = .86 (Wang, Bian, et al., 2014). In the present study, the scale demonstrated good internal consistency (α = .78).

Shame

The Experience of Shame Scale (ESS; Andrews, Qian, & Valentine, 2002) was used to assess levels of shame in the present study. The ESS measures three dimensions of shame: characterological shame, behavioral shame, and bodily shame. Characterological shame encompasses shame of personal habits, manner dealing with others, the sort of person one is, and personal ability. Behavioral shame refers to feeling ashamed about doing something wrong, saying something stupid, and failure in competitive situations. Bodily shame refers to feeling ashamed about an individual’s body or any part of the body. Examples are Have you worried about what other people think of your appearance? and Have you wanted to hide or conceal your body or any part of it? Participants were asked how often they have felt such feelings in the past year and to rate their answers on a 4-point scale, ranging from not at all (1) to very much (4), with a higher score representing higher levels of shame. ESS scores range from 25 to 100. Andrews et al. (2002) have shown that the questionnaire is a reliable scale with an alpha coefficient .92. The Chinese version of the ESS had additional items added to assess shame of one’s family. The Chinese version has shown good psychometric properties in a sample of Chinese college students (Qian, Andrews, Zhu, & Wang, 2000). For this study, we used the original 25-item ESS, which had a Cronbach’s alpha coefficient of .93.

Demographic Information

Participants reported their age, gender, father’s years of education, and family structure (e.g., During your first 18 years of life, did your parents ever separate or divorce?).

Data Analysis

The data were analyzed using STATA, Version 13.0. Descriptive analyses of demographic variables, negative emotions, and violence variables were performed. A t test (for continuous variables) was performed and chi-square test statistics (for categorical variables) were analyzed to assess gender differences with respect to demographic variables, negative emotions, and violence variables. We then used separate regression models to examine the roles of negative emotions in predicting engagement in self-directed violence and intimate partner violence perpetration. Given the binary nature of dependent variables (except for suicidal thoughts and behaviors), we used logistic regression models to predict engagement in NSSI, intimate partner physical violence, sexual violence, and psychological violence. Given a continuous measure of suicidal thoughts and behaviors, we used linear regression to examine the variance in suicidal thoughts and behaviors. Demographic variables and emotional factors were entered in Model 1 of the regression analyses and the interactions between each of the negative emotions and gender were entered in Model 2. To test the association of self-directed violence with intimate partner violence, violence variables were entered in Model 3 to determine whether one behavior was a significant predictor of the other. The mean substitution method was used to deal with the missing value in the present study because the number of missing cases was relatively small. Out of the 752 participants, 0.7% (n = 5) did not answer the question on depression, 0.1% (n = 1) did not answer the question on anger, 0.8% (n = 6) did not answer the question on suicidal thoughts and behavior, and 1.7% (n = 13) did not answer the question on father’s education.

Results

Descriptive Data

Table 1 presents the descriptive statistics for the overall sample and for men and women separately. Among all the participants, 18.9% (n = 142) had perpetrated physical violence against their partner, 58.5% (n = 440) had perpetrated psychological violence, and 5.9% (n = 44) had perpetrated sexual violence. Gender differences were found for each type of intimate partner violence. Women were significantly more likely to report physical violence perpetration than men, χ²(1) = 12.6, p < .001. Women were also significantly more likely to report psychological violence perpetration than men, χ²(1) = 4.5, p < .05. In addition, men were significantly more likely to report sexual violence perpetration than women, χ²(1) = 24.5, p < .001. Among all the participants, 32.9% (n = 247) reported that they had engaged in NSSI. No significant gender differences were found in the prevalence of NSSI, χ²(1) = 0.02, p = .877.

The average suicide score for the entire sample was 4.4 (SD = 2.3). Women scored significantly higher on suicidal thoughts and behaviors, t(750) = 4.14, p < .001. Regarding negative emotions, women scored significantly higher on anger than did men, t(750) = 3.30, p < .01, but both women and men did not differ on depression and shame. Finally, the average father’s education was 11.2 years (SD = 3.2). Women’s fathers had significantly higher levels of education than men’s fathers, t(750) = 2.38, p < .05. No gender differences were found in the prevalence of parental divorce or separation.

Relationships Between Negative Emotions and Self-Directed Violence

Table 2 presents the results of the multiple regression analyses that used self-directed violence as the outcome variable. A first model of analyses indicated that depression (odds ratio [OR] = 1.048, p < .05) and shame (OR = 1.016, p < .05) showed positive relationships with NSSI after controlling for age, gender, father’s education, and family structure. The results of the linear regression analyses on suicidal thoughts and behavior indicated that depression (B = 0.134, p < .001) and shame (B = 0.027, p < .001) also showed positive relationships with this type of self-directed violence.

Table 2.

Logistic Regression and Linear Regression Analysis Predicting Engagement in Self-directed Violence (N = 752).

Variable	NSSI		STB
Variable	B	OR (95% CI)	B	B (SE)
Model 1
Age	−0.118	0.889 [0.768, 1.029]	−0.073	0.072
Gender	0.065	1.067 [0.778, 1.463]	−0.561***	0.158
Father’s education	0.005	1.004 [0.956, 1.056]	0.007	0.025
Family structure	0.411	1.509 [0.888, 2.562]	0.229	0.275
Anger	0.026	1.026 [0.995, 1.059]	0.026	0.016
Depression	0.047*	1.048 [1.006, 1.093]	0.134***	0.021
Shame	0.016*	1.016 [1.003, 1.030]	0.027***	0.007
Model χ²/F test	34.06***		19.35***
Model 2
Age	−0.110	0.896 [0.773, 1.037]	−0.067	0.072
Gender	0.796	2.217 [0.474, 10.362]	−0.007	0.747
Father’s education	0.004	1.004 [0.955, 1.055]	0.008	0.025
Family structure	0.439	1.552 [0.912, 2.640]	0.241	0.275
Anger	0.002	1.002 [0.960, 1.046]	0.030	0.022
Depression	0.067*	1.069 [1.009, 1.134]	0.174***	0.029
Shame	0.030**	1.030 [1.012, 1.049]	0.033***	0.009
Anger × Gender	0.056	1.057 [0.992, 1.127]	−0.007	0.032
Depression × Gender	−0.035	0.965 [0.888, 1.049]	−0.080	0.042
Shame × Gender	−0.031*	0.970 [0.944, 0.996]	−0.012	0.013
Model χ²/F test	41.93***		14.40***
Model 3
Age	−0.137	0.872 [0.751, 1.012]	−0.089	0.072
Gender	0.053	1.055 [0.759, 1.466]	−0.550**	0.162
Father’s education	0.003	1.003 [0.954, 1.054]	0.004	0.025
Family structure	0.376	1.456 [0.852, 2.488]	0.182	0.275
Anger	0.019	1.019 [0.987, 1.052]	0.018	0.016
Depression	0.042*	1.043 [1.000, 1.088]	0.128***	0.021
Shame	0.017*	1.017 [1.004, 1.030]	0.028***	0.007
IPV (physical)	0.492*	1.636 [1.081, 2.475]	0.525*	0.215
IPV (sexual)	0.646	1.909 [0.984, 3.701]	0.449	0.344
IPV (psychological)	0.072	1.075 [0.757, 1.526]	0.109	0.171
Model χ²/F test	46.56***		14.83***

Note. NSSI = nonsuicidal self-injury; STB = suicidal thoughts and behaviors; B = regression coefficient; OR = odds ratio; CI = confidence interval; SE = standard error; IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001.

We conducted a second model of analyses to examine the moderating effects of gender between each of the negative emotions and self-directed violence. Moderation for negative emotions and gender was significant only for NSSI. These results are complemented by Figure 1, which shows the respective simple slopes of the subgroups by gender. The y-axis shows the probability of nonsuicidal self-harm predicted by the logistic regression, the x-axis shows the value of the independent variable shame, and the lines represent the slope of the regression line for the subgroups by gender. Significant moderating effects were found for gender and NSSI, where females were influenced to a greater degree by their feelings of shame as compared with males. This is illustrated by the steeper slope of the female regression line as compared with that of males.

Figure 1.

Interaction plots showing the moderation by gender of the shame variable on NSSI.

Relationships Between Negative Emotions and Intimate Partner Violence

Table 3 presents the results of the multiple logistic regression analyses using intimate partner violence perpetration as the outcome variable. A first model of analyses showed that anger predicted all three forms of intimate partner violence, including physical violence (OR = 1.053, p < .01), sexual violence (OR = 1.075, p < .05), and psychological violence (OR = 1.063, p < .001). The association between depression and intimate partner violence was significant for physical violence (OR = 1.050, p < .05) and psychological violence (OR = 1.068, p < .01), but not for sexual violence. We did not find a significant relationship between shame and intimate partner violence. Furthermore, we conducted a second model of analyses to examine the moderating effects of gender on each of the negative emotions and intimate partner violence. Gender did not moderate the relationship of these negative emotions with intimate partner violence. Thus, the results of our second model of analyses for intimate partner violence are not shown in Table 3.

Table 3.

Logistic Regression Analysis Predicting Probability of Engaging in Intimate Partner Violence Perpetration (N = 752).

Variable	Physical Violence		Sexual Violence		Psychological Violence
Variable	B	OR (95% CI)	B	OR (95% CI)	B	OR (95% CI)
Model 1^a
Age	0.083	1.087 [0.913, 1.294]	0.181	1.199 [0.923, 1.558]	0.195**	1.216 [1.056, 1.400]
Gender	−0.611**	0.543 [0.366, 0.805]	1.816***	6.150 [2.790, 13.557]	−0.224	0.799 [0.590, 1.083]
Father’s education	0.042	1.043 [0.983, 1.107]	−0.044	0.956 [0.864, 1.058]	0.024	1.024 [0.976, 1.075]
Family structure	0.532	1.702 [0.946, 3.060]	−0.214	0.807 [0.237, 2.752]	0.224	1.251 [0.728, 2.152]
Anger	0.052**	1.053 [1.015, 1.093]	0.073*	1.075 [1.011, 1.144]	0.061***	1.063 [1.029, 1.098]
Depression	0.049*	1.050 [1.000, 1.103]	0.021	1.021 [0.944, 1.104]	0.066**	1.068 [1.023, 1.115]
Shame	0.000	1.000 [0.985, 1.016]	−0.014	0.986 [0.960, 1.013]	0.001	1.001 [0.989, 1.014]
Model χ²	37.39***		34.26***		52.95***
Model 3^a
Age	0.109	1.115 [0.935, 1.329]	0.204	1.227 [0.943, 1.596]	0.203	1.225 [1.063, 1.411]
Gender	−0.576**	0.562 [0.376, 0.840]	1.898***	6.673 [2.958, 15.057]	−0.201	0.818 [0.601, 1.112]
Father’s education	0.039	1.040 [0.980, 1.104]	−0.042	0.867 [0.867, 1.061]	0.024	1.025 [0.976, 1.075]
Family structure	0.474	1.606 [0.886, 2.914]	−0.294	0.745 [0.216, 2.571]	0.198	1.218 [0.707, 2.101]
Anger	0.478*	1.049 [1.011, 1.089]	0.064*	1.066 [1.002, 1.134]	0.060***	1.061 [1.027, 1.097]
Depression	0.033	1.033 [0.982, 1.087]	0.004	1.004 [0.925, 1.090]	0.058*	1.059 [1.013, 1.107]
Shame	−0.004	0.996 [0.980, 1.012]	−0.018	0.982 [0.956, 1.010]	−0.001	0.999 [0.986, 1.013]
NSSI	0.466*	1.594 [1.051, 2.417]	0.598	1.819 [0.944, 1.104]	0.170	1.185 [0.838, 1.676]
STB	0.074	1.077 [0.993, 1.168]	0.103	1.108 [0.964, 1.274]	0.051	1.052 [0.972, 1.140]
Model χ²	48.91***		41.13***		56.58***

Note. B = regression coefficient; OR = odds ratio; CI = confidence interval; NSSI = nonsuicidal self-injury; STB = suicidal thoughts and behaviors.

Only results of Model 1 and Model 3 are shown in the table. The interactions between each of the negative emotions and gender (Anger × Gender, Depression × Gender, and Shame × Gender) are entered in Model 2 and no significant effects were found.

p < .05. **p < .01. ***p < .001.

The Association of Self-Directed Violence and Intimate Partner Violence

To test the hypothesis that life history of self-directed violence and life history of intimate partner violence are related, we ran a third model of analyses to determine whether one behavior was a significant predictor of the other (see Tables 2 and 3). After controlling for the demographic variables and emotional factors, the risk of NSSI significantly increased in the presence of intimate partner physical violence perpetration (OR = 1.636, p < .05). Also, intimate partner physical violence showed a positive and significant relationship with suicidal thoughts and behaviors (B = 0.525, p < .05). Conversely, the risk of intimate partner physical violence increased in the presence of NSSI (OR = 1.594, p < .05). No significant relationships were found between sexual or psychological violence and self-directed violence after controlling for the demographic variables and emotional factors.

Discussion

The findings of the current study extend previous research by including intimate partner violence and self-directed violence in one study. Our findings improve the understanding of the unique contributions of negative emotions such as anger, depression, and shame for self-directed violence and intimate partner violence in a college sample where these dysregulated behaviors frequently occur. By including different types of negative emotions in the same model, we were able to demonstrate that not all types of negative emotions had the same effects on self-directed violence and intimate partner violence. Our moderation analysis advances the literature by providing detailed examination of gender differences in the relationship of shame with NSSI. More importantly, the results demonstrate links between self-directed violence and intimate partner violence.

One contribution of the present study was the finding that anger contributes to engagement in intimate partner physical, sexual, and psychological violence perpetration. Anger emerged as a unique and consistent contributor to all three types of intimate partner violence perpetration. While anger has been reported as a reason for self-harming behaviors (Nock, Prinstein, & Sterba, 2009), the present study did not find anger to be a unique contributor to self-injury or suicidal thoughts and behaviors. Previous research has shown that anger is a correlate of perpetrating physical violence and psychological violence against a partner (Shorey et al., 2011; Stith, Smith, Penn, Ward, & Tritt, 2004). Our findings extend the previous research by showing that anger also independently contributes to perpetrating intimate partner sexual violence. These associations can be explained by the goals of anger (e.g., wanting to hurt someone; Roseman et al., 1994). The cognitive-neoassociation conception of the relation of anger to aggression pays attention to the prototypic nature of anger, automatically generated impulsive anger/aggression reactions, and anger as an approach motivation focusing on doing injury to another (Berkowitz, 2012). Our finding of this relation between anger and intimate partner violence do not mean that individual will attack their partners when they experience feelings and action tendencies of anger. As Berkowitz (2012) noted, the aggressive motivation is easily aroused in persons characteristically disposed to be easily angered, and then individuals also differ in the propensity to overt aggression after being provoked. The current study did not find a significant moderating role of gender in the association between anger and intimate partner violence. Thus, the relationship between anger and intimate partner violence was consistent between males and females. Our results suggest that anger management should be addressed in intimate partner violence intervention programs, regardless of whether the perpetrator is male or female.

Although depression reflects a decrease in approach-related motivation (Henriques & Davidson, 2000) and may sound counterindicative of violence against others, our findings indicate that depression is associated with an increased risk of perpetrating physical violence and psychological violence against an intimate partner, consistent with previous findings (Banyard, Cross, & Modecki, 2006; Kim & Capaldi, 2004; Kim et al., 2008). Depression typically associated with aversive self-awareness involves avoidance and escape (Baumeister, 1990). But, we often overlook irritability as a common feature of depression (Fava et al., 2010). Previous couple studies have documented the association between depressive symptoms and marital conflicts (Davila et al., 1997; Du Rocher Schudlich, Papp, & Cummings, 2004). Although there is some evidence to suggest that depression is associated with sexual offending (McCoy & Fremouw, 2010), we did not find a significant relationship between depression and intimate partner sexual violence perpetration. One possible explanation is that the evidence of this association mainly comes from studies with high-risk sex offender population (e.g., incarcerated sex offenders, rapists, child molesters). Depression does not necessarily elicit perpetrating sexual violence against an intimate partner in college student samples. Nevertheless, our results underscore the importance of interpersonal perspectives on depression in the context of intimate relationships. Screening perpetrators of intimate partner violence for depression as they are in counseling or battering programs may improve treatment outcomes.

Our findings consistently demonstrate that depression is related to an increase in self-directed violence, including NSSI and suicidal thoughts and behaviors. The link between depression and self-directed violence has been well supported in previous studies (Hankin & Abela, 2011; Wilcox et al., 2012). The findings of psychological autopsy studies of suicide suggested that 90% of people who killed themselves had psychiatric disorders and more than 50% of people who killed themselves had depressive disorder (Cavanagh, Carson, Sharpe, & Lawrie, 2003). To sum up, our findings demonstrate that feelings of depression are associated with increased engagement in both self-directed violence and intimate partner violence. This strong association between depression and violent behaviors makes this a vital area for assessment with self-injurers and perpetrator of intimate partner violence.

In the present study, we find that anger predicts intimate partner violence perpetration but not self-directed violence, underscoring its relevance for engaging in violence directed toward others. Conversely, shame predicts self-directed violence but not intimate partner violence. Consistent with prior research (Xavier, Gouveia, & Cunha, 2016), shame positively contributes to NSSI and suicidal ideation and behavior. As opposed to anger as an approach motivation (Harmon-Jones, Peterson, & Harmon-Jones, 2010), shame invokes a desire to escape or hide from negative feelings or situations (Hastings et al., 2002). Some individuals may choose self-injury as a means of escaping from aversive affected states (Nock, 2010), while some individuals may choose suicide as the ultimate escape from self (Baumeister, 1990). Shame is an important concept in understanding Chinese culture (Bedford, 2004). Although Chinese people, like Western people, experience similar feelings of shame, the events that elicited shame may differ in two cultures. The maintenance of social harmony is of vital importance in Chinese culture. This means that Chinese are more sensitive than Westerners to being personally ashamed by other people’s actions or lack of action (Bedford, 2004). Anderson et al. (2011) found that higher levels of perceived shame were associated with more accepting attitudes toward perpetrating physical and psychological violence against an intimate partner among Chinese college students. Our findings did not provide further evidence of the relationship between shame and actual physical, sexual or psychological violence perpetrated by an intimate partner. However, Harper et al. (2005) found that more feelings of shame were associated with greater anger, which in turn would be associated with increased levels of intimate partner psychological violence perpetration. Future studies are needed to explore the mediating role of anger to clarify this relationship.

To our best knowledge, the results from this study are the first to suggest that women appear more susceptible to NSSI that is influenced by shame. It is notable that the significant moderating effects remained, even after controlling for participants’ experiences of anger and depression. This suggests that shame may be a unique predictor of women’s engagement in NSSI. One interpretation for the reason behind females’ NSSI being associated with shame is that shame is associated with a passive/dependent orientation and self-punitive internalization for women (Ferguson & Crowley, 1997). Our results indicate the importance of tailoring self-injury prevention programs to gender.

Overall, the results of this study provide important information on the differential contributions of anger, depression, and shame for self-directed and intimate partner violence, particularly in nonclinical samples. Our findings may be useful for improving the understanding of the contribution of each negative emotion to disparate violent behaviors engaged in by young adults. The results suggest that anger and depression are important predictors of intimate partner violence, while shame and depression are important predictors of self-directed violence. Despite the fact that significant associations were found between negative emotions, self-directed violence, and intimate partner violence in the present study, we do not propose a simple causal relationship between negative emotions and violence. It is important for practitioners and researchers to consider an ecological model in designing violence intervention and prevention programs (Krug et al., 2002). Nevertheless, our findings highlight the need to address negative emotions and to include an emotion-regulation component in intervention and prevention. Although people in Western and Chinese culture may experience similar feelings and action tendencies of negative emotion, antecedent events that cause negative emotion to occur may differ cross-culturally. Future research is needed to understand the occasions in which negative emotion is aroused in different cultures. In the current study, the observed relations between negative emotions and violence were very similar across two cultures, perhaps reflecting cross-cultural generality for the behavioral manifestations of negative emotions.

Finally, the present study enhances our understanding of the association between self-directed violence and intimate partner violence perpetration. Consistent with previous research (Murray et al., 2008), the present study has demonstrated the significant positive correlations between self-directed violence and intimate partner physical violence among college students, even after taking emotional factors into account. Individuals with histories of physical violence against their intimate partners are at an elevated risk of NSSI and suicidal thoughts and behaviors. Although an association between intimate partner physical violence and self-directed violence is found in this study, we should interpret it with caution. The proposal that the risk of one behavior increasing can lead to increase of the other behaviors could not be concluded from this study. The preliminary evidence of co-occurring violence against self and against partners warrants further study and suggests the need for integrated violence prevention programs.

As with any research, this study has limitations. First, we based our findings on data from a convenience sample of college students in an urban city of China. The generalizability of the findings to the college student population in China is limited. Second, the use of self-report data may cause retrospective bias. Third, the present study utilized a cross-sectional design. It is impossible to infer causality. The knowledge of the association between negative emotions and these violent behaviors would be greatly enhanced through prospective and longitudinal design in future studies. Fourth, we acknowledge that anger, depression, and shame are not the only emotional factors associated with self-directed violence and intimate partner violence. Future research would benefit from including other emotional variables in understanding distinct facets of negative emotions for engagement in these violent behaviors. Fifth, we included intimate partner violence in the present study, which is only one type of other-directed violence that occurs in an intimate relationship. It is possible that each of the negative emotions assessed in this study would be differentially associated with violence that happens in other contexts (e.g., peer-to-peer violence). Finally, we did not include all of the confounding variables when assessing the association between self-directed violence and intimate partner violence. Despite these limitations, the results of the present study contribute to a deeper understanding of self-directed violence and intimate partner violence among young adults.

Footnotes

Acknowledgements

We would like to thank all of the college students who participated in this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Ling Wang is a doctoral candidate in the Department of Social Work and Social Administration at the University of Hong Kong. Her primary research interests include correlates of intimate partner violence (IPV), sexual violence, child abuse, and witnessing interparental violence. She had previously worked in the China White Ribbon Volunteer Network promoting the active engagement of men in the fight against gender-based violence. She is interested in using research to increase people’s understanding of violence-related issues in Mainland China.

Qinglu Wu is a PhD candidate in the Department of Social Work and Social Administration at the University of Hong Kong. His research interests include the personal recovery of IPV survivors in postseparation period (especially the experience and process of forgiveness), the influence of childhood maltreatment on prosocial behaviors in adulthood and its mechanism, and the protective factors (e.g., forgiveness, sacrifice) in marriage and their influence on marital satisfaction.

Anna Wai-Man Choi is an assistant professor in the Department of Social Work and Social Administration at the University of Hong Kong. She is also a registered social worker and an accredited family mediator. Her research area is intimate partner violence and family conflict, specifically gender and culture issues in family context. Her latest work focuses on the women’s use of force and male victim of IPV, funded by the Research Grants Council’s General Research Fund (GRF) of the Hong Kong Special Administrative Region Government. Besides, some projects on high conflict and violence in divorce/separation were conducted, including an Evaluation Study of the Pilot Scheme on Children’s Dispute Resolution commissioned by the HK Judiciary in 2013 to 2015 and a study on the Child-Visitation Service commissioned by a nongovernmental organization in Hong Kong. She had previously worked in various service settings as a frontline social worker and a center-in-charge, and she has tremendous experience in handling couples’ conflicts and addressing the needs of families with violence. She is currently a committee member of the Advisory Council of the Family Crisis Support Services in Po Leung Kuk HK, a member of the District Coordinating Committee of Domestic Violence and Family & Child Welfare, and a specialist of the Hong Kong Council for Accreditation of Academic and Vocational Qualifications.

References

Agnew

Brezina

Wright

J. P.

Cullen

F. T.

(2002). Strain, personality traits, and delinquency: Extending general strain theory. Criminology, 40, 43-72.

Anderson

J. R.

Chen

W. C.

Johnson

M. D.

Lyon

S. E.

Lee

C. Y.

Zheng

. . . Peterson

F. R.

(2011). Attitudes toward dating violence among Chinese college students: An exploratory study. Violence and Victims, 26, 631-647.

Andrews

Qian

Valentine

J. D.

(2002). Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale. British Journal of Clinical Psychology, 41, 29-42.

Banyard

V. L.

Cross

Modecki

K. L.

(2006). Interpersonal violence in adolescence ecological correlates of self-reported perpetration. Journal of Interpersonal Violence, 21, 1314-1332.

Baumeister

R. F.

(1990). Suicide as escape from self. Psychological Review, 97, 90-113.

Bedford

O. A.

(2004). The individual experience of guilt and shame in Chinese culture. Culture & Psychology, 10, 29-52.

Berkowitz

(1990). On the formation and regulation of anger and aggression: A cognitive-neoassociationistic analysis. American Psychologist, 45, 494-503.

Berkowitz

(2012). A different view of anger: The cognitive-neoassociation conception of the relation of anger to aggression. Aggressive Behavior, 38, 322-333.

Birkley

E. L.

Eckhardt

C. I.

(2015). Anger, hostility, internalizing negative emotions, and intimate partner violence perpetration: A meta-analytic review. Clinical Psychology Review, 37, 40-56.

10.

Buss

A. H.

Perry

(1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452-459.

11.

Campbell

J. C.

(2002). Health consequences of intimate partner violence. The Lancet, 359, 1331-1336.

12.

Cavanagh

J. T.

Carson

A. J.

Sharpe

Lawrie

S. M.

(2003). Psychological autopsy studies of suicide: A systematic review. Psychological Medicine, 33, 395-405.

13.

Chan

K. L.

(2012). The role of Chinese face in the perpetration of dating partner violence. Journal of Interpersonal Violence, 27, 793-811.

14.

Chan

K. L.

Tiwari

Leung

W. C.

H. W.

Cerulli

(2007). Common correlates of suicidal ideation and physical assault among male and female university students in Hong Kong. Violence and Victims, 22, 290-303.

15.

Chapman

A. L.

Dixon-Gordon

K. L.

(2007). Emotional antecedents and consequences of deliberate self-harm and suicide attempts. Suicide and Life-Threatening Behavior, 37, 543-552.

16.

Cogan

Fennell

(2007). Sexuality and the commission of physical violence to partners and non-partners by men and women. Journal of Consulting and Clinical Psychology, 75, 960-967.

17.

Cortoni

Marshall

W. L.

(2001). Sex as a coping strategy and its relationship to juvenile sexual history and intimacy in sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 13, 27-43.

18.

Coyne

J. C.

(1976). Toward an interactional description of depression. Psychiatry, 39, 28-40.

19.

Davila

Bradbury

T. N.

Cohan

C. L.

Tochluk

(1997). Marital functioning and depressive symptoms: Evidence for a stress generation model. Journal of Personality and Social Psychology, 73, 849-861.

20.

Du Rocher Schudlich

T. D.

Papp

L. M.

Cummings

E. M

. (2004). Relations of husbands’ and wives’ dysphoria to marital conflict resolution strategies. Journal of Family Psychology, 18, 171-183.

21.

Dutton

D. G.

Karakanta

(2013). Depression as a risk marker for aggression: A critical review. Aggression and Violent Behavior, 18, 310-319.

22.

Ehrensaft

M. K.

Cohen

Johnson

J. G.

(2006). Development of personality disorder symptoms and the risk for partner violence. Journal of Abnormal Psychology, 115, 474-483.

23.

Ekman

(1992). An argument for basic emotions. Cognition and Emotion, 6, 169-200.

24.

Elison

Garofalo

Velotti

(2014). Shame and aggression: Theoretical considerations. Aggression and Violent Behavior, 19, 447-453.

25.

Elkins

S. R.

Moore

T. M.

McNulty

J. K.

Kivisto

A. J.

Handsel

V. A.

(2013). Electronic diary assessment of the temporal association between proximal anger and intimate partner violence perpetration. Psychology of Violence, 3, 100-113.

26.

Fava

Hwang

Rush

A. J.

Sampson

Walters

E. E.

Kessler

R. C.

(2010). The importance of irritability as a symptom of major depressive disorder: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 14, 1-12.

27.

Ferguson

T. J.

Crowley

S. L.

(1997). Gender differences in the organization of guilt and shame. Sex Roles, 37, 19-44.

28.

Gilbert

(1997). The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy. British Journal of Medical Psychology, 70, 113-147.

29.

Gratz

K. L.

(2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.

30.

Hankin

B. L.

Abela

J. R.

(2011). Nonsuicidal self-injury in adolescence: Prospective rates and risk factors in a 2½ year longitudinal study. Psychiatry Research, 186, 65-70.

31.

Harford

T. C.

H. Y.

Grant

B. F.

(2013). Other- and self-directed forms of violence and their relationships to DSM-IV substance use and other psychiatric disorders in a national survey of adults. Comprehensive Psychiatry, 54, 731-739.

32.

Harmon-Jones

Peterson

C. K.

Harmon-Jones

(2010). Anger, motivation, and asymmetrical frontal cortical activations. In Potegal

Stemmler

Spielberger

(Eds.), International handbook of anger (pp. 61-78). New York, NY: Springer.

33.

Harper

F. W.

Austin

A. G.

Cercone

J. J.

Arias

(2005). The role of shame, anger, and affect regulation in men’s perpetration of psychological abuse in dating relationships. Journal of Interpersonal Violence, 20, 1648-1662.

34.

Hastings

M. E.

Northman

L. M.

Tangney

J. P.

(2002). Shame, guilt, and suicide. In Joiner

Rudd

M. D.

(Eds.), Suicide science (pp. 67-79). New York, NY: Kluwer Academic Publishers.

35.

Henriques

J. B.

Davidson

R. J.

(2000). Decreased responsiveness to reward in depression. Cognition and Emotion, 14, 711-724.

36.

Hillbrand

(2001). Homicide–suicide and other forms of co-occurring aggression against self and against others. Professional Psychology: Research and Practice, 32, 626-635.

37.

H. C.

(1944). The Chinese concepts of “face.” American Anthropologist, 46, 45-64.

38.

Hundt

N. E.

Holohan

D. R.

(2012). The role of shame in distinguishing perpetrators of intimate partner violence in U.S. veterans. Journal of Traumatic Stress, 25, 191-197.

39.

Hwang

K. K.

(1987). Face and favor: The Chinese power game. American Journal of Sociology, 92, 944-974.

40.

Jacobson

Batejan

Kleinman

Gould

(2013). Reasons for attempting suicide among a community sample of adolescents. Suicide and Life-Threatening Behavior, 43, 646-662.

41.

Joiner

T. E.

Timmons

K. A.

(2002). Depression in its interpersonal context. In Gotlib

I. H.

Hammen

C. L.

(Eds.), Handbook of depression (2nd ed., pp. 322-339). New York, NY: Guilford Press.

42.

Kim

H. K.

Capaldi

D. M.

(2004). The association of antisocial behavior and depressive symptoms between partners and risk for aggression in romantic relationships. Journal of Family Psychology, 18, 82-96.

43.

Kim

H. K.

Laurent

H. K.

Capaldi

D. M.

Feingold

(2008). Men’s aggression toward women: A 10-year panel study. Journal of Marriage and Family, 70, 1169-1187.

44.

Klonsky

E. D.

(2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226-239.

45.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613.

46.

Krug

E. G.

Dahlberg

L. L.

Mercy

J. A.

Zwi

A. B.

Lozano

(2002). World report on violence and health. Geneva, Switzerland: World Health Organization.

47.

Lang

C. M.

Sharma-Patel

(2011). The relation between childhood maltreatment and self-injury: A review of the literature on conceptualization and intervention. Trauma, Violence, & Abuse, 12, 23-37.

48.

Laye-Gindhu

Schonert-Reichl

K. A.

(2005). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34, 447-457.

49.

Wang

Fischer

K. W.

(2004). The organisation of Chinese shame concepts. Cognition and Emotion, 18, 767-797.

50.

Liu

H.-J.

Gao

H.-M.

(2012). Reliability and validity of the Chinese version of State-Trait Anger Expression Inventory–2 in college students. Chinese Mental Health Journal, 26, 70-76.

51.

M. C.

(2006). Exploring the relation of the motivation of deliberate self-harm, negative affect, experiential avoidance, emotion regulation and adolescents’ deliberate self-harm behaviors (Master’s thesis, National Chengchi University, Taiwan). Retrieved from http://nccur.lib.nccu.edu.tw/handle/140.119/32545

52.

MacDonald

Leary

M. R.

(2005). Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin, 131, 202-223.

53.

McCoy

Fremouw

(2010). The relation between negative affect and sexual offending: A critical review. Clinical Psychology Review, 30, 317-325.

54.

Milligan

Andrews

(2005). Suicidal and other self-harming behavior in offender women: The role of shame, anger and childhood abuse. Legal and Criminological Psychology, 10, 13-25.

55.

Murray

C. E.

Wester

K. L.

Paladino

D. A.

(2008). Dating violence and self-injury among undergraduate college students: Attitudes and experiences. Journal of College Counseling, 11, 42-57.

56.

Nock

M. K.

(2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18, 78-83.

57.

Nock

M. K.

(2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363.

58.

Nock

M. K.

Prinstein

M. J.

Sterba

S. K.

(2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118, 816-827.

59.

Osman

Bagge

C. L.

Gutierrez

P. M.

Konick

L. C.

Kopper

B. A.

Barrios

F. X.

(2001). The Suicidal Behaviors Questionnaire–Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443-454.

60.

Qian

Andrews

Zhu

Wang

(2000). The development of Shame Scale of Chinese college students. Chinese Mental Health Journal, 14, 217-221.

61.

Rehman

U. S.

Gollan

Mortimer

A. R.

(2008). The marital context of depression: Research, limitations, and new directions. Clinical Psychology Review, 28, 179-198.

62.

Riggs

S. A.

Kaminski

(2010). Childhood emotional abuse, adult attachment, and depression as predictors of relational adjustment and psychological aggression. Journal of Aggression, Maltreatment & Trauma, 19, 75-104.

63.

Roseman

I. J.

Wiest

Swartz

T. S.

(1994). Phenomenology, behaviors, and goals differentiate discrete emotions. Journal of Personality and Social Psychology, 55, 52-77.

64.

Sadeh

Javdani

Finy

M. S.

Verona

(2011). Gender differences in emotional risk for self- and other-directed violence among externalizing adults. Journal of Consulting and Clinical Psychology, 79, 106-117.

65.

Shorey

R. C.

Cornelius

T. L.

Idema

(2011). Trait anger as a mediator of difficulties with emotion regulation and female-perpetrated psychological aggression. Violence and Victims, 26, 271-282.

66.

Spielberger

C. D.

(1999). State-Trait Anger Expression Inventory–2. Port Huron, MI: Sigma Assessment Systems.

67.

Spielberger

C. D.

Jacobs

Russell

Crane

R. S.

(1983). Assessment of anger: The State-Trait Anger Scale. Advances in Personality Assessment, 2, 159-187.

68.

Spitzer

R. L.

Kroenke

Williams

J. B. W.

, & Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. The Journal of the American Medical Association, 282, 1737-1744.

69.

Stith

S. M.

Smith

D. B.

Penn

C. E.

Ward

D. B.

Tritt

(2004). Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Aggression and Violent Behavior, 10, 65-98.

70.

Straus

M. A.

(2004). Cross-cultural reliability and validity of the Revised Conflict Tactics Scales: A study of university student dating couples in 17 nations. Cross-Cultural Research, 38, 407-432.

71.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316.

72.

Swannell

S. V.

Martin

G. E.

Page

Hasking

St John

N. J.

(2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44, 273-303.

73.

Tang

Zhu

. . . Liu

(2011). Association between non-suicidal self-injuries and suicide attempts in Chinese adolescents and college students: A cross-section study. PLoS ONE, 6, e17977.

74.

Tangney

J. P.

Dearing

R. L.

(2003). Shame and guilt. New York, NY: Guilford Press.

75.

Wang

C. W.

Chan

C. L.

Yip

P. S.

(2014). Suicide rates in China from 2002 to 2011: An update. Social Psychiatry & Psychiatric Epidemiology, 49, 929-941.

76.

Wang

Bian

Zhao

Wang

. . . Zhao

(2014). Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 36, 539-544.

77.

Watson

Clark

L. A.

Tellegen

(1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070.

78.

Whitfield

C. L.

Anda

R. F.

Dube

S. R.

Felitti

V. J.

(2003). Violent childhood experiences and the risk of intimate partner violence in adults: Assessment in a large health maintenance organization. Journal of Interpersonal Violence, 18, 166-185.

79.

Whitlock

Muehlenkamp

Purington

Eckenrode

Barreira

Baral Abrams

. . . Chin

(2011). Nonsuicidal self-injury in a college population: General trends and sex differences. Journal of American College Health, 59, 691-698.

80.

Wilcox

H. C.

Arria

A. M.

Caldeira

K. M.

Vincent

K. B.

Pinchevsky

G. M.

O’Grady

K. E.

(2012). Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. Psychological Medicine, 42, 717-726.

81.

World Health Organization. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva, Switzerland: World Health Organisation and London School of Hygiene and Tropical Medicine.

82.

Xavier

Gouveia

Cunha

(2016). Non-suicidal self-injury in adolescence: The role of shame, self-criticism and fear of self-compassion. Child & Youth Care Forum, 45, 571-586.

83.

Zhao

Yang

Xiao

Zhang

Aguilera

Zhao

(2012). Belief system, meaningfulness, and psychopathology associated with suicidality among Chinese college students: A cross-sectional survey. BMC Public Health, 12, Article 668.