When Depression Becomes Terminal: The Impact of Patient Suicide during Residency

Abstract

Patient suicide often results in profound personal and professional crises for the treating clinicians. Residency training in psychiatry represents a critical time for experiencing the death of patients by suicide. While residents often treat some of the most acutely ill, high-risk patients, during a uniquely vulnerable phase of professional development, many training programs do not have formalized procedures in place for aiding residents in the event of patient suicide. The working through of a suicide offers an opportunity for personal and professional growth. This paper examines this issue from the perspective of a resident-in-training who experienced the suicide of a long-term outpatient. Issues explored include personal and professional reactions to the patient's death as well as a discussion of the organizational response to the event.

The Impact of Patient Suicide on the Professional Reactions and Practices of Mental Health Caregivers and Social Workers

“…In line with earlier studies (Chemtob, Hamada, Bauer, Kinney et al, 1988, Chemtob, Hamada, Bauer, Torigoe et al, 1988; Collins, 2003; Goldstein & Buongiorno, 1984; Grad et al, 1997; Henry et al, 2003, 2004; McAdams & Foster, 2000; Pieters et al, 2003; Pompili, Mancinelli, & Tatarelli, 2002; Yousaf, Hawthorne, & Sedgwick, 2002), respondents in the present survey reported an increased focus on potential suicide cues, reflecting a possibly constructive effect of the event on professional reactions. Similar to previous research there was a long-term effect, i.e., a persistent impact at the time of the survey, in that the professionals felt more anxious about working with suicidal patients (Biermann, 2003; Goldstein & Buongiorno, 1984; Goodman, 1995; Hendin et al, 2000; Henry et al, 2003, 2004; Kleespies et al, 1990; Schnur & Levin, 1985; Söderlund, 2006).…”

Supporting Providers After Drug Overdose Death

“…As noted earlier, it is important for providers to receive support from colleagues after a drug overdose death. After a patient suicide, providers have found it helpful to discuss the case with colleagues and to hear other providers’ experiences with patient deaths from suicide (48). This can also be helpful after an overdose death, as in the example of Dr. Jones listening to Dr. Smith discuss Mr. A’s case and sharing his experiences after patient overdose death.…”

Training as a Psychiatrist When Having a Psychiatric Illness

“…While much has been written about the general stresses of residency (e.g., fatigue and sleep disruption, frustrations from working with uncooperative or demanding patients, demoralization from feeling that efforts are not resulting in substantial patient improvements), psychiatry training has its own relatively unique set of stressors, including adversities associated with aggressive acts by patients towards residents and the suicide of a patient [11,15,16]. Loss of patients is a grave stressor for residents in many fields, but loss by suicide carries unique challenges for the physician [1,15].…”