Does Gender Really Matter: Childhood Trauma,Trait Anger,and Suicide Risk in Early Adulthood

Abstract

Background: Previous studies have reported mixed findings regarding gender differences in suicidal behavior. This discrepancy may be partly attributable to common predictors of suicide risk, such as childhood trauma and anger, and may also be independent of gender. Objectives: The present study investigated gender differences in the impact of childhood trauma and current trait anger on suicide risk, in a group of young Turkish adults. We hypothesized that trait anger would mediate the association between childhood trauma and suicide risk, independently of gender. Participants and Setting: Participants were 589 university students (84.3% women) aged 18–34 years (M = 21.43, SD = 1.82). Methods: Gender group differences in suicide risk, history of childhood trauma, and trait anger as well as possible covariates (i.e., self-rated socio-economic status and academic performance) were assessed. Possible predictors of suicide risk in gender groups were examined. The role of trait anger as a mediator of the relationship between childhood trauma and suicide risk was also examined. Results: Results showed that men reported a higher suicide risk, history of childhood trauma, and trait anger than women. Early childhood trauma and current trait anger scores were significant predictors of suicide risk in both gender groups. Trait anger significantly mediated the relationship between early trauma history and risk for suicide, independently of gender. Conclusions: Study findings support early reports of the effects of childhood trauma and trait anger on suicide risk. It was suggested that preventive interventions for suicidal behavior and monitoring risk groups with aggressive tendencies and childhood trauma history may be important.

Keywords

suicide gender childhood trauma anger early adulthood

Introduction

Suicide is a form of self-injurious behavior to end one’s own life with a specific intent to die. Several behaviors and thoughts are considered relevant to suicide (Turecki & Brent, 2016; Posner et al., 2007), such as suicide attempt (i.e., a potential self-injurious behavior with intent to die), suicide plan/active suicide ideation (i.e., thinking about the details to end one’s own life), and suicide ideation/passive suicide ideation (i.e., thoughts about ending one’s own life without specific planning). Investigating these different groups of thoughts and behaviors helps with assessing the probability/risk for suicide (i.e., the likelihood of one’s committing a suicide), since the predictive effects have been widely reported (Bostwick et al., 2016; Victor & Klonsky, 2014).

Approximately 800.000 people die by suicide every year, making it a leading cause of death worldwide. Rates of suicide attempts are even higher, approximately 20-fold World Health Organization (WHO, 2022). Previous research indicates that around 2% of the population thinks about suicide every year, highlighting the magnitude of the problem and associated risk (Borges et al., 2010). While suicidal ideation does not always lead to immediate suicide attempts, more than 50% potentially act on these thoughts within a year (Borges et al., 2010; Nock et al., 2008).

Suicidal behavior is a significant public health concern. Yet, most of the published research in English stems from Western countries, which limits understanding of the possible cultural differences in suicide (Colucci & Lester, 2012). This research gap is considered one of the main challenges to suicide research (O’Connor & Portzky, 2018). Turkey is a developing non-Western country with increasing suicide rates (Göktaş & Metintaş, 2019). Official reports show that around 3000 people per year commit suicide in Turkey (Turkish Statistical Institute, 2019). These reports show death and attempt rates, but there is limited research focusing on suicidal ideation or plans although these are potentially more common. Research about suicide ideation and planning in especially specific groups (e.g., young adults, students) in Turkey is also needed.

Suicidal behavior is likely to occur as a result of multifactorial causes. A history of psychiatric problems has often been found to be related to suicidal behavior (Bachmann, 2018). There are also possible interactions between different factors leading to suicide. Both clinical and general population studies report several factors associated with people’s intent to end their own lives. Suicidal ideation and plans were found to be significantly more prevalent among women than men (Borges et al., 2010), although some studies have found the opposite trend (Wetherall et al., 2018). Findings of suicide attempt rates are also mixed: some reports show that women are more likely to attempt suicide (Miranda-Mendizabal et al., 2019; Turecki & Brent, 2016; Wetherall et al., 2018), whereas some studies report no significant difference between men and women (Borges et al., 2010; Cano-Montalbán & Quevedo-Blasco, 2018). The rates of deaths by suicide have been reported to be higher in men compared to women (Cano-Montalbán & Quevedo-Blasco, 2018; Emiral et al., 2022; Miranda-Mendizabal et al., 2019; WHO, 2021). It has also been shown that being younger and being a student may be predictive of unplanned attempts of suicide (Borges et al., 2010), thereby suggesting that young adults and, more specifically, university students may be more vulnerable to suicide. Academic challenges and poor socioeconomic status (SES) have been reported to be associated with suicidality in these groups (De Luca et al., 2016; Grimmond et al., 2019; Näher et al., 2020). In 2016, the WHO reported suicide as the fourth leading cause of death in late adolescence and early adulthood (aged 15–29 years) (WHO, 2021). Approximately 750 people aged 15–24 commit suicide in Turkey every year (Turkish Statistical Institute, 2019).

Traumatic experiences in early life, especially a history of childhood maltreatment, are related to suicidal thoughts and behaviors in adolescence and adulthood (Fergusson et al., 2013). The WHO defines childhood maltreatment as any form of abuse and neglect before the age of 18. This includes all forms of physical, sexual, or psychological abuse and/or neglect that cause, or have the potential to cause, harm to a child’s wellbeing, functioning, and/or development (WHO, 2020). Different forms of childhood abuse have been found to predict planned/unplanned suicide attempts in adulthood (Borges et al., 2010; Hoertel et al., 2015). The relationship between childhood adversity and suicidal thoughts and behaviors in adolescence and early adulthood has also been reported in the general population when controlling for lifetime mental health problems (Bruffaerts et al., 2010).

Personality traits have also been found to be related to suicidal thoughts and behaviors. Many aspects of personality have been investigated concerning suicidality, with more emphasis on impulsivity and aggression-related characteristics (O’Connor & Nock, 2014). The relationship between trait anger and suicidal thoughts and behaviors has previously been reported in clinical and general populations (Kämpfer et al., 2016). Trait anger is defined as the tendency to experience anger often, and in multiple situations (Spielberger et al., 1988). Trait anger has also been proposed to be a potential factor for self-directed aggressiveness and impulsivity leading to suicidal thoughts and behaviors (Ammerman et al., 2015; Giegling et al., 2009).

The possible mechanism explaining the relationship between childhood maltreatment and suicidal behavior may be through trait anger, as this has previously been proposed to be a mediator for suicide attempts (Daniel et al., 2009). Recent studies have reported the impact of childhood maltreatment on psychological functioning, including impulsivity and trait anger (Ford et al., 2013; Quenneville et al., 2020), which may help to illuminate the mechanism between childhood adversity and suicide risk. Early life adversity has been found to be linked to later internal and external emotional difficulties (Briggs-Gowan et al., 2012). Anger is considered an adaptive and reasonable response for victims of abuse, for example, as this can contribute to a sense of control over the environment, protecting self-worth, and building resilience (Novaco & Chemtob, 1998). Yet, this also has the potential to be destructive for survivors, due to the possibility of activating aggression.

Research groups focusing on suicide risk and attempts have observed significant mediating effects of anger. Swogger et al. (2011) found that the relationship between physical abuse in childhood and lifetime suicide attempt history was mediated by lifetime aggression (Swogger et al., 2011). A more recent study by Charak et al. (2016) investigated different types of childhood adversity, including poly-victimization, defined as being exposed multiple traumatic events, including conventional crime, various forms of abuse by peers/siblings, and witnessing violence. They found that dispositional anger moderated the relationship between a history of certain forms of childhood adversity (e.g., crime-related, siblings and peers, or poly-victimization) and higher suicide risk. They suggested that anger disposition had a greater moderating effect in the poly-victimization group than the predominantly crime and sibling/peer victimization group (Charak et al., 2016).

The mediating role of trait anger on childhood maltreatment and suicide risk appears to be independent of age and gender. Charak et al. (2016) found that age and gender did not predict suicidal behavior scores once childhood victimization and dispositional anger were considered. Swogger et al. (2011) also found that the mediating role of lifetime aggression was present after controlling for possible confounders, including age and gender. Taken together, the relationship between suicide risk, childhood maltreatment, and trait anger gives rise to the possibility that a history of childhood maltreatment may increase the risk of suicide risk.

The present study aimed to better understand the association between childhood adversity and suicide risk, by investigating possible gender differences in suicide risk and the potential mediating role of trait anger, in a group of Turkish university students. To this end, the study examined: (1) Whether men and women differed in suicide risk, trait anger, childhood adversity, and confounding variables (i.e., SES and academic performance), (2) Whether childhood adversity, trait anger, SES, and academic performance were significant predictors of suicide risk across gender, and (3) Whether trait anger mediated the relationship between childhood trauma and suicide risk independently of gender. It was hypothesized that the suicide risk would be similar across genders, and that both childhood adversity and trait anger would predict suicide risk significantly across genders. We also hypothesized that trait anger would significantly mediate the relationship between childhood trauma history and suicide risk independently of gender.

Methods

Participants and Procedure

Five hundred eighty-nine students, aged 18–34 years (M = 21.43, SD = 1.82) participated in the study, with a response rate of 100%. Data were collected in the faculty of education of a university in Ankara, the capital city of Turkey. The difference in the ratio of men and women in the dataset is due to the fact that the students in the faculty of education in Turkey are predominantly women. The study was announced in the class before lectures started, and participants completed the measures. All participants were informed that their attendance was completely voluntary and their responses would be kept confidential. All questionnaires were returned by closed envelopes and stored anonymously. The study protocol was approved by the Human Subjects Ethics Committee of the university.

Measures

A sociodemographic form was created to obtain information about age, gender, subjective evaluation of SES, and academic performance. The latter two were self-rated on a four-point scale, low to very high.

The Turkish version of the Childhood Trauma Questionnaire (CTQ, Aslan & Alparslan, 1999; Bernstein et al., 1994) assesses self-reported abuse and neglect experiences occurring before the age of 18. The questionnaire comprises 40 items rated on a 5-point Likert scale, from “never true” to “very often true.” The total score ranges from 40 to 200, with higher scores indicating higher levels of early trauma. The CTQ has three subscales: Physical Abuse (PA), Emotional Abuse and Neglect (EAN), and Sexual Abuse (SA). In this study, only the total score was used, to reduce the chance of Type 1 error due to multiple comparisons. Cronbach’s alpha for the total score was 0.93.

The Turkish version of the Trait Anger and the Anger Expressions Scale (T Anger-Anger EX: Ozer, 1994; Spielberger et al., 1983) was used to assess trait anger. The scale has 34 items, and higher scores reflect higher levels of anger. Items are rated on a 4-point Likert scale. The T Anger-Anger EX has four subscores: The Trait Anger (T-Anger), the Anger-in (AEX In) (the anger that is experienced but held in or suppressed), the Anger-out (AEX-Out) (the anger expressed toward other people or objects in the environment), and the Anger Control (AEX-Con) (how frequently a person endeavors to control the angry feelings). In this study, only the T-Anger score (ranging from 10 to 40) was used in line with the research objectives. Cronbach’s alpha was 0.79.

Suicide risk was estimated using the Turkish version of the Suicide Probability Scale (SPS: Cull & Gill, 1989; Tuğcu, 2006). The questionnaire has 36 items, which are assessed on a 4-point Likert scale (ranging from (1) “none or little of the time” to (4) “most or all of the time”). The total score ranges from 36 to 146, with higher scores indicating higher suicide risk. The scale has four subscales: Hopelessness (12-item), Suicidal Ideation (8-item), Negative Self-Assessment (9-item), and Hostility (7-item). Each subscale was developed based on different theories used to predict suicide, the sum of which leads to a total score tapping on an overall probability of suicide for an individual. In this study, only the total score was used to assess this overall suicide probability/risk as well as to reduce the chance of Type 1 error due to multiple comparisons. Cronbach’s alpha was 0.88 for the total score in the present dataset.

Statistical Analysis

Data were analyzed using SPSS version 25. Missing data (incomplete item scores) were handled using multiple imputation method with five iterations (Rubin, 1987). Parametric tests were employed for statistical analysis where applicable. Due to the number of analyses conducted, the significance level was adjusted to p < .01.

Gender differences in suicide risk scores were explored by the Mann-Whitney test with Pearson’s correlation coefficient r used to estimate the effect size (.10 small, .30 medium, and. 50 large effects as suggested by Cohen, 1988, 1990). Men and women were also compared on self-rated SES and academic performance using Fisher’s exact test. Associations among possible predictors of suicide risk (e.g., history of childhood trauma and anger) were examined by calculating Pearson’s r/Spearman’s rhos in men and women. Multiple regression analysis was conducted for suicide risk score in gender groups; only variables that had a significant correlation with the outcome variable were included as possible predictors. The forward stepwise method was used in the regression analysis, the result of which was confirmed using the backward elimination method to identify all significant predictors. Clogg’s z-test (Clogg et al., 1995) was performed to establish whether significant predictors differ across gender. A mediation analysis was conducted using PROCESS v3.5 (Hayes, 2018) to test whether trait anger mediated the relationship between childhood trauma and suicide risk independently of gender. Baron and Kenny’s (1986) guidelines were used for the mediation analysis.

Results

The percentage of missing values across individual item scores of the SPS, CTQ, and T-Anger varied between 0 and 43.3% (M=7.12%). In total, 548 out of 44,805 item scores (1.21%) were missing. The investigation of missing values did not suggest a specific pattern; therefore, analyses were conducted on multiple imputed data. For comparison, we also performed all analyses on the subset of complete cases.

Men’s scores were significantly higher than women on total suicide risk score (Table 1). Men also reported higher scores on childhood trauma history and trait anger than women (Table 1). Gender group differences were further examined for possible confounding variables: self-rated SES and academic performance scores differed between men and women significantly, showing that men reported lower SES and poorer academic performance than women (Table 1).

Table 1.

Gender Group Differences in Suicide Risk (SPS-Total), Childhood Trauma History (CTQ-Total), Trait Anger (T-Anger) Scores, SES and Academic Performance: Median/count.

		Women (n = 92)	Men (n = 92)	U	z	P	r
SES ^a	Low	3	4	N/A	N/A	.06^b	N/A
	Average	22	38
	High	51	42
	Very high	15	8
Academic performance	Low	3	9	N/A	N/A	.007^c	N/A
	Average	45	60
	High	36	17
	Very high	8	6
SPS-total		56.00	72.50	13685.40	−6.12	<.001	-.25
CTQ-total		53.50	64.00	14655.60	−5.48	<.001	-.23
T-Anger		22.00	23.50	18752.70	−2.75	.006	-.11

SES: Self-rated socio-economic status, SPS-Total: Total score of the Suicide Probability Scale, CTQ-Total: Total score of the Childhood Trauma Questionnaire, T-Anger: The trait anger score of the Trait Anger and the Anger Expressions Scale, r: Pearson’s correlation coefficient as the effect size.

^an for Women=91.

^bFisher’s exact test.

^cχ² (3)=12.24.

Associations between total self-reported suicide risk score and possible predictors (childhood trauma history and self-reported trait anger) were examined in gender groups separately. Results showed that self-reported suicide risk score was significantly associated with both self-reported trait anger and childhood trauma history scores in both men and women (Table 2).

Table 2.

Associations Between Suicide Risk (SPS-Total) and Childhood Trauma History (CTQ-Total) and Trait Anger (T-Anger) Scores in Men and Women: Pearson’s r/Spearman’s Rho.

		SPS-Total	CTQ-Total	T-Anger
Men (n = 92)	SPS-total	-	.45^***b	.49^***a
	CTQ-total	-	-	.23^*b (p = .03)
	T-Anger	-	-	-
Women (n = 92)	SPS-total	-	.57^***b	.47^***b
	CTQ-total	-	-	.38^***b
	T-Anger	-	-	-

SPS-Total: Total score of the Suicide Probability Scale, CTQ-Total: Total score of the Childhood Trauma Questionnaire, T-Anger: The trait anger score of the Trait Anger and the Anger Expressions Scale. ^*p < .05, ^***p < .001.

^aPearson’s r.

^bSpearman’s rho.

A multiple regression analysis was conducted to explore significant predictors of self-reported total suicide risk score in gender groups separately (Table 3). In addition to significant correlates of self-reported total suicide risk score, namely self-reported trait anger and total history of childhood trauma scores, self-rated SES and academic performance were also included as possible predictors. A significant regression equation was found (n = 491, F (3,487) = 105.87, p < 0.001 and n = 92, F (2,89) = 23.49, p < 0.001) with R²=0.40 and 0.35 for women and men, respectively. Significant predictors of total suicide risk were total childhood trauma history (β = 0.40, p < 0.001), trait anger (β = 0.36, p < 0.001) scores, and self-rated academic performance (β = −0.13, p < 0.001) in women, whereas only the first two were true for men (β = 0.33, p < 0.001 and β = 0.41, p < 0.001, respectively). Clogg’s z-test results showed that regression coefficients for childhood trauma history differed between gender groups significantly (z = 2.42, p = .007), whereas the difference between regression coefficients of trait anger score was not significant (z = 0.30, p = .38).

Table 3.

Predictors of Suicide Risk (SPS-Total) in Men and Women: Multiple Regression.

			B	SE B	B
Men (n=92)	Step 1	Constant	43.29	5.24
	Step 1	T-Anger	1.14	.21	.49^***
	Step 2	Constant	33.18	5.64
		T-Anger	.94	.21	.41^***
		CTQ-total	.21	.06	.33^***
Women (n = 92)	Step 1	Constant	28.28	4.19
	Step 1	CTQ-total	.54	.07	.64^***
	Step 2	Constant	14.08	5.92
		CTQ-total	.47	.07	.57^***
		T-Anger	.80	.25	.26^**
	Step 3	Constant	31.49	8.35
		CTQ-total	.41	.07	.49^***
		T-Anger	.79	.24	.26^***
		SES	−4.60	1.61	-.23^**

SES: Self-rated socio-economic status, SPS-Total: Total score of the Suicide Probability Scale, CTQ-Total: Total score of the Childhood Trauma Questionnaire, T-Anger: The trait anger score of the Trait Anger and the Anger Expressions Scale, R2=.24 for Step 1, .34 for Step 2 (ps < .001) in men, R2=.41 for Step 1 (p < .001), .48 for Step 2 and .52 (p < .01) for Step 3 (p<.01) in women, **p < .01, ***p < .001.

A regression-based mediation analysis was performed using the PROCESS macro (Hayes, 2018) to see whether trait anger score mediated the association between history of childhood trauma and the risk of suicide scores after controlling for gender and academic performance (Figure 1). The overall mediation model was significant, F (4,584) = 103.23, p < 0.001, R²=0.41. In the first step of the mediation model, the regression of exposure to childhood trauma on suicide risk in early adulthood, without controlling for the mediator effect of trait anger, was significant, b = 0.41, t (585) = 12.89, p < 0.001. The second step showed that the regression of exposure to childhood trauma on trait anger (the mediator) was significant, b = 0.08, t (585) = 5.95, p < 0.001. The association between trait anger and suicide risk was also significant, b=1.00, t (584) = 11.02, p < 0.001. After controlling for trait anger, exposure to childhood trauma remained a significant predictor of suicide risk b = 0.33, t (584) = 11.11, p < 0.001. As the predictive power of exposure to childhood trauma on suicide risk weakened when this relationship was mediated by trait anger, a Sobel test was conducted to determine whether this reduction was significant or not. Although full mediation was not supported, the results of the Sobel test showed there was a significant partial mediation (z = 5.24, p < 0.001).

Figure 1.

Standardized regression coefficients for the relationship between childhood trauma history (CTQ-Total) and suicide risk (SPS-Total) as mediated by trait anger (T-Anger), controlling for gender and self-rated academic performance. ***p < 0.001. SPS-Total: Total score of the Suicide Probability Scale, CTQ-Total: Total score of the Childhood Trauma Questionnaire, T-Anger: The trait anger score of the Trait Anger and the Anger Expressions Scale ***p < 0.001.

Discussion

The current study sought to examine whether gender, trait anger, and childhood trauma history are predictive of suicide risk. In addition, we examined the role of trait anger in the relationship between exposure to childhood abuse/neglect and suicide risk in early adulthood. Contrary to our first hypothesis, results showed that men were at higher risk for suicide than women. However, childhood trauma and trait anger predicted suicide risk in both gender groups as expected. Results were further supported by the possible mediating role of trait anger on the relationship between childhood trauma history and suicide risk, independent of gender. To our knowledge, this is the first study investigating mediating effects of trait anger on the long-known relationship between childhood abuse/neglect and suicide risk in young adult students.

Our results showing a significant difference in suicide risk between men and women were partly in parallel with the mixed results about gender differences reported by previous studies (Borges et al., 2010; Miranda-Mendizabal et al., 2019). As young men are more likely to engage with more serious suicidal behaviors than young women (Emiral et al., 2022; Miranda-Mendizabal et al., 2019; Turecki & Brent, 2016), the risk for suicide in men might be higher than for women in our group. Yet, it may also be that gender alone is not the sole factor accounting for suicidal behaviors. Differential exposure to varied risk factors, such as childhood abuse and trait anger, may be the underlying cause of the found difference (Canetto & Sakinofsky, 1998; Hawton, 2000). The significant mediating role of trait anger could explain the relationship between childhood trauma and suicide risk, as well as mixed results of gender differences in the literature. Childhood abuse and neglect may be related to a generalized anger problem on a trait level that contributes to vulnerability to suicidal behaviors. This explanation was supported in the current sample, in which history of childhood trauma and trait anger scores were significant predictors of suicide risk score in both men and women. Similarly, men reported higher scores on childhood trauma history as well as trait anger measures than women, and this might explain higher risk for suicide in men. This was demonstrated in a mediation model in the current work, showing that trait anger might mediate the association between childhood trauma and suicide risk in young adults. However, the increased suicide risk for men may be a product of some unexamined factor not addressed by the study, such as internalization and externalization.

The significant mediating effect of trait anger supports the previously reported mechanism explaining the relationship between childhood maltreatment and suicidal behaviors (Charak et al., 2016; Daniel et al., 2009; Swogger et al., 2011). The results from this research are consistent with previous research findings, as the proposed model explains both the relationship between trait anger and suicidal thoughts/behaviors in clinical and general populations (Kämpfer et al., 2016), and the reported associations between childhood adversity and suicide risk (Zatti et al., 2017). These findings suggest preventive interventions for suicidal behavior, and monitoring of young adults who have generalized aggressive tendencies with a history of early maltreatment, may be important. Further research is needed to investigate the mediating effect of anger on the relationship between childhood trauma and suicide risk, including other important factors such as depressed mood and externalization/internalization traits.

There are several study limitations. As this was not a clinical sample, results may not be generalizable to clinic groups. However, this can also be regarded as a strength, as studies on suicidal behavior were generally conducted on clinical samples (Hawton et al., 1996). This could provide an opportunity to investigate the role of childhood trauma and trait anger on suicidal risk in non-clinical samples. A higher proportion of women in the current dataset may also limit the generalizability of results. Yet, similar results were drawn, re-running the analyses on a randomly selected subset of the data with an equal number of men and women (results are available upon request). Another limitation might be using retrospective reports of childhood abuse and neglect. Although assessment of maltreatment history retrospectively and based on self-reports is a general practice, using a multi-informant approach by collecting data from different sources like parents has been suggested by Wherry et al. (2013) as important for increasing reliability. Future studies could include maltreatment data from various sources and, perhaps ideally, employ a longitudinal design. The sample in the present study comprised young adults who have been reported to be more vulnerable to suicidal thoughts and behaviors (Borges et al., 2010; WHO, 2021). Future studies may focus on other age groups to investigate possible age-related changes in the predictors of suicide risk and mediating effects. The present study focused on testing a relationship between childhood trauma history, anger on a trait level, and overall suicidal risk. Solely analyzing total scores may have provided a general picture of the suggested relationship, but also reduced the chance of Type 1 error due to multiple comparisons. Replicating current findings and investigating the dynamics of the reported relationship of childhood trauma-anger-suicide further (e.g., effects of different abuse types, anger expression, and various forms of suicidal thoughts/behaviors) is needed.

The present study extends prior research on gender differences in suicide risk and suggests a model identifying the mediating role of trait anger on the relationship between childhood trauma and suicide risk in early adulthood. As suicide is one of the major causes of death in young adulthood, these results underscore the need for monitoring possible vulnerable groups, especially those with childhood abuse/neglect history and dispositional anger. Using tailored assessment tools and future research for developing preventive interventions for these groups may help to reduce suicidal behaviors in young adults.

Footnotes

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.

ORCID iD

Esra Zıvralı Yarar

Author Biographies

Esra Zıvralı Yarar, PhD, is an Assistant Professor in the Faculty of Social Sciences and Humanities at Social Sciences University of Ankara. Her research focuses on risk and resilience factors for mental health problems with a specific interest in autism spectrum disorder. She is interested in understanding biological and environmental influences (including history of maltreatment) for developing psychological disorders and developing effective interventions for treatment and/or prevention.

Burcu Pinar Bulut, PhD, is a Clinical Psychologist and a Research Assistant in the Psychology Department at Ankara Haci Bayram Veli University. She conducted various research on health anxiety, loneliness and child abuse. Since 2015, she has been working on Lacanian Psychoanalysis.

Hatice Demirbaş, PhD, is a Professor in the Psychology Department at Ankara Haci Bayram Veli University. Her research focuses on child abuse and neglect, substance use and addiction, psychopathology and forensic psychology. She is interested in screening and preventing sexual assault against women in the society.

References

Ammerman

B. A.

Kleiman

E. M.

Uyeji

L. L.

Knorr

A. C.

McCloskey

M. S.

(2015). Suicidal and violent behavior: The role of anger, emotion dysregulation, and impulsivity. Personality and Individual Differences, 79, 57–62. https://doi.org/10.1016/j.paid.2015.01.044

Aslan

S. H.

Alparslan

Z. N.

(1999). Çocukluk örselenme yaşantıları ölçeğinin bir üniversite öğrencisi örnekleminde geçerlik, güvenirlik ve faktör yapısı (The validity, reliability, and factor structure of the Childhood Trauma Questionnaire in a college student sample). Türk Psikiyatri Dergisi, 10(4), 275–285.

Bachmann

(2018). Epidemiology of suicide and the psychiatric perspective. International Journal of Environmental Research and Public Health, 15(7), 1425–1447. https://doi.org/10.3390/ijerph15071425

Baron

RM.

Kenny

(1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037//0022-3514.51.6.1173

Bernstein

DP.

Fink

Handelsman

Foote

Lovejoy

Wenzel

Sapareto

Ruggiero

(1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. The American Journal of Psychiatry, 151(8), 1132–1136. https://doi.org/10.1176/ajp.151.8.1132

Borges

Nock

Haro Abad

, et al. (2010). Twelve-month prevalence of and risk factors for suicide attempts in the WHO World Mental Health Surveys. The Journal of Clinical Psychiatry, 71(12), 1617–1628. https://doi.org/10.4088/JCP.08m04967blu

Bostwick

Pabbati

Geske

McKean

(2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100. https://doi.org/10.1176/appi.ajp.2016.15070854

Briggs-Gowan

Carter

Ford

(2012). Parsing the effects violence exposure in early childhood: Modeling developmental pathways. Journal of Pediatric Psychology, 37(1), 11–22. https://doi.org/10.1093/jpepsy/jsr063

Bruffaerts

Demyttenaere

Borges

, et al. (2010). Childhood adversities as risk factors for onset and persistence of suicidal behaviour. The British Journal of Psychiatry, 197(1), 20–27. https://doi.org/10.1192/bjp.bp.109.074716

10.

Canetto

Sakinofsky

(1998). The gender paradox in suicide. Suicide and Life‐Threatening Behavior, 28(1), 1–23. https://doi.org/10.1111/j.1943-278X.1998.tb00622.x

11.

Cano-Montalbán

Quevedo-Blasco

(2018). Sociodemographic variables most associated with suicidal behaviour and suicide methods in Europe and America. A systematic review. The European Journal of Psychology Applied to Legal Context, 10(1), 15–25. https://doi.org/10.5093/ejpalc2018a2

12.

Charak

Byllesby

Roley

Claycomb

Durham

Ross

Armour

Elhai

(2016). Latent classes of childhood poly-victimization and associations with suicidal behavior among adult trauma victims: Moderating role of anger. Child Abuse & Neglect, 62, 19–28. https://doi.org/10.1016/j.chiabu.2016.10.010

13.

Clogg

C. C.

Petkova

Haritou

(1995). Statistical methods for comparing regression coefficients between models. American Journal of Sociology, 100(5), 1261–1293. https://doi.org/10.1086/230638

14.

Cohen

(1988). Statistical power analysis for the behavioural sciences (2nd ed.). Academic Press.

15.

Cohen

(1990). Things I have learned (so far). American Psychologist, 45(12), 1304–1312. https://doi.org/10.1037/0003-066X.45.12.1304

16.

Colucci

Lester

(2012). Culture, cultural meaning (s), and suicide. In Colucci

Lester

(Eds.), Suicide and culture: Understanding the context (pp. 25–46). Hogrefe.

17.

Cull

J. G.

Gill

W. S.

(1989). Suicide probability scale (SPS). Western Psychological Services.

18.

Daniel

Goldston

Erkanli

Franklin

Mayfield

(2009). Trait anger, anger expression, and suicide attempts among adolescents and young adults: A prospective study. Journal of Clinical Child & Adolescent Psychology, 38(5), 661–671. https://doi.org/10.1080/15374410903103494

19.

De Luca

Franklin

Yueqi

Johnson

Brownson

(2016). The relationship between suicide ideation, behavioral health, and college academic performance. Community Mental Health Journal, 52(5), 534–540. https://doi.org/10.1007/s10597-016-9987-4

20.

Emiral

G. O.

Cevik

Z. A.

Canturk

(2022). Investigation of suicide deaths in Turkey between 2015 and 2019. Journal of Men’s Health, 18. https://doi.org/10.31083/jomh.2021.100

21.

Fergusson

McLeod

Horwood

(2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect, 37(9), 664–674. https://doi.org/10.1016/j.chiabu.2013.03.013

22.

Ford

Grasso

Hawke

Chapman

(2013). Poly-victimization among juvenile justice-involved youths. Child Abuse & Neglect, 37(10), 788–800. https://doi.org/10.1016/j.chiabu.2013.01.005

23.

Giegling

Olgiati

Hartmann

Calati

Möller

Rujescu

Serretti

(2009). Personality and attempted suicide. Analysis of anger, aggression and impulsivity. Journal of Psychiatric Research, 43(16), 1262–1271. https://doi.org/10.1016/j.jpsychires.2009.04.013

24.

Göktaş

Metintaş

(2019). Suicide mortality trends by age, gender and method in Turkey, 2002–2015. Turkish Journal of Public Health, 17(2), 195–206. https://doi.org/10.20518/tjph.442055

25.

Grimmond

Kornhaber

Visentin

Cleary

(2019). A qualitative systematic review of experiences and perceptions of youth suicide. Plos One, 14(6), Article e0217568. https://doi.org/10.1371/journal.pone.0217568

26.

Hawton

(2000). Sex and suicide: Gender differences in suicidal behaviour. The British Journal of Psychiatry, 177(6), 484–485. https://doi.org/10.1192/bjp.177.6.484

27.

Hawton

Fagg

Simkin

(1996). Deliberate self-poisoning and self-injury in children and adolescents under 16 years of age in Oxford, 1976–1993. The British Journal of Psychiatry, 169(2), 202–208. https://doi.org/10.1192/bjp.169.2.202

28.

Hayes

A. F.

(2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Publications.

29.

Hoertel

Franco

Wall

Oquendo

Wang

Limosin

Blanco

(2015). Childhood maltreatment and risk of suicide attempt: A nationally representative study. The Journal of Clinical Psychiatry, 76(7), 916–923. https://dx-doi-org-s.web.bisu.edu.cn/10.4088/JCP.14m09420

30.

Kämpfer

Staufenbiel

Wegener

Rambau

Urbach

Mücke

Geiser

Conrad

(2016). Suicidality in patients with somatoform disorder–the speechless expression of anger? Psychiatry Research, 246, 485–491. https://doi.org/10.1016/j.psychres.2016.10.022

31.

Miranda-Mendizabal

Castellví

Parés-Badell

Alayo

Almenara

Alonso

Blasco

Cebrià

Gabilondo

Gili

Lagares

Piqueras

Rodríguez-Jiménez

Rodríguez-Marín

Roca

Soto-Sanz

Vilagut

Alonso

(2019). Gender differences in suicidal behavior in adolescents and young adults: Systematic review and meta-analysis of longitudinal studies. International Journal of Public Health, 64(2), 265–283. https://doi.org/10.1007/s00038-018-1196-1

32.

Näher

A. F.

Rummel-Kluge

Hegerl

(2020). Associations of suicide rates with socioeconomic status and social isolation: Findings from longitudinal register and census data. Frontiers in Psychiatry, 10, 898. https://doi.org/10.3389/fpsyt.2019.00898

33.

Nock

Borges

Bromet

, et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113

34.

Novaco

R. W.

Chemtob

C. M.

(1998). Anger and trauma: Conceptualization, assessment, and treatment. In Follette

V. M.

Ruzek

J. I.

Abueg

F. R.

(Eds.), Cognitive behavioral therapies for trauma (pp. 162–190). Guilford Press.

35.

O’Connor

R. C.

Nock

M. K.

(2014). The psychology of suicidal behaviour. The Lancet Psychiatry, 1(1), 73–85. https://doi.org/10.1016/S2215-0366(14)70222-6

36.

O’Connor

R. C.

Portzky

(2018). Looking to the future: A synthesis of new developments and challenges in suicide research and prevention. Frontiers in Psychology, 9, 2139. https://doi.org/10.3389/fpsyg.2018.02139

37.

Ozer

A. K.

(1994). Prestudy of the state-trait anger scale and the anger expression scale. Turkish Journal of Psychology, 31, 26–35.

38.

Posner

Oquendo

Gould

Stanley

Davies

(2007). Columbia classification algorithm of suicide assessment (C-CASA): Classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. American Journal of Psychiatry, 164(7), 1035–1043. doi: 10.1176/ajp.2007.164.7.1035. https://doi.org/10.1176/ajp.2007.164.7.1035

39.

Quenneville

Kalogeropoulou

Küng

Hasler

Nicastro

Prada

Perroud

(2020). Childhood maltreatment, anxiety disorders and outcome in borderline personality disorder. Psychiatry Research, 284, 112688. https://doi.org/10.1016/j.psychres.2019.112688

40.

Rubin

D. B.

(1987). Multiple imputation for nonresponse in surveys. Wiley.

41.

Spielberger

C.D.

Jacobs

Russell

Crane

(1983). Assessment of anger: The State-Trait Anger Scale. In Butcher

J.N.

Spielberger

C.D.

(Eds.), Advances in personality assessment (Vol. 2, pp. 159–187). Lawrence Erlbaum Associates.

42.

Spielberger

C. D.

Krasner

S. S.

Solomon

E. P.

(1988). The experience, expression, and control of anger. In Individual differences, stress, and health psychology (pp. 89–108). Springer.

43.

Swogger

You

Cashman-Brown

Conner

(2011). Childhood physical abuse, aggression, and suicide attempts among criminal offenders. Psychiatry Research, 185(3), 363–367. https://doi.org/10.1016/j.psychres.2010.07.036

44.

Tuğcu

(2006). A study various factors related to suicide probability. Kriz Dergisi, 14(2), 17–21. https://doi.org/10.1501/Kriz_0000000248

45.

Turecki

Brent

(2016). Suicide and suicidal behaviour. Lancet, 387(10024), 1227–1239. https://doi.org/10.1016/S0140-6736(15)00234-2

46.

Turkish Statistical Institute (2019). Suicide statistics. Turkish Statistical Institute. Retrieved from https://data.tuik.gov.tr/Kategori/GetKategori?p=nufus-ve-demografi-109&dil=1

47.

Victor

Klonsky

(2014). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34(4), 282–297. https://doi.org/10.1016/j.cpr.2014.03.005

48.

Wetherall

Cleare

Eschle

Ferguson

O'Connor

O'Carroll

O'Connor

(2018). From ideation to action: Differentiating between those who think about suicide and those who attempt suicide in a national study of young adults. Journal of Affective Disorders, 241, 475–483. https://doi.org/10.1016/j.jad.2018.07.074

49.

Wherry

Baldwin

Junco

Floyd

(2013). Suicidal thoughts/behaviors in sexually abused children. Journal of Child Sexual Abuse, 22(5), 534–551. https://doi.org/10.1080/10538712.2013.800938

50.

World Health Organization (2020). Child maltreatment. WHO. Retrieved from https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

51.

World health Organization (2021). Suicide worldwide in 2019. WHO. Retrieved from https://www.who.int/teams/mental-health-and-substance-use/data-research/suicide-data

52.

World Health Organization (2022). Suicide. WHO. Retrieved from https://www.who.int/health-topics/suicide#tab=tab_1

53.

Zatti

Rosa

Barros

Valdivia

Calegaro

Freitas

Ceresér

KMM

Rocha

NSD

Bastos

Schuch

(2017). Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade. Psychiatry Research, 256, 353–358. https://doi.org/10.1016/j.psychres.2017.06.082