ior. Self-reported ideation, however, was not predicted by alcohol consumption, but rather by the severity of depression and family dysfunction.

Comorbidity of Psychiatric Disorders

Comorbidity of psychiatric disorders with other psychiatric illnesses including substance use disorders or with somatic disorders increases risk of suicide (Lönnqvist, 2000). Co-occurrence of mental disorders and substance abuse disorders increases the risk of suicide beyond that for each of these disorders singly (Suominen et al., 1996). Methodological practices in psychiatry present obstacles to understanding this increased risk posed by comorbidity. It is common to provide only one “primary” psychiatric diagnosis (e.g., Roy and Draper, 1995). Since this primary diagnosis is often the only one analyzed, important data on co-occurrence of disorders is minimized or lost. Some researchers believe it is the co-occurrence of psychiatric disorders itself that mediates suicide risk (Goldsmith et al., 1990). The importance of comorbidity may be part of the increased risk for suicide that cumulative risk factors confer.

PSYCHOLOGICAL DIMENSIONS OF SUICIDE RISK

Information from a number of fields has converged over the last 30 years on an understanding of how genetic, developmental, environmental, physiological, and psychological factors all effect health through multiple, complex causal pathways (IOM, 2001). A growing body of data shows that the physiological responses to stress are potent contributors to physical illnesses including cardiac diseases and cancer, as well as mental disorders including depression and post-traumatic stress disorder (Heim et al., 1997; Nemeroff, 1996). The physiological response to stress can be modified through psychosocial components (e.g., Koenig et al., 1997), including learning new coping skills and thinking habits (Antoni et al., 2000; Bandura, 1992; Cruess et al., 2000a; 2000b).

These psychosocial and learning interventions significantly improve psychological responses to stressors, as well (e.g., Antoni et al., 2001; Cruess et al., 2000b; Gillham et al., 1995; Jaycox et al., 1994; Wyman et al., 2000). “Resilience” represents positive adaptations in the face of life stress. Resilience has been studied alternately as an individual trait or quality, an outcome, or, more recently, as an interactive process of positive factors and negative factors within and between individuals and their environments (see Glantz and Sloboda, 1999; Kaplan, 1999; Kumpfer, 1999, for reviews). Psychological research on resilient outcomes largely focuses on habits of thinking, problem solving, and expectations about the future



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