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Impact of Patient Suicide on Psychiatrists and Psychiatric Trainees

Dr. Ruskin, Dr. Sakinofsky, Dr. Bagby, Ms. Dickens, and Mr. Sousa are all from the Joint General Psychiatry Program, Mount Sinai Hospital, Toronto, Canada, and the Centre for Addiction and Mental Health (Clarke Division), University of Toronto, Toronto, Canada. Address correspondence to Dr. Sakinofsky, Suicide Studies Program and High Risk Consultation Clinic, University of Toronto, 250 College St., Toronto, Ont. M5T 1R8.

Objective: The authors investigated the impact of patient suicides on trainees and psychiatrists and their utilization of supports. Methods: Graduates in practice and trainees of the residency program of the University of Toronto from 1980–1995 (N=495) were surveyed, retrospectively, with 239/495 responding (48%). Demographic and educational information, exposure to suicide, impact of the suicide(s), use of support systems, acute stress disorder and posttraumatic stress disorder symptoms, and impact of events and social relationship scores were collected. Results: One-half of the respondents (120/239) experienced at least one suicide of a patient, 62% of them (74/120) during postgraduate training. Biologically oriented psychiatrists in practice were more at risk for patient suicide. An important minority (one-quarter) among those who experienced patient suicide had substantially higher (morbid) scores than the overall group. They also scored higher on an acute stress disorder and a posttraumatic stress disorder symptom checklist. The impact was more severe when the patient suicide occurred during training than after graduation and was inversely correlated with clinicians' perceived social integration into their relational professional network. Conclusions: The experience of patient suicide is common during training and in clinical practice. The majority of trainees and clinicians are able to cope normally with the trauma, but in an important minority the emotional impact approaches morbid levels. Training programs should prepare students for this occupational hazard and implement systematic protocols to support those trainees who are especially vulnerable to their patient's suicide and reduce their social isolation from their peer group. Formal and informal professional networks should heighten awareness of the impact of patient suicide on practicing colleagues and take adequate measures to support them.

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