Impact of patient suicide on consultant psychiatrists in Ireland

Abstract

Suicide of a patient is a very distressing event for a consultant psychiatrist and can adversely affect both their personal and professional life. Consultant psychiatrists have been shown to have higher levels of work-related exhaustion than their medical and surgical colleagues and patient suicide potentially contributes to this.1 A review of studies from the USA, Canada and the UK suggests that 50-70% of consultant psychiatrists will experience the suicide of a patient at some point in their career.2 Despite it potentially being one of the most distressing events in a psychiatrist's career, the number of studies in the literature is relatively small and there has been only one Irish study to date.3 The studies conducted thus far have all identified patient suicide as a cause of considerable distress, yet it is an event for which training leaves psychiatrists underprepared. We conducted a nationwide study of all consultant adult psychiatrists in Ireland to establish the impact on their personal and professional life. MethodWe sent a confidential postal questionnaire to 292 consultant psychiatrists in Ireland (not including child and adolescent psychiatrists), identified through records held by the Irish Medical Council and the Irish Medical Directory (www.imd.ie) that were cross-checked with each individual hospital. To maintain confidentiality and thus optimise our response rate, the questionnaires were not coded or numbered in any way and were sent with a noncoded, stamped, addressed return envelope. However, each participant was assigned a number and was sent a corresponding numbered envelope and asked to post this simultaneously with their questionnaire, to aid identification of non-responders. Non-responders were contacted again by post after 10 weeks and after a further 8 weeks they were contacted by email if available.We examined each consultant's most recent experience of patient suicide as well as the suicide they perceived to be most distressing. We did not specify that the deaths had to have been recorded as suicides in the coroner's court, instead leaving the choice of case to each individual's judgement.The questionnaire (available from the author on request) was divided into three sections: the first gathered basic demographic data; this was followed by a section relating to the consultant's most recent experience of patient suicide, the individual patient's characteristics, the effect the suicide had on the consultant, both personally and professionally, and what coping strategies they used in its aftermath. The final section of the questionnaire asked the psychiatrists to provide that same information regarding the suicide they had found to be most distressing during their consultant career. Consultants had the opportunity to provide additional information in free-text boxes. Results Study sampleA total of 292 questionnaires were sent. We received 182 responses, of which 4 were excluded owing to incomplete information; this gave us a response rate of 61%. The Aims and method To study the effects...

Patient Suicide: The Experience of Flemish Psychiatrists

“…It adds further evidence that patient suicide is a very common phenomenon for psychiatrists. The frequency of patient suicide experience was considerably higher in this study (92%) than in analogous studies on psychiatrists in Canada (Ruskin et al., ), the United States (Chemtob et al., ), the United Kingdom (Alexander et al., ), and Ireland (Cryan et al., ; Landers et al., ). These data are in line with the higher suicide rate in Belgium than in those countries and with the findings in previous research in Belgian psychiatrist trainees (Pieters et al., ).…”

“…However, there may be a bias due to the probable greater interest of those who have had a patient suicide to participate. It should also be taken into account that data on frequency came from different types of studies, namely cross‐sectionals (e.g., Chemtob et al., ; Landers et al., ), as in this study, and longitudinals (e.g., Brown, ; Ruskin et al., ). Thus, frequency is presented by different epidemiological measures: prevalence and incidence, respectively.…”

“…Despite its relatively frequent nature, patient suicide impact should not be undervalued. Indeed, there is a general agreement in the relevant literature that death by suicide of a patient is a disturbing experience for psychiatrists (Alexander et al., ; Brown, ; Chemtob et al., ; Courtenay & Stephens, ; Cryan et al., ; Landers et al., ; Pieters et al., ; Pilkinton & Etkin, ; Ruskin et al., ; Yousaf et al., ), as well as for others health professionals (e.g., Chemtob et al., ; Gaffney et al., ; Gulfi, Dransart, Heeb, & Gutjahr, ; Kleespies et al., , ; Linke, Wojciak, & Day, ; Wurst et al., ). The literature states that guilt and self‐blame, anger, shock, fear, concerns, loss of self‐confidence, and feelings of incompetence or failure are among the most common reactions reported by psychiatrists whose patient committed suicide.…”

“…Previous research has shown the high prevalence rates of patient suicides among these health professionals, including both graduates and trainees (e.g., Alexander, Klein, Gray, Dewar, & Eagles, ; Pieters, De Gucht, Joos, & De Heyn, ; Pilkinton, & Etkin, ; Ruskin, Sakinofsky, Bagby, Dickens, & Sousa, ). The rates range between 33% (Brown, ) and 80% (Landers, O'Brien, & Phelan, ).…”

“…In the aftermath of a patient suicide, psychiatrists react, simultaneously, according to a common mourning process and to their specific professional role (Litman, ). The most usual emotional reactions reported by psychiatrists include guilt and self‐blame, anger, shock, fear, concern, loss of self‐confidence, and feelings of incompetence or failure (e.g., Chemtob, Hamada, Bauer, Kinney, & Torigoe, ; Cryan, Kelly, & McCaffrey, ; Landers et al., ; Pieters et al., ; Ruskin et al., ). Research indicates that female health professionals express feelings of shame, responsibility, and guilt more often than their male colleagues.…”