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Impact of patient suicide on consultant psychiatrists in Ireland

  • Anne Landers (a1), Sinead O'Brien (a1) and Darra Phelan (a2)
Abstract
Aims and method

To study the effects of patient suicide on both personal and professional life of consultant psychiatrists in Ireland. A questionnaire was sent to all practising consultants.

Results

Most respondents (80%) had experienced patient suicide in their careers; in up to 97% it had an impact on either their professional or personal life. The most common effects were preoccupation with the suicide and guilt. Unpredicted suicides and perceived effect on patients' families worsened the distress. Informal support was of most help, with a large proportion of study participants suggesting independent case review would be helpful.

Clinical implications

Patient suicide is an almost universally distressing event for psychiatrists. Although consultants receive psychological support from family and friends, many would also welcome an objective professional review.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Anne Landers (annemtlanders@yahoo.com)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Deary, IJ, Agius, RM, Sadler, A. Personality and stress in consultant psychiatrists. Int J Soc Psychiatry 1996; 42: 112–23.
2 Foley, SR, Kelly, BD. When a patient dies by suicide: incidence, implications and coping strategies. Adv Psychiatr Treat 2007; 13: 134–8.
3 Cryan, EMJ, Kelly, P, McCaffrey, B. The experience of patient suicide among Irish psychiatrists. Psychiatr Bull 1995; 19: 47.
4 Ruskin, R, Sakinofsky, I, Bagby, RM, Dickens, S, Sousa, G. Impact of patient suicide on psychiatrists and psychiatric trainees. Acad Psychiatry 2004; 28: 104–10.
5 Chemtob, C, Hamada, R, Bauer, G. Patients' suicides: frequency and impact on psychiatrists. Am J Psychiatry 1988; 145: 224–8.
6 Alexander, DA, Klein, S, Gray, NM, Dewar, IG, Eagles, JM. Suicide by patients: questionnaire study of its effect on consultant psychiatrists. BMJ 2000; 320: 1571–4.
7 Pilkinton, P, Etkin, M. Encountering suicide: the experience of psychiatric residents. Acad Psychiatr 2003; 27: 93–9.
8 Hendin, H, Pollinger Haas, A, Maltsberger, J, Szanto, K, Rabinowicz, H. Factors contributing to therapists' distress after the suicide of a patient. Am J Psychiatry 2004; 161: 1442–6.
9 Mayou, RA, Ehlers, A, Hobbs, M. Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. Br J Psychiatry 2000; 176: 589–93.
10 Morris, M. The aftermath of suicide. Br J Nurs 1995; 4: 205–8.
11 Gitlin, MJ. A psychiatrist's reaction to a patient's suicide. Am J Psychiatry 1999; 156: 1630–4.
12 Dewar, IG, Eagles, JM, Klein, S, Gray, N, Alexander, DA. Psychiatric trainees' experience of, and reactions to, patient suicide. Psychiatr Bull 2000; 24: 20–3.
13 Department of Health. Help is at Hand: A Resource for People Bereaved by Suicide and Other Sudden, Traumatic Death (2008 edn). Department of Health, 2008 (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_092247.pdf).
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BJPsych Bulletin
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Impact of patient suicide on consultant psychiatrists in Ireland

  • Anne Landers (a1), Sinead O'Brien (a1) and Darra Phelan (a2)
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eLetters

Impact on newly appointed psychiatrists

Eric B Kelleher, Psychiatry Registrar
08 November 2010

Landers et al (The Psychiatrist April (2010) 34: 136-140. doi: 10.1192/pb.bp.109.025312) highlight the impact of suicide on consultant psychiatrists in Ireland. The emotional processing after a suicide has been noted to be not necessarily more difficult than that experienced following other sudden deaths. However certain feelings such as guilt and shame are experienced more often.

To further support the results of this study, we describe a study we undertook in 2003-2004. Using the questionnaire from Alexander et al’s original study, which surveyed consultant psychiatrists in Scotland, We conducted a study into the impact of suicide on consultant psychiatrists in the southern region of the republic of Ireland. Of 74 consultants at that time, 50 responded, a response rate of 67.5%. 80% of consultants had a patient commit suicide under their care. This is a similar figure to that obtained by Landers et al.

In our study, 27.5% of consultants said that their personal lives hadbeen affected by the suicide and 32.5% of consultants said that their professional lives had been affected. These figures are less than those obtained by Landers et al but are similar to those obtained by Alexander et al. They are also similar to those obtained by Cryan et al, who used the Impact of Events Scale to investigate the impact of suicide on Irish consultants in 1995. For the vast majority of those affected, their symptoms had resolved at 3 months.

In all of the Irish studies in this area, 4 out of five consultants have experienced patient suicide. This emphasizes the need to provide training in this area both in terms of risk assessment of suicidal patients but also to highlight to trainees the unfortunate likelihood and impact of patient suicide. Ideally, as Landers et al point out, the sources of help, family and informal peer support, should be raised also. In our study, the majority of those affected in the aftermath of the suicide were recently appointed consultants. This lends support for a system of mentoring outlined by Dean, whereby newly appointed consultants having access to a designated senior colleague who could offer guidance. Such a system already appears to be operating, on an informal basis

Suicide is a complex phenomenon. Strategies for prevention have been instigated in many countries. As the founder of the International Association for Suicide Prevention (IASP) Erwin Ringel wrote “the purpose of suicide prevention is not to simply reduce the suicide rate but to helppeople”. Yet as all the research into consultant and trainees shows, thosewho are expected to provide help to others in the time after suicide may, in fact, be in need of help themselves. Landers et al have highlighted anarea that needs further discussion and acknowledgement.

References: 1. Anne Landers et al, The Psychiatrist (2010) 34: 136-140. doi: 10.1192/pb.bp.109.025312. 2. David A Alexander, BMJ 2000;320(7249):1571 (10 June), doi:10.1136/bmj.320.7249.1571 3. Cryan et al Psychiatric Bulletin (1995) 19, 4-7. 4. Dean A. Advances in Psychiatric Treatment (2000) 9, 164 -165 5. Ringel E, In: Suicide: the philosophical issues. (1980). pp. 205–211
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Conflict of interest: None Declared

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Impact of patient suicide

Srinatha Doniparthi, Speciality Registrar
09 June 2010

Dr Landers raises an important issue, which would be of concern to most psychiatrists (The Psychiatrist April(2010) 34: 136-140. doi: 10.1192/pb.bp.109.025312). Indeed it is very stressful when a patient diesand the potential consequences can be huge, both personally and professionally. This is very well reflected in her study.

It is therefore, no doubt that a patient suicide could possibly have a larger effect on consultant as, most often than not, the buck stops here. However, I was interested in the effect of the same on doctors of other grades in psychiatry too. I therefore conducted an online pilot survey of ‘impact of patient suicide’ with in the trust I work (North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, Staffordshire). A link, http://www.surveymonkey.com/s/7JWWWF3, for the survey was generated and emailed to all the doctors across all grades working in the trust.

The results of the pilot study varied considerably as some doctors (30.4%), especially Foundation/GPVTS trainees, have never come across a patient suicide in their short span of hospital career. Among others (69.6%) who have experienced at least one suicide in their career, a significant number (43.5%) of them were consultants and 27.3% were aged between 40-50 years. More than half (56.5%) of the doctors had experienceda patient suicide within the last 5 years of their practice. Nearly 2/3rd (62.5%) of the respondents were from General Adult Psychiatry.

In relation to their personal life, out of those respondents who haveexperienced a patient suicide, 50% of them suffered with ‘guilt’ and about30% were preoccupied with the suicide for about a month. Majority of them,however, did not experience Sleep disturbance (75%), Low mood (80%) or Decreased confidence (56%). As far as professional life is concerned, 40% showed increased awareness of risk in their future assessments, while 30% considered increased observation level & patient follow up. A further 2/3rds considered increased use of Mental Health Act, while only 6% thought of a career change.

In conclusion, the experience of patient suicide is common in clinical practice. Whilst majority of them are able to cope normally, an important minority suffer both personally and professionally for a limitedtime frame. Support from colleagues and professional reviews should be considered to provide opportunities for learning and improved management of suicide and its aftermath.

References1.Anne Landers et al, The Psychiatrist (2010) 34: 136-140. doi: 10.1192/pb.bp.109.0253122.R. Ruskin, et al, Academic Psychiatry 28:104-110, June 20043.David A Alexander, BMJ 2000;320(7249):1571 (10 June), doi:10.1136/bmj.320.7249.1571
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