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.
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Brown HN: The impact of suicide on therapists in training. Compr Psychiatry 1987; 28: 101–112
Litman RE: When patients commit suicide. Am J Psychother 1960; 19: 570–576
Perr HM: Suicide and the doctor-patient relationship. Am J Psychoanal 1968; 28: 177–188
Goldstein LS, Buongiorno PA: Psychotherapists as suicide survivors. Am J Psychother 1984; 38: 392–398
Kleespies PM, Smith MR, Becker BR: Psychology interns as patient suicide survivors: incidence, impact and recovery. Prof Psychol Res Pract 1990; 21: 257–263
Kahne MJ: Suicide among patients in mental hospitals: a study of the psychiatrists who conducted their psychotherapy. Psychiatry 1968; 31: 32–43
Rosen DH: Mental stresses in residency training and opportunities for prevention, in Proceedings of the 1974 Annual Meeting of the American Psychiatric Association. Washington, DC, APA, 1974
Koslowska K, Nunn K, Cousens P: Adverse experiences in psychiatric training, part 2. Aust N Z J Psychiatry 1997; 31: 641–652
Henn RP: Patient suicide as part of psychiatric residency. Am J Psychiatry 1978; 135: 745–746
Hendin H, Lipschitz A, Maltsberger JT, Pollinger Haas A, Wynecoop S: Therapists’ reactions to patients’ suicides. Am J Psychiatry 2000; 157: 2022–2027
Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY: Patients’ suicides: frequencies, and impact on psychiatrists. Am J Psychiatry 1988; 145: 224–228
Kaye NS, Soreff S: The psychiatrist’s role, responses, and responsibilities when a patient commits suicide. Am J Psychiatry 1991;148: 739–743
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, APA, 1994
Horowitz MJ, Wilner N, Alvarez W: Impact of Events Scale: a measure of subjective stress. Psychosom Med 1979; 41: 209–218
Zilberg NJ, Weiss DS, Horowitz MJ: Impact of Event Scale: a cross-validation study and some empirical evidence supporting a conceptual model of stress response syndrome. J Consult Clin Psychol 1982; 50: 407–414
O’Brien K, Wortman CB, Kessler RC, Joseph JG: Social relationships of men at risk for AIDS. Soc Sc Med 1993; 36: 1161–1169
Quintero CV: Psychological impact of patients’ suicides on psychiatrists, in Proceedings of the 1998 Annual Meeting of the American Psychiatric Association. Toronto, Canada, APA, 1998
Alexander DA, Klein S, Gray NM, Dewar IG, Eagles JM: Suicide by patients: questionnaire study of its effect on consultant psychiatrists. Br Med J 2000; 320: 1571–1574
Kravetz P, Etkin M: Encountering suicide: the experience of psychiatric residents, in Proceedings of the 1999 Annual Meeting of the American Psychiatric Association. Washington, DC, APA, 1999
This study was supported by a research grant from the Department of Psychiatry, Mount Sinai Hospital, and the Psychotherapy Program, Department of Psychiatry, University of Toronto. This study was first presented at the Harvey Stancer Research Day of the University of Toronto Department of Psychiatry in June 1996 and at the annual meetings of the American Psychiatric Association (May 1999) and Canadian Psychiatric Association (September 1999).
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Ruskin, R., Sakinofsky, I., Bagby, R.M. et al. Impact of Patient Suicide on Psychiatrists and Psychiatric Trainees. Acad Psychiatry 28, 104–110 (2004). https://doi.org/10.1176/appi.ap.28.2.104
- Academic Psychiatry
- Posttraumatic Stress Disorder
- Patient Suicide
- Administrative Inquiry
- Acute Stress Disorder