Impact of Patient Suicide on Psychiatry Residents

1
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
Introduction
Results

• 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

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.
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
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
  suicide
• The 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

Discussion
References

• 1. Brown HN The impact of suicide on therapist
  in training. Compr Psychiatry 28101-112, 1987.
• 2. Ruskin R, Sakinofsky I, Bagby RM Impact of
  patient suicide on psychiatrists and psychiatric
  trainees. Acad Psychiatry 28104-110, 2004.
• Pilkinton P, Etkin M Encountering suicide the
  experience of psychiatry residents. Acad
  Psychiatry 2793-99, 2003.
• Ellis TE, Dickey TO III, Jones EC Patient
  suicide in psychiatric residency programs a
  national survey of training and postvention
  practices. Acad Psychiatry 22181-189, 1998.
• Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe
  RY Patients suicides frequency and impact on
  psychiatrists. Am J Psychiatry 145224-228, 1998.

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.