Anger-Related Affect and Suicidal Thoughts and Behaviors: A Systematic Review and Meta-Analysis.

Objective: Growing evidence indicates anger-related affect (i.e., anger, hostility, and irritability) is a transdiagnostic risk factor for suicide. The goal of this meta-analysis was to systematically review the literature and calculate the effect size of these relationships. Method: We examined the relationships between suicidal thoughts and behaviors and anger, irritability, and hostility with data from 107 published studies (total N = 141,434). Results: Our analyses uncovered a moderate-sized average correlation (r = .31) between anger-related affect and suicidal thoughts and behaviors. There were no significant differences between the effect size estimates of the three separate anger constructs. Studies assessing suicide attempts were associated with significantly lower effect sizes than studies assessing death by suicide or suicidal ideation. Studies that assessed suicidal thoughts and behaviors using a clinical interview were associated with lower effect size estimates than those assessing via self-report or chart review. Additionally, studies that assessed current suicidal thoughts and behaviors were associated with higher effect size estimates versus those that assessed lifetime occurrence. Studies that assessed suicide in an outpatient setting were associated with lower effect sizes than those in community, inpatient, or forensic settings. There were no other significant moderators (i.e., sociodemographic or study design variables) of the relationship between overall anger and suicide. Conclusions: Findings highlight the importance of anger as a potential risk factor for suicide. Future research is needed to examine these relationships longitudinally and to look at different facets of anger (e.g. experience vs. expression).