Exploring the impact of suicide on clinicians: a multidisciplinary retreat model

Interventions to support medical trainee well-being after patient death: A scoping review

BACKGROUND

Medical trainees are at the forefront of end-of-life care provision in the hospital setting but often feel unprepared to manage the complex emotions after patient death.

OBJECTIVES

To systematically identify and synthesize the published literature on interventions to support medical trainees dealing with patient death.

METHODS

Searches were conducted in MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL, and ERIC from inception to June 30, 2023. English language peer-reviewed publications of interventions to support medical students and residents/fellows dealing with patient death. Studies of practicing clinicians and nonphysician healthcare trainees were excluded. Two reviewers independently determined study eligibility. Discrepancies were resolved through consensus and a third reviewer served as a tiebreaker if needed.

RESULTS

Of the 9107 articles retrieved, 973 underwent full-text review, and 50 studies met inclusion criteria. Most interventions targeted residents (n = 32; 64%) and were conducted in North America (n = 45, 90%). Types of interventions included preventive measures involving educational lectures and workshops (n = 19; 38%), clinical placements (n = 10; 20%), and postventions (n = 16; 32%), including debriefing and memorial services. Several interventions incorporated the arts (n = 5; 10%), including movies, drama, and artwork, and most incorporated reflective narratives (n = 16; 32%). Most interventions were limited in frequency and duration.

CONCLUSIONS

This review identified several interventions to support trainees through the experience of patient death but also highlighted areas for improvement. Strengthening support for medical trainees will foster emotionally resilient physicians who are better equipped to deliver high-quality, empathetic care to dying patients and their families.

Prevalence and impact of patient suicide in psychiatrists: Results from a national French web-based survey

BACKGROUND

Patient suicide (PS) is known to be a frequent and challenging occupational hazard for mental health professionals. No study previously explored the prevalence and impact of PS in a large sample of French psychiatrists.

METHOD

A national web-based survey was performed between September and December 2019 to assess (a) the prevalence of the exposure to PS, (b) the emotional, traumatic and professional impacts of PS, and (c) the perceived support in the aftermath of PS in French psychiatrists. Participants were contacted through email to answer the online 62-item questionnaire, including a measure of traumatic impact through the Impact of Event Scale-Revised. Emotional and professional impacts and perceived support were assessed through dedicated items.

RESULTS

A total of 764 psychiatrists fully completed the survey. Of them, 87.3% reported an exposure to PS and 13.7% reported PTSD symptoms afterward. Guilt, sadness and shock were the most frequent emotions. Among the exposed psychiatrists, 15.1% have temporarily considered changing their career path. The most emotionally distressing PS occurred during their ten first years of practice or during residency. A total of 37.1% of respondents felt unsupported and 50.4% reported that no team meeting had been organized in the aftermath. The feeling of responsibility for the death was strongly associated with negative impacts.

CONCLUSION

Our results entail considerations to prevent negative mental health outcomes in psychiatrists after PS. Notably, our results advocate for the implementation of educational programs during psychiatric residency and postvention programs in healthcare settings to effectively help psychiatrists in dealing with PS.

Mental Health and Social Care Professionals After a Patient Suicide: Interrelation Between Support Needed, Sought, and Received

This article investigates the support needed, sought, and received by professionals following a patient suicide. A self-administered questionnaire about the consequences of patient suicide and support issues was completed by 704 professionals. Profiles of support were defined using a 3-dimensional, 8-fold typology based on need for, search for, and sufficiency of support. Stress reactions, professionals' characteristics, relationship with the patient, training, and providers of support were used to characterize the profiles. Most professionals acknowledged receiving sufficient support to manage the aftermath of patient suicide. Almost two thirds of the respondents who received sufficient support reported either not needing or seeking support or both needing and seeking support. Almost 1 in 10 respondents who reported needing and seeking support received insufficient support. Stress reactions were highest among professionals who needed but did not receive sufficient support. Professionals who did not need or seek support were less often in a relationship with the patient at the time of the suicide and less frequently felt close to or responsible for the patient than those who needed and sought support. Trained professionals were overrepresented among those who reported receiving sufficient support while they were less likely to report needing and seeking support or receiving insufficient support. Findings concerning support and its relationship to risk and protective factors suggest the need to adopt a multidimensional approach that distinguishes among support needed, sought, and received. Although an association may exist between perceived stress and need for support, involvement of professionals in the patient relationship may also be linked with the search for support, while training may be associated with receipt of sufficient support.

The SUPPORT-S Protocol Study: A Postvention Program for Professionals After Patient or User Suicide

Background

Exposure to patient or user suicide (PUS) is identified as a challenging occupational hazard for mental health and social work professionals. Professionals exposed to PUS may encounter several ranges of emotional, traumatic or professional impacts in the aftermath. A high proportion of exposed professionals reports a lack of support in the aftermath of PUS. SUPPORT is a postvention program designed to provide a comprehensive, adaptative and effective support to professionals impacted by PUS. The aims of the SUPPORT-S study are to (1) improve the design of the SUPPORT program, (2) evaluate the effectiveness of the program to buffer the emotional, traumatic and professional impacts and to improve the perceived social support for professionals exposed to PUS, and (3) provide more insights into the consequences of PUS on both professionals and organizations.

Method

The SUPPORT-S study is a mixed method collaborative and participatory action research. The simultaneous and complementary collection and analysis of qualitative and quantitative data will offer an in-depth evaluation of the implementation and the effectiveness of the program. The qualitative evaluation includes: (a) an ethnographic observation; (b) 25 semi-directed interviews with randomized participants; (c) an activity analysis with providers of the program; and (d) collaborative sharing of the results with providers and participants. The quantitative evaluation includes pre- and post-measures in participants of: (a) emotional impact (Differential Emotions Scale IV); (b) traumatic impact (Impact of Event Scale-Revised); (c) professional impact (non-validated questionnaire); and (d) perceived social support (Perceived Social Support Scale for Professionals). The action research design will rely on: (a) the cycling process of implementation/evaluation/data sharing/adjustment and (b) the participatory approach through data sharing with providers and participants. Triangulation, saturation, randomization, and participatory design will also reduce the risk of biases and will improve the generalizability of conclusions.

Expected Results

We expect the SUPPORT-S study to evaluate and improve the design of the SUPPORT program to effectively help professionals to cope with PUS.

Conclusion

The results of the study will allow us to disseminate an effective and adaptive postvention program for professionals and institutions encountering PUS.

Psychiatrist facing litigation

Malpractice is civil wrong actionable by law. It is true, we have statistically an outside chance of getting sued. Among physicians of all specialties, we have, between 2.6% in North America and 1.3% in Europe, chance of facing malpractice suit. But, that is no comfort for one being sued. Malpractice generally involves, among others, wrongdoing or professional misconduct. It may or may not lead to legal action. I describe two cases of malpractice and its impact on the morale of my mental health team. In one case, the family were seeking compensation by claiming "medical negligence" in a trivial mishap. They had involved the local press to "publicize" their claim. In another case, the grievance arose due to anti-electroconvulsive therapy views of the patient's sister. The families decided not to sue us and accepted decisions of local inquiry. Not much is written on this subject in our country. The cases are almost 20 years old but are still relevant. The author describes the harrowing experience of the team members while the investigation was on. Fortunately, the inquiry panel concluded the proceedings in just 4 weeks. In addition, the author advises how one can prepare the defense. The readers would find informative the case vignettes and strategy to deal with the crisis.

Stress reactions after a patient suicide and their relations to the profile of mental health professionals

BACKGROUND

Patient suicide is a professional hazard for mental health professionals and an event likely to trigger stress reactions among them. This study aimed to identify typical profiles of professionals after a patient suicide to address the severity of stress reactions and its discriminant variables.

METHODS

Mental health professionals (N = 666) working in institutional settings or private practice in the French-speaking part of Switzerland filled out a self-administered questionnaire including the IES-R (Impact of Event Scale-Revised). Profiles were identified by cluster analysis.

RESULTS

The interplay of variables pertaining to the relationship to the patient, exposure to suicide, support and training contributed to explaining the severity of stress reactions after a patient suicide. Five profiles of professionals were identified. Low-impacted professionals (55.8% of the sample) were characterised either by high support and anticipation (anticipators with support), emotional distance to the patient (distant professionals) or no contact with the patient at the time of death (no more contact with patient professionals). Emotional closeness to, and responsibility for the patient were typical of moderately-impacted professionals (36.6%, concerned professionals), while highly-impacted professionals felt emotionally close to the patient and lacked support although more than half of them sought it (7.7%, unsupported professionals).

CONCLUSIONS

Differences in the professionals' profiles relate prominently to the interplay between risk and protective factors. Professionals who were appropriately supported, i.e., according to their risk profile, were able to cope with the event. Taking into account the profiles of professionals and the severity of stress reactions may enable the screening of those professionals most in need of support. Those most impacted sought out help more frequently. However, only a minority of them were offered sufficient support. Institutional or vocational bodies should take measures to ensure that professionals seeking help find it easily and promptly. The combination of training and support seems to be crucial for mitigating risk factors since the three low impacted subgroups had received the most training and support.

The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others

Eating disorder clinicians from various disciplines participated in one of two surveys: the "self" group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the "other" group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent.

What is the prevalence of the experience of death of a patient by suicide among medical students and residents? A systematic review

OBJECTIVE

The purposes of this study were to examine the literature on the proportion of medical students and residents who experience the death of a patient by suicide and to identify curricula with data on outcomes that assist medical students or residents in preparing for or managing the psychological stress in dealing with those suicides.

METHODS

The authors searched PubMed, Scopus, Google Scholar, and ScienceDirect databases using search terms patient suicide, trainee, medical student, and resident. They conducted a separate search to identify relevant curricula using the same terms in combination with coping, teaching, programs, and education.

RESULTS

Eight studies met inclusion criteria, all of which concerned psychiatry residents alone. We found no studies that determined the prevalence of the experience of death of a patient by suicide among medical students or residents in specialties other than psychiatry. The prevalences were 31, 33, 43, 47, 54, 61, 68, and 69 %. All studies were cross-sectional, and none collected data prospectively. Limitations of these data included single-site studies, lack of clarity of the specific question asked, low response rates, and uncertain reporting periods. The authors found two curricula with outcome data that assisted medical trainees in managing the psychologically distressing consequences of the death of a patient.

CONCLUSION

Although the data are limited, psychiatry residents commonly experience the death of a patient by suicide. There is a paucity of data on this topic concerning the experiences of medical students and of residents in other specialties.

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.