showing good mental health outcomes (Durlak, 1997; Durlak and Wells, 1997; NRC, 2002). Chapter 8 describes school-based coping skills training programs that appear to reduce youth suicide. Longitudinal studies of children at risk for behavioral and mental health problems reveal that effective problem-solving skills correlate with positive outcomes in adulthood (Felsman and Vaillant, 1987; Rutter and Quinton, 1984; Werner, 1995).

The psychological variables reviewed in this section interact with each other and with environmental and biological factors in their influence on suicidality. Yet these attributes have not been broadly addressed in an integrated way. Coping, attributional style, and self-efficacy beliefs have largely been studied separately from hopelessness and suicidality. As described in Chapter 8, recent suicide prevention programs across the world have incorporated skills training and efficacy enhancement into their efforts, and evaluation of such interventions should yield critical information about the relationship between these variables and suicide.

Temperament and Personality

Research shows that mental health and the experience of stress is confounded with aspects of temperament and personality—individuals higher in emotionality report more negative life events and daily stresses than individuals lower in emotionality (Aldwin et al., 1989). One longitudinal study of older men found that personality characteristics accounted for 25 percent of the variance in mental health (Levenson et al., 1988). Classic studies linking certain personality types high in hostility, anger, stress, and anxiety to a greater susceptibility to coronary heart disease (for review, see IOM, 2001), along with evidence showing that subjective, rather than objective, life stress predicts suicidal outcomes among depressed patients (Malone et al., 2000) highlight the importance of disentangling the relationships between temperament, personality, stress and suicide. Chapter 5 provides a developmental perspective on how stress can affect psychology, but the converse also needs to be better understood. The various personalities and temperaments of individuals may necessitate different treatment, intervention, and prevention strategies for suicidality.

Two temperament types, impulsive/aggressive and depressive/withdrawn, are highly associated with suicide in adults (Kotler et al., 2001; Plutchik, 1995) and in adolescents (Apter et al., 1995; Brent et al., 1994). A cluster analysis of personality traits (Rudd et al., 2000) revealed that three clusters of personality traits describe 97 percent of suicidal psychiatric patients:



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