Patient Suicide: Impact on the Psychiatrist and the Health Care System

It is estimated that 25% to 60% of psychiatrists will experience patient suicide. Although psychiatrists understand that the suicide of a patient is an expectable event, its actual occurrence can be devastating. As the adage says, “There are two kinds of psychiatrist: those who have lost a patient to suicide, and those who will.”  To the extent the patient is in the care of a mental health team, ...it can be devastating to the team, as well.

  • This psychiatrist recalls the impact of a patient’s suicide during his residency forty years earlier. He notes, “. . . since that tragic event, she remains a reoccurring and sustaining presence. . .”  (See ‘A Senior Psychiatrist Recalls the Impact of a Patient’s Suicide During Residency’)
  • In his forty-three years of practice, the psychiatrist Peter Olsson details his experience of patient suicide, the impact it had on him, and the steps he took to manage the distress with his patients’ relatives—and with himself. See ‘Suicides of Several of My Patients’.
  • Eric Plakun and Jane Tillman note that studies of 38% of clincians who have experienced patient suicide suffer extreme distress. Most commonly, psychiatric residents and early career psychiatrists are most vulnerable when patients suicide. See https://www.psychiatrictimes.com/apa/impact-patient-suicide-clinicians
  • In their article, “Impact of Patient Suicide on Psychiatrists and Psychiatric Trainees, R. Ruskin , et. al., report that half of the 239 respondents of 495 surveyed experienced at least one suicide.  They note that “biologically oriented psychiatrists were more at risk for patient suicide.” See https://link.springer.com/article/10.1176/appi.ap.28.2.104  Additional references are cited.
  • In a survey of 174 psychiatrists on the effects of patient suicide, Gibbons et. al. note that “Clinical practice was often negatively affected, and over a quarter of respondents considered a change of career path as a result. There were some gender differences in responses, with women reporting more sense of responsibility for the deaths and a greater effect on their clinical confidence.” See https://www.cambridge.org/core/journals/bjpsych-bulletin/article/effects-of-patient-suicide-on-psychiatrists-survey-of-experiences-and-support-required/96DDE04D9A4D6DC916E4588E8F6D4952/core-reader
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  • In the introduction of a special issue of the journal Psychodynamic Psychiatry, Jane Tillman introduces articles that address the matter of patient suicide (see below for links).  The paper by Gloria Reeves, a resident, describes the suicide of a short-term therapy patient. Bernard Biermann, also a resident, provided psychopharmacologic support in a split-treatment with a colleague who provided psychotherapy.  In the final paper we offer in the series, Donald Misch, a director of residency training, examines how procedures that elaborate reviews of sentinel events, such a patient suicide, can inflict additional distress on residents who have suffered loss of a patient through suicide.
    With appreciation, we acknowledge Psychodynamic Psychiatry for permission to make these articles available in full. These articles are copyright 2003 by The American Academy of Psychodynamic Psychiatry and Psychoanalysis. All rights are reserved under International Copyright Convention. No part of this text may be reproduced, transmitted, downloaded, or stored in or introduced into any information storage or retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the written permission of The American Academy of Psychodynamic Psychiatry and Psychoanalysis.
    Tillman, J (2003). Frontline: The suicide of the patient and the quiet voice of the therapist. 31:425-428. https://guilfordjournals.com/doi/pdf/10.1521/jaap.31.3.425.22138
    Reeves, G (2003). Terminal mental illness: Resident experience of patient suicide. 31:429-442. https://guilfordjournals.com/doi/pdf/10.1521/jaap.31.3.429.22135
    Biermann, B (2003). When depression becomes terminal: The impact of patient suicide during residency. 31:443-458. https://guilfordjournals.com/doi/pdf/10.1521/jaap.31.3.443.22130
    Misch, D (2003). When a psychiatry resident 's patient commits suicide: Transference trials and tribulations. 31:459-476. https://guilfordjournals.com/doi/pdf/10.1521/jaap.31.3.459.22134
  • In the article, “Helping Psychiatry Residents Cope with Patient Suicide,” appearing in Academic Psychiatry 38(5):593-597, the authors describe the benefits from “educating residents about patient suicide, common reactions, and steps to attenuate distress while facilitating learning.” The program entails video vignettes and focused discussion.
 See: https://link.springer.com/article/10.1007/s40596-014-0083-1#citeas
    The article is a companion to “’Collateral Damages’: Preparing Residents for Coping with Patient Suicide,” appearing in the same journal 37(429-430) 
See: https://link.springer.com/article/10.1007/BF03340086
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