Impact of Patient Suicide on Psychiatry Residents

Sue K. DiGiovanni, MD, Scott F. McMahon, MD, Yeates Conwell, MD,

Tana A. Grady-Weliky, MD University of Rochester Medical Center

Department of Psychiatry

1. Brown HN: The impact of suicide on therapist in training. Compr Psychiatry 28:101-112, 1987.

2. Ruskin R, Sakinofsky I, Bagby RM: Impact of patient suicide on psychiatrists and psychiatric trainees. Acad Psychiatry 28:104-110, 2004.

3. Pilkinton P, Etkin M: Encountering suicide: the experience of psychiatry residents. Acad Psychiatry 27:93-99, 2003.

4. Ellis TE, Dickey TO III, Jones EC: Patient suicide in psychiatric residency programs: a national survey of training and postvention practices. Acad Psychiatry 22:181-189, 1998.

5. Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY: Patients’ suicides: frequency and impact on psychiatrists. Am J Psychiatry 145:224-228, 1998.

Discussion References

An American Psychiatric Association Assembly Action paper in November of 2006 declared suicide an occupational hazard for psychiatrists. Studies suggest that about 50% of psychiatrists experience the suicide of a patient during their clinical careers. Few studies address residents’ experiences with patient suicide with varying reported rates. Brown et al. reported 1 in 3 psychiatry residents experienced the suicide of a patient at some point during their psychiatry training experience. Ruskin et al. found that 62% of respondents experienced a patient suicide during residency training.

In order to further explore the incidence and impact of this significant issue, our study consisted of two surveys, one sent to psychiatry residents and another to psychiatry residency program directors. Aims of the surveys included discovering the proportion of residents who had experienced a patient suicide, identifying the emotional sequelae of a patient suicide, and availability of resources and policies to address this issue.

Introduction

Methods

Two related surveys were conducted. One survey was distributed by e-mail to 202 chief residents of U.S. Psychiatry programs and 10 chief residents of Canadian programs using a web based survey tool, Survey Monkey. The chief residents were asked to forward the survey to their resident group. The residents in this group were in their first through sixth years of post-graduate training. The resident survey consisted of 17 questions that addressed:

•Proportion of residents who have experienced a patient suicide

•Emotional sequelae of patient suicide on residents

•Availability of resources to address patient suicideThe second survey was sent by Survey

Monkey to psychiatry residency training directors and associate directors at 181 programs nationally. The program director survey consisted of 9 questions which addressed the following:

•Their attitudes regarding the effect of patient suicide on residents

•Existing policies and procedures•Availability of resources to address patient suicide

Educational Objectives

1) Discover the attitudes regarding patient suicide

2) Determine the effect of patient suicide on psychiatry residents

3) Determine effectiveness of training programs’ responses to patient suicide

4) Determine availability of educational resources to support residents in dealing with patient suicide

5) Compare program directors’ responses to residents’ responses

There are a limited number of studies that address residents’ experiences with patient suicide with anywhere from 33% to 62% of psychiatry residents experiencing the suicide of a patient at some point in their training. In our study 32% of residents experienced a patient suicide during training.

Residents and training directors agreed that patient suicide is an important issue for residents. The majority of residents experienced some level of emotional distress such as anxiety, guilt, isolation, and self doubt. Both residents and training directors considered a change in admitting practices to be a common outcome following a patient suicide. Interestingly, 12% of residents considered changing specialties following the suicide of one their patients while 100% of training directors considered this to be an uncommon outcome.

Although residents and training directors agreed that residents needed more training and education in dealing with patient suicide, there was less agreement about the effectiveness of programs in dealing with patient suicide and education during training about the impact of patient suicide during training. A higher percentage of program directors than residents felt the program dealt effectively with the impact of patient suicide and provided education to residents during training. Residents often turned to preceptors, supervisors, mentors, family, friends and other residents for support following a patient suicide. Of the 33% of program directors who reported having a risk management policy regarding patient suicide, the majority had no formal policy, but rather instructed residents to contact hospital risk management.

The impact of patient suicide is significant. More effective ways to educate and deal with the emotional and administrative aftermath of patient suicide might benefit individual residents dealing with patient suicide, the larger resident group, and future clinical practice.

Results

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% R

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Consideredchanging specialty

Changed admittingpractices

Sustained emotionalsequelae

Figure 4: ResidentsRank the following outcomes based on your experience

with a patient suicide.

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

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% R

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StronglyAgree

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Figure 3: The program deals effectively with the impact of patient suicide on psychiatry residents.

Resident

Director

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% R

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Strongly Agree Agree Undecided Disagree StronglyDisagree

Figure 1: Psychiatry residents should have more training and education in dealing with the impact of patient suicide.

Resident

Director

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Yes No Don't Know

Figure 2: Does your residency program have an educational component regarding the impact of patient suicide on residents?

Resident

Director

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Changing specialty Change inadmissionpractices

Sustainedemotional sequelae

Figure 5: Program DirectorAmong residents who have experienced a patient suicide, how common are the

following outcomes?

Most Common

Somewhat Common

Uncommon

% Resident Respondents

% Program Director Respondents

Impact:•Impact of patient suicide on psychiatry residents is an important issue•Impact of patient suicide is comparable to loss of friend or colleague

N/A

45%

98%

N/A

Outcomes:•Resident experienced sustained emotional sequelae(e.g. depression, PTSD)•Resident experienced distress •Resident considered change in specialty•Change in resident admitting practices

5%

87% mild/moderate12%24%

52%

N/A0%73%

Resources:•Resident utilized preceptor/supervisors for support following a patient suicide

60% 100%

Educational Component:•Program has educational component regarding impact of patient suicide on residents•Program dealt effectively with impact of patient suicide on residents•More training and education needed in dealing with the impact of patient suicide•Program has a risk management policyfor patient suicide

18%

32%

53%

N/A

40%

61%

82%

33%

•340 of 4776 residents surveyed responded for a response rate of 7%•108 (or 32%) of the responding residents reported experiencing a patient suicide during training•44 of 181 program directors responded for a response rate of 24%