Responding to a Tragedy: Evaluation of a Postvention Protocol Among Adult Psychiatry Residents

Abstract

Objective In a time of “zero suicide” initiatives and rising suicide rates, resident physicians are particularly susceptible to the psychological and professional ramifications of patient suicide. An adult psychiatry residency program developed and implemented a postvention protocol to address the impact of patient suicide among resident physicians. The current study is a formal evaluation of a training program’s postvention protocol from June 2018 to April 2020. Methods Process and outcome indicators were identified to assess protocol implementation and effectiveness. Process indicators included were postvention protocol adherence. Outcome indicators were perceived helpfulness of postvention protocol–related supports, occupational and general health measures, posttraumatic growth, and posttraumatic stress symptoms following resident participation in the postvention protocol. Results Study response rate was 97% (n = 57/59) and 81% completed the entire survey (n = 48/59). Twenty percent of residents (n = 10/48) experienced patient suicide during residency. Postvention protocol adherence was between 57 and 100%. Protocol-related supports, such as speaking with attendings who had previously experienced an adverse event, were more helpful than other supports (p < 0.01). Compared to residents who had not experienced patient suicide, mean work empowerment, burnout, mental health, and quality of life scores were not significantly different from residents who participated in the postvention protocol (p > 0.05). Posttraumatic growth was positively correlated with self-determination at work (p = 0.01). Conclusions The postvention protocol was helpful to residents and potentially effective at mitigating the psychological and professional consequences of patient suicide. Study findings may inform standardization of postvention protocols among psychiatry training programs.

Psychiatric trainees as second victims after exposure to patient suicide: a French qualitative study

“…The resource recommends meeting with a senior clinician who comprehends the impact of PS and can provide confidential advice and support, as well as joining a confidential reflective practice group or space to process the effects of PS. In the study conducted by Agrawal et al in the United States ( 28 ), residents also reported that debriefing with their supervisors was beneficial after PS.…”

“…Employing a team-based debriefing, involving both the trainee and the entire team, can be a useful strategy in mitigating negative emotional and professional outcomes for trainees ( 27 ). According to a recent study assessing a postvention protocol among adult psychiatry trainees in the United States ( 28 ), support from attendings who had previously experienced an adverse event and from the program director was reported to be more helpful than other types of support. In addition, a resource has been produced in the United Kingdom by the Royal College of Psychiatrists ( 29 ) to aid psychiatrists in their recovery from PS.…”

In This Issue: June 2021

“…McCutcheon and Hyman's brief report [12] describes the implementation and evaluation of a curriculum about the consequences to providers of a death by suicide, which covered both the emotional and the medico-legal implications. Agrawal et al [13] report their evaluation of a postvention protocol for residents who experience a patient's suicide. Their study indicates that support provided by the program director and attendings (especially those who have themselves experienced a loss by suicide) is deeply valuable to residents.…”