This study enhances and replicates an earlier study (Kleespies, Smith, & Becker, 1990) on the incidence and impact of patient suicidal behavior on psychology interns/trainees, using a much larger sample, a broader spectrum of patient suicidal behaviors, and more adequate comparison groups. The findings indicate that more than 1:4 interns/trainees needed to deal with a patient suicide attempt, and that 1:9 had to cope with a patient suicide completion. Stress level followed a graduated increase in impact with increasing severity of patient suicidal behavior (i.e., from suicidal ideation to suicide attempt to suicide completion). Trainees who had a patient suicide were distinguished from those who experienced patient suicide ideation by significantly greater feelings of shock, disbelief, failure, sadness, self-blame, guilt, shame, and depression. Results are discussed in terms of the importance of developing mechanisms to assist trainees in anticipating and working through the strong psychological impact of losing a patient through a self-inflicted death. Some clinical events are sufficiently stressful to precipitate a crisis for clinicians. The loss of a patient by suicide, as well as other patient suicidal behaviors, are prime examples of events PHILLIP M. KLEESPIES was awarded his PhD in clinical psychology from Clark University in 1971. He serves as a Clinical Psychologist on an acute inpatient psychiatry unit at the Veterans Administration Medical Center in Boston. He is also the current Coordinator of Emergency Services for Psychology and the former Director of Psychology Training at the Boston Department of Veterans Affairs (DVA) Medical Center. He is an Assistant Clinical Professor of Psychiatry, Tufts University School of Medicine.

Although consumers more frequently prefer independent living, placement in staffed group housing resulted in somewhat fewer days homeless for some groups of consumers. Further experience of homelessness by formerly homeless mentally ill individuals may be reduced by providing effective substance abuse treatment and by paying special attention to consumers identified by clinicians to be at particular risk for housing loss.

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A sample of 274 Vietnam-era veterans seeking treatment for substance abuse was divided on the basis of combat experience and Diagnostic and Statistical Manual of Mental Disorders (DSM-III; APA, 1980) criteria of Posttraumatic Stress Disorder (PTSD). Veterans with evidence of PTSD were compared with a non-PTSD group of Vietnam combat veterans and a noncombat group of Vietnam-era veterans on measures of specific interpersonal problems using the Horowitz Interpersonal Problem Inventory (Horowitz, 1979), as well as more traditional mea'sures of family and social adjustment and the Minnesota Multiphasic Personality Inventory (MMPI). The PTSD group scored significantly higher on clusters of problems dealing with intimacy and sociability than did either of the comparison groups. PTSD veterans also scored higher on the MMPI scales of Paranoia, Psychopathic Deviate, Social Introversion, Social Maladjustment, Family Problems, and Manifest Hostility but did not differ from other groups on the Family Environment Scale (Moos, 1974) variables. The results, which were not attributable to premilitary adjustment differences or to confounding demographic variables, are compared to previous studies, and research questions that remain outstanding are discussed.