Anger as a Predictor of Suicidal Ideation in Prisoners: an Ecological Momentary Assessment Study

Suicidal ideation and behaviour are common among inmates. Anger is found at exaggerated levels and has been associated with suicidal ideation and behavior in inmate samples suggesting its possible salience in the prediction of suicide. The study investigated relationships between anger, psychological distress, and suicidal ideation among inmates. The principles of Ecological Momentary Assessment were considered and a structured self-assessment diary was utilised to examine relationships between the variables of interest. Participants completed a structured self-assessment diary for six consecutive days which included momentary ratings of items describing psychological states of concurrent affects, thoughts, and appraisals related to anger, psychological distress, and suicidal ideation. Psychometric assessment measures were also conducted. Temporal associations between predictors and outcomes were investigated. Multilevel modelling analyses were performed. Increased anger was significantly associated with concurrent high levels of suicidal ideation in inmates, when controlling for depression and hopelessness. Temporal analyses also revealed that anger at one time point did not predict suicidal ideation at the next time point. Elucidating the temporal nature of the relationship between anger, psychological distress, and suicidal ideation has advanced understanding of the mechanisms of suicidal behavior, by demonstrating an increased risk of suicide when a male inmate is angry.