After suicide: who counsels the therapist?

The Impact of Knowledge of Suicide Prevention and Work Experience among Clinical Staff on Attitudes towards Working with Suicidal Patients and Suicide Prevention

Suicide-preventive training has shown to influence attitudes. This study aimed at investigating what impact other factors than knowledge might have on attitudes towards work with suicidal patients and suicide prevention. In 2007, 500 health-care staff working in a psychiatric clinic in Stockholm received a questionnaire with items concerning work with suicidal patients to which 358 (71.6%) responded. A set of attitude items were tested using structural equation modelling (LISREL). Three models were found to be satisfactory valid and reliable: Job clarity, Job confidence and Attitudes towards prevention. These were then used in regression analyses as dependent variables with predictors such as experience of work with suicidal patients, perceived sufficient training,age and gender. Perceived sufficient training was consistently the most important predictor for all three attitude concepts (p < 0.01, β = 0.559 for Job clarity; p < 0.01, β = 0.53 for Job confidence; p < 0.01, β = 0.191 for Attitudes towards prevention). Age was another significant predictor for Job clarity (p < 0.05, β = 0.134), as was experience of patient suicide for Job confidence (p < 0.05, β = 0.137). It is concluded that providing suicide preventive education is likely to improve attitudes towards the prevention of suicide, clarity and confidence regarding their role in the care for suicidal patients. These improvements may contribute to the prevention of suicide in health care settings.

The impact of patient suicide and sudden death on health care professionals

OBJECTIVE

To compare the professional and personal impact of patient suicide and sudden death on health care professionals (HCPs) and determine factors associated with these impacts.

METHOD

The sample was derived from a sudden death-controlled psychological autopsy study of suicide. HCPs were identified by deceased's next of kin, by other HCPs, from coroners' files and from medical records. The HCPs were interviewed about their last contact with the deceased and the impact of the death on their lives.

RESULTS

Two hundred eleven HCPs were interviewed following suicide; 92 after sudden death. Suicide deaths were significantly more likely to impact upon the HCP's professional practice [suicide n = 79 (37.4%); sudden death n=9 (9.9%); χ(2) = 22.06, P < .001] and personal life [suicide deaths n = 55 (26.1%); sudden death n = 12 (13.0%); χ(2) = 5.58, P = .018] than sudden deaths. Using multinomial logistic regression, being female and suicide within a week of the consultation predicted professional and personal impacts; having less than 5 years experience predicted professional impact and receipt of support/counseling predicted personal impact.

CONCLUSION

Suicide deaths have a greater impact than sudden deaths upon the life of HCPs. Clinical inexperience influences impacts on professional practice and availability of support impacts on personal life.

How therapists react to patient's suicide: findings and consequences for health care professionals' wellbeing

OBJECTIVES

To test the robustness of the findings of previous studies in a large aggregated sample regarding (a) the impact of a patient's suicide on therapist's distress; (b) identify a potential subgroup of therapists needing special postvention; (c) and assess potential differences in overall distress between professional groups and at different levels of care.

METHODS

A questionnaire, characterizing the therapists, their reactions and the patients, had been sent out to 201 psychiatric hospitals in Germany providing different levels of care. Aggregated data from previous studies have been used.

RESULTS

In 39.6% of all cases, therapists suffer from severe distress after a patients' suicide. The global item "overall distress" can be used as an indicator to identify a subgroup of therapists that might need individualized postvention. No significant difference in overall distress experienced was observed between professional groups and at different levels of care.

CONCLUSION

Our data suggest that identifying the severely distressed subgroup could be done using a visual analogue scale for overall distress. As a consequence, more specific, individualized and intensified help could be provided to these professionals, helping them to overcome distress and thereby ensuring delivery of high quality care to the patient.

Patient suicide: the experience of Flemish psychiatrists

The experience of the most distressing patient suicide on Flemish psychiatrists is described. Of 584 psychiatrists, 107 filled a self-report questionnaire. Ninety-eight psychiatrists had been confronted with at least one patient suicide. Emotional suffering and impotence were the most common feelings reported. Changes in professional practice were described and included a more structured approach to the management of suicidal patients. Colleagues and contact with the patient's family were the most frequently used sources of help, whereas team case review and colleagues were rated as the most useful ones. Patient suicide leads to emotional suffering and has a considerable professional impact.

The therapist's reaction to a patient's suicide: results of a survey and implicationsfor health care professionals’well-being

BACKGROUND

A substantial proportion of therapists experience the loss of a patient to suicide at some point during their professional life.

AIMS

To assess (1) the impact of a patient's suicide on therapists distress and well-being over time, (2) which factors contribute to the reaction, and (3) which subgroup might need special interventions in the aftermath of suicide.

METHODS

A 63-item questionnaire was sent to all 185 Psychiatric Clinics at General Hospitals in Germany. The emotional reaction of therapists to patient's suicide was measured immediately, after 2 weeks, and after 6 months.

RESULTS

Three out of ten therapists suffer from severe distress after a patients' suicide. The item "overall distress" immediately after the suicide predicts emotional reactions and changes in behavior. The emotional responses immediately after the suicide explained 43.5% of the variance of total distress in a regression analysis.

LIMITATIONS

The retrospective nature of the study is its primary limitation.

CONCLUSIONS

Our data suggest that identifying the severely distressed subgroup could be done using a visual analog scale for overall distress. As a consequence, more specific and intensified help could be provided to these professionals.

Patient suicide: a survey of therapists' reactions

A substantial proportion of therapists will at some point in their professional life experience the loss of a patient to suicide. Our aims were to assess how therapists react to patient's suicide over time and which factors contribute to the reaction. One third of the therapists, mostly women, suffer from severe distress. The impact is not different for therapists in institutional settings and therapists in private practice. The item "overall distress" immediately after the suicide predicts emotional reactions and changes in behavior. Our data suggest that identifying the severely distressed subgroup could be done using a visual analogue scale for overall distress. As a consequence, more specific and intensified help could be provided to these individuals.

When depression becomes terminal: the impact of patient suicide during residency

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.

Bereavement after Suicide—How Far Have We Come and Where Do We Go from Here?

Summary: This paper identifies major issues faced by the bereaved, the community, and the helping professions after a suicide. Some significant milestones in knowledge and service provision that have been achieved so far are discussed. It considers how past research in the fields of suicide postvention and general bereavement have developed new variables and frameworks with which to find a way forward in understanding this neglected field. The new standards of care and public policy are described that are anticipated in the light of these insights.