Objective: The authors investigated the impact of patient suicides on trainees and psychiatrists and their utilization of supports. Methods: Graduates in practice and trainees of the residency program of the University of Toronto from 1980–1995 (N = 495) were surveyed, retrospectively, with 239/495responding (48%). Demographic and educational information, exposure to suicide, impact of the suicide(s), use of support systems, acute stress disorder and posttraumatic stress disorder symptoms, and impact of events and social relationship scores were collected. Results: One-half of the respondents (120/239) experienced at least one suicide of a patient, 62% of them (74/120) during postgraduate training. Biologically oriented psychiatrists in practice were more at risk for patient suicide. An important minority (one-quarter) among those who experienced patient suicide had substantially higher (morbid) scores than the overall group. They also scored higher on an acute stress disorder and a posttraumatic stress disorder symptom checklist. The impact was more severe when the patient suicide occurred during training than after graduation and was inversely correlated with clinicians’ perceived social integration into their relational professional network. Conclusions: The experience of patient suicide is common during training and in clinical practice. The majority of trainees and clinicians are able to cope normally with the trauma, but in an important minority the emotional impact approaches morbid levels. Training programs should prepare students for this occupational hazard and implement systematic protocols to support those trainees who are especially vulnerable to their patient’s suicide and reduce their social isolation from their peer group. Formal and informal professional networks should heighten awareness of the impact of patient suicide on practicing colleagues and take adequate measures to support them.

https://rd.springer.com/content/pdf/10.1176%2Fappi.ap.28.2.104.pdf

Impact of patient suicide on psychiatrists and psychiatric trainees.

As the overwhelmingly most common cause of death from psychiatric disorders, suicide has been the topic of many books, research articles, and philosophical treatises (1–3). In the literature on suicide, among the least commonly discussed topics is the reaction of mental health professionals when one of their patients in treatment commits suicide. This relative silence is especially noteworthy given that a substantial proportion of the more than 30,000 individuals who commit suicide yearly in the United States have been in treatment with a mental health professional, and many more have had recent contact with a primary care physician (4). In the following case discussion, interspersed with a review of the sparse relevant literature, the responses of one clinician to a patient’s suicide are presented.

https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/ajp.156.10.1630

A psychiatrist's reaction to a patient's suicide.

Combining theoretical and empirical material, this paper outlines why mistakes and acts which might be regarded as mistakes are an important vehicle for analyzing the social organization of professional work. It investigates a major event of potential error in psychiatry-suicide of a patient-as a means of understanding basic beliefs and organizational feature of the psychiatric profession. Based on participant observation and interviews, the evidence is also supported by all previous studies on this subject. In presenting its argument, the paper brings together a body of psychiatric literature on professional response to suicide not previously organized.

Psychiatry and Suicide: The Management of a Mistake

Self-mutilation in combat-related PTSD.

Randomly selected clinical psychologists, psychiatrists, and oncologists were mailed a questionnaire assessing attitudes toward suicide and the personal, professional, and societal values which underlie these attitudes. Suicides in the face of physical illness were judged to be significantly more acceptable than suicides committed in response to chronic psychiatric illness. Psychologists were most accepting, and oncologists least accepting, of suicide in response to chronic pain. There were no significant differences in the acceptability of suicide between those professionals who had experienced suicidal ideation themselves and those who had not.

Attitudes of clinical psychologists, psychiatrists, and oncologists toward suicide

Suicide and the doctor-patient relationship

The process in psychoanalysis

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Suicide and the doctor-patient relationship

The process in psychoanalysis