The impact on mental health practitioners of the death of a patient by suicide: A systematic review

Abstract

There is a growing body of research investigating the impact on mental health professionals of losing a patient through suicide. However, the nature and extent of the impact is unclear. This systematic review synthesizes both quantitative and qualitative studies in the area. The aim was to review the literature on the impact of losing a patient through suicide with respect to both personal and professional practice responses as well as the support received. A search of the major psychological and medical databases was conducted, using keywords including suicide, patient, practitioner, and impact, which yielded 3,942 records. Fifty‐four studies were included in the final narrative synthesis. Most common personal reactions in qualitative studies included guilt, shock, sadness, anger, and blame. Impact on professional practice included self‐doubt and being more cautious and defensive in the management of suicide risk. As quantitative study methodologies were heterogeneous, it was difficult to make direct comparisons across studies. However, 13 studies (total n = 717 practitioners) utilized the Impact of Event Scale, finding that between 12% and 53% of practitioners recorded clinically significant scores. The need for training that is focused on the impact of suicides, and the value placed upon informal support was often cited. The experience of losing a patient through suicide can have a significant impact on mental health professionals, both in terms of their personal reactions and subsequent changes to professional practice. The negative impact, however, may be moderated by cultural and organisational factors and by the nature of support available.

The impact of patient suicidal behavior on the personal and professional well-being of mental health providers: A systematic review.

“…Fourth, the present review synthesized evidence on patient suicidal behavior including both attempted and death by suicide, which extends findings from previous reviews (e.g., Sandford et al, 2021). Our findings identified a gap in the empirical literature with only two studies (Leaune et al, 2021;Scupham & Goss, 2020) comparing the impact between death by suicide and attempted patient suicide.…”

“…Previous studies have identified impacts of client suicidal behavior falling within the domains of personal and professional functioning (Leaune et al, 2019; Sandford et al, 2021; Séguin et al, 2014). Two comprehensive systematic reviews on this topic, conducted seven years apart, corroborated the professional and personal impact of patient suicidal behavior on mental health providers (Séguin et al, 2014; Sandford et al, 2021). Séguin and colleagues (2014) highlighted methodological drawbacks that required further addressing.…”

“…Moreover, whilst subsequent systematic reviews have been carried out by Puttagunta et al (2014) and Leaune et al (2019) in this area, these reviews included studies that specifically sampled psychiatry trainees. A more recent review conducted by Sandford and colleagues (2021) indeed offered an updated synthesis of the contemporary evidence on the impact of patient death by suicide on mental health professionals. However, similarly to previous systematic reviews, this review (Sandford et al, 2021) only included studies that focused on death of a patient by suicide without being inclusive of studies examining the impact of attempted patient suicide.…”

“…A more recent review conducted by Sandford and colleagues (2021) indeed offered an updated synthesis of the contemporary evidence on the impact of patient death by suicide on mental health professionals. However, similarly to previous systematic reviews, this review (Sandford et al, 2021) only included studies that focused on death of a patient by suicide without being inclusive of studies examining the impact of attempted patient suicide. Because the operationalization of suicidal behavior encompasses both death by suicide and/or attempted suicide (American Psychiatric Association, 2013), it is important to obtain an updated synthesis of evidence that will holistically evaluate patient suicidal behavior.…”

Integrating a functional view on suicide risk into idiographic statistical models

“…Because of this unpredictability, clinicians often refuse to accept suicidal patients, refer those that become suicidal, or even terminate care with patients who attempt suicide after contractually agreeing not to do so (Linehan et al, 2012;Stanley & Brown, 2012). Many clinicians feel responsible for the lives of their patients and fear liability risks as well as the traumatizing impact of losing a patient to suicide (Linehan et al, 2012;Sandford et al, 2020), and find little comfort in a research on risk factors that oftentimes do not help in clinical decision-making (Burger et al, 2020).…”