Encountering Suicide: The Experience of Psychiatric Residents

Pilkinton, Patricia

doi:10.1176/appi.ap.27.2.93

Cited by 64 publications

(39 citation statements)

References 16 publications

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“…2,6 Informal support from colleagues was identified by the majority of respondents as the most effective support, which is again reflective of other studies. 6,7 However, the number seeking formal and independent reviews suggests that, although many receive psychological support from family and friends, consultants would also welcome an objective review from a professional view point. It is likely that such service, protected from legal disclosure, would be welcomed, although rather surprisingly fear of legal consequences was rarely cited by our respondents as a factor increasing their distress.…”

Section: Discussionmentioning

confidence: 99%

“…This ambivalence towards employer-provided support is mirrored in Pilkinton & Etkin's study. 7 Formal interventions should ideally be evidence-based and those availing themselves of them should be cognisant of the dangers as well as the benefits of debriefing. 9 Chemtob et al identified a lack of established protocols to help a psychiatrist in the aftermath of a suicide.…”

Section: Discussionmentioning

confidence: 99%

“…Chemtob et al 5 and Hendin et al 8 both identified trainee psychiatrists and those with less experience to be at greater risk of distress after a patient dies by suicide, and thus highlight the need for training; in one study only a third of psychiatric residents had received any instruction in this area. 7 Such training should emphasise the likelihood of experiencing patient suicide and prepare the psychiatrist for their potential personal and professional reactions. It should also emphasise help-seeking, pointing to the finding that fellow professionals and family have been found most helpful.…”

Section: Discussionmentioning

confidence: 99%

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Impact of patient suicide on consultant psychiatrists in Ireland

2010

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Suicide of a patient is a very distressing event for a consultant psychiatrist and can adversely affect both their personal and professional life. Consultant psychiatrists have been shown to have higher levels of work-related exhaustion than their medical and surgical colleagues and patient suicide potentially contributes to this.1 A review of studies from the USA, Canada and the UK suggests that 50-70% of consultant psychiatrists will experience the suicide of a patient at some point in their career.2 Despite it potentially being one of the most distressing events in a psychiatrist's career, the number of studies in the literature is relatively small and there has been only one Irish study to date.3 The studies conducted thus far have all identified patient suicide as a cause of considerable distress, yet it is an event for which training leaves psychiatrists underprepared. We conducted a nationwide study of all consultant adult psychiatrists in Ireland to establish the impact on their personal and professional life. MethodWe sent a confidential postal questionnaire to 292 consultant psychiatrists in Ireland (not including child and adolescent psychiatrists), identified through records held by the Irish Medical Council and the Irish Medical Directory (www.imd.ie) that were cross-checked with each individual hospital. To maintain confidentiality and thus optimise our response rate, the questionnaires were not coded or numbered in any way and were sent with a noncoded, stamped, addressed return envelope. However, each participant was assigned a number and was sent a corresponding numbered envelope and asked to post this simultaneously with their questionnaire, to aid identification of non-responders. Non-responders were contacted again by post after 10 weeks and after a further 8 weeks they were contacted by email if available.We examined each consultant's most recent experience of patient suicide as well as the suicide they perceived to be most distressing. We did not specify that the deaths had to have been recorded as suicides in the coroner's court, instead leaving the choice of case to each individual's judgement.The questionnaire (available from the author on request) was divided into three sections: the first gathered basic demographic data; this was followed by a section relating to the consultant's most recent experience of patient suicide, the individual patient's characteristics, the effect the suicide had on the consultant, both personally and professionally, and what coping strategies they used in its aftermath. The final section of the questionnaire asked the psychiatrists to provide that same information regarding the suicide they had found to be most distressing during their consultant career. Consultants had the opportunity to provide additional information in free-text boxes. Results Study sampleA total of 292 questionnaires were sent. We received 182 responses, of which 4 were excluded owing to incomplete information; this gave us a response rate of 61%. The Aims and method To study the effects...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of patient suicide on consultant psychiatrists in Ireland

2010

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“…The authors comment on training directly; clinicians should be sensitized to various cultural perspectives on suicide and trained in the ethical standards of the profession to prevent and manage suicidal behaviours. As others have argued (Coverdale, Roberts, & Louie, 2007;Fang et al, 2007), psychiatry training programmes should teach suicide care as an integral part of training and should prepare trainees for the possibility of a suicide of a patient and to learn how best to respond to the suicide of a patient (Balon, 2007;Ellis, Dickey, & Jones, 1998;Hamaoka et al, 2007;Mangurian, Harre, Reliford, Booty, & Cournos, 2009;Melton & Coverdale, 2009;Pilkinton & Etkin, 2003;Ruskin, Sakinofsky, Bagby, Dickens, & Sousa, 2004;Schwartz, Kaslow, & McDonald, 2007;Sockalingam, Flett, & Bergmans, 2010;Sudak, 2007).…”

Section: Special Groupsmentioning

confidence: 99%

Global challenges and ethics in protecting and promoting the interests of psychiatrically ill patients

Coverdale¹,

Roberts²

2010

International Review of Psychiatry

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“…Mental Health professionals have reported that difficulties in assessing risk arise from inadequate knowledge of risk factors and inadequate interpersonal skills. Additionally some physicians identify inadequate applied risk assessment skills as contributing to their personal distress following a patient suicide (Pilkington & Etkin 2003).…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of a vignette approach to teaching suicide risk factors: An Omani perspective

Norrish

2009

Medical Teacher

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This within subjects study assessed the effectiveness of a previously published vignettes approach to the teaching of suicide risk factors in a cohort of students in an Omani medical school. As part of their learning, students were asked to rank four case descriptions for suicide risk, after which there was a specific discussion of the cases and of suicide risk assessment. A previous study had shown significant and dramatic improvement in students from a US university. However the students in this study showed a very different profile of learning about suicide risk from this activity. They had particular difficulty in weighing risk and protective factors when determining relative risk. The impact of cultural and religious context on the effectiveness of this learning activity is discussed. It is clear that there is a continuing need for evaluation and research as to the efficacy of developments in medical education as they are applied in international medical schools with students of different cultural and religious backgrounds.

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Encountering Suicide: The Experience of Psychiatric Residents

Abstract: Suicide is a commonly encountered, stressful event for trainees. Additional supports, education, and policies should be implemented to address this issue.

Cited by 64 publications

References 16 publications

Impact of patient suicide on consultant psychiatrists in Ireland

Impact of patient suicide on consultant psychiatrists in Ireland

Global challenges and ethics in protecting and promoting the interests of psychiatrically ill patients

The effectiveness of a vignette approach to teaching suicide risk factors: An Omani perspective

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