Helping Psychiatry Residents Cope with Patient Suicide

Abstract

Objective

Every clinical specialty has its own high risk patient challenges that threaten to undermine their trainees’ professional identity, evolving sense of competence. In psychiatric training, it is patient suicide, an all-too frequently encountered consequence of severe mental illness that may leave the treating resident perplexed, guilt-ridden, and uncertain of their suitability for the profession. This study evaluates a patient suicide training program aimed at educating residents about patient suicide, common reactions, and steps to attenuate emotional distress while facilitating learning.

Methods

The intervention was selected aspects of a patient suicide educational program, “Collateral Damages,”—video vignettes, focused discussions, and a patient-based learning exercise. Pre- and post-survey results were compared to assess both knowledge and attitudes resulting from this educational program. Eight psychiatry residency training programs participated in the study, and 167 of a possible 240 trainees (response rate = 69.58 %) completed pre- and post-surveys.

Results

Knowledge of issues related to patient suicide increased after the program. Participants reported increased awareness of the common feelings physicians and trainees often experience after a patient suicide, of recommended “next” steps, available support systems, required documentation, and the role played by risk management.

Conclusions

This patient suicide educational program increased awareness of issues related to patient suicide and shows promise as a useful and long overdue educational program in residency training. It will be useful to learn whether this program enhances patient care or coping with actual patient suicide. Similar programs might be useful for other specialties.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Gitlin M. A psychiatrist’s response to patient’s suicide. Am J Psychiatr. 1999;156(10):1630–4.

    PubMed  CAS  Google Scholar 

  2. 2.

    Ruskin R, Sakinofsky I, Bagby RM, Dickens S, Sousa G. Impact of patient suicide on psychiatrists and psychiatric trainees. Acad Psychiatry. 2004;28(2):104–10.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY. Patients’ suicides: frequency and impact on psychiatrists. Am J Psychiatr. 1988;145(2):224–8.

    PubMed  CAS  Google Scholar 

  4. 4.

    Fang F, Kemp J, Jawandha A, Juros J, Long L, Nanayakkara S, et al. Encountering patient suicide: a resident’s experience. Acad Psychiatry. 2007;31(5):340–4.

    PubMed  Article  Google Scholar 

  5. 5.

    Balon R. Encountering patient suicide: the need for guidelines. Acad Psychiatry. 2007;31(5):336–7.

    PubMed  Article  Google Scholar 

  6. 6.

    Brown HN. The impact of suicide on therapists in training. Compr Psychiatry. 1987;28(2):101–12.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Prabhakar D, Anzia J, Balon R, Gabbard G, Gray E, Hatzis N, Lanouette N, Lomax J, Puri P, Zisook S. “Collateral damages”: preparing residents for coping with patient suicide. Academic Psychiatry. In press

  8. 8.

    Coverdale JH, Roberts LW, Louie AK. Encountering patient suicide: emotional responses, ethics, and implications for training programs. Acad Psychiatry. 2007;31(5):329–32.

    PubMed  Article  Google Scholar 

  9. 9.

    Lerner U, Brooks K, McNiel DE, Cramer RJ, Haller E. Coping with a patient’s suicide: a curriculum for psychiatry residency training programs. Acad Psychiatry. 2012;36(1):29–33.

    PubMed  Article  Google Scholar 

  10. 10.

    Pilkinton P, Etkin M. Encountering suicide: the experience of psychiatric residents. Acad Psychiatry. 2003;27(2):93–9.

    PubMed  Article  Google Scholar 

  11. 11.

    Melton BB, Coverdale JH. What do we teach psychiatric residents about suicide? A national survey of chief residents. Acad Psychiatry. 2009;33(1):47–50.

    PubMed  Article  Google Scholar 

  12. 12.

    Brownstein M. Contacting the family after a suicide. Can J Psychiatry. 1992;37(3):208–12.

    PubMed  CAS  Google Scholar 

  13. 13.

    Schwartz AC, Kaslow NJ, McDonald WM. Encountering patient suicide: a requirement of the residency program curriculum. Academic Psychiatry. 2007;31(5):338–9.

    PubMed  Article  Google Scholar 

  14. 14.

    Engel KG, Rosenthal M, Sutcliffe KM. Residents’ responses to medical error: coping, learning, and change. Acad Med. 2006;81(1):86–93.

    PubMed  Article  Google Scholar 

  15. 15.

    Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007–14.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Khaneja S, Milrod B. Educational needs among pediatricians regarding caring for terminally ill children. Arch Pediatr Adolesc Med. 1998;152(9):909–14.

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Cynthia L. Arfken, Ph.D. for her invaluable assistance with statistical analysis, Glen Gabbard, M.D., Emily Gray, M.D., Nicholas Hatzis, M.D., Nicole Lanouette, M.D., James Lomax, M.D., and Paul Puri, M.D. for courageously providing their personal narratives on Collateral Damages and the John A Majda, MD Foundation for its support of the production and dissemination of Collateral Damages.

Disclosure

Dr. Seritan is the PI of a student wellness grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). The other authors have no disclosures.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Deepak Prabhakar.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Prabhakar, D., Balon, R., Anzia, J.M. et al. Helping Psychiatry Residents Cope with Patient Suicide. Acad Psychiatry 38, 593–597 (2014). https://doi.org/10.1007/s40596-014-0083-1

Download citation

Keywords

  • Patient suicide
  • Psychiatry residents
  • Curriculum