Suicide is an overarching social concern that affects all age groups. In recent years, there has been growing concern regarding the increasing rates of suicidal tendencies among adolescents. The National Youth Risk Behavior Survey (YRBS) in the United States showed that 8.4% of high school students attempted suicide one or more times in the previous 12 months (Centers for Disease Control and Prevention, 2007). In Korea, 11.6% of middle and high school students reported attempting suicide, which is a higher rate than that for their U.S. counterparts (H.S. Kim & Kim, 2008). Suicide was one of the two most prevalent causes of death in Korean adolescents, and the first leading cause of death among girls in 2006 (Korea National Statistical Office, 2007).
Persons with suicidal tendencies are categorized into three groups: those with suicidal ideation, those who attempted suicide, and those who have completed suicide (Linehan, 1986). In the YRBS survey, 16.9% of participants (21.8% of girls and 12.0% of boys) reported seriously considering suicide in the past 12 months (Centers for Disease Control and Prevention, 2007). The prevalence of suicidal ideation was higher than the rate of suicide attempt (Centers for Disease Control and Prevention, 2007), and suicidal ideation may be the earliest recognition o-f suicidal tendencies (Keane, Dick, Bechtold, & Manson, 1996). This paper focuses on suicidal ideation, which may lend itself to being an indicator of when to initiate actions most likely to prevent an actual suicide attempt.
Risk factors for suicidal tendencies among adolescents have been reported by numerous studies. These include the relationships between various personality and temperamental factors and adolescents' susceptibility to suicidal tendencies such as anxiety, depression, anger, aggression, impulsivity, and helplessness (Conner, Meldrum, Wieczorek, Duberstein, & Welte, 2004; Fennig et al., 2005; Horesh, Orbach, Gothelf, Efrati, & Apter, 2003; Park, Schepp, Jang, & Koo, 2006). Social, familial, and environmental factors were also studied to determine the extent of their influence on suicide risk in adolescents (Heo, 2007; Park et al., 2006). A lack of social support is a significant predictor of suicidal ideation, whereas strong family support protects adolescents from suicidal ideation (Heo, 2007). Park et al. found that parental divorce and parental alcohol abuse are significant predictors of suicidal ideation, particularly for boys. Sexuality, body image, and social challenges may result in further stress to the adolescent that could lead to a state of depression, which is the most common cause of suicide (Giddens, 2007). Experience at school is another significant factor determining the vulnerability to suicide. Dealing with school-related stress including building and maintaining close peer relationships, completing day-to-day school work, getting good grades, and being accepted in prestigious colleges places adolescents at increased risk for suicidal ideation (Giddens, 2007).
Among those identified risk factors, anger has long been considered crucial in the development of suicidal tendencies (Goldney, Winefield, Saebel, Winefield, & Tiggeman, 1997). If a person is not allowed to or is unable to express anger outwardly, anger turned inwards may result in depression, guilt, shame, anxiety or lethargy (Tavris, 1989). Adolescents encounter many anger-producing situations, such as disappointment, pain, and frustration. A major problem for adolescents is lack of skills and resources required to manage and express anger in acceptable ways (Jones, Peacock, & Christopher, 1992). Adolescents may be unable to express anger to persons in authority positions, such as mothers, fathers or teachers. This is particularly true in Korean culture, which considers suppressing anger as a good deed or a virtue. This can be seen in Chon's report (1999) that "loved ones" as the target of anger was quite low in Korea (2%) compared to the U. …