Helping psychiatry residents cope with patient suicide

Coping strategies of psychiatrists and psychiatry trainees following patient suicide and suicide attempt: A national cross-sectional study in Saudi Arabia

A patient's suicide or suicide attempt is a challenging experience for psychiatrists. This study aimed to explore the common coping strategies and habits developed by psychiatrists/trainees following such incidents. A self-administered questionnaire was distributed among participants in Saudi Arabia. The study enrolled 178 participants, of whom 38.8% experienced a patient's suicide, 12.9% experienced a patient's severe suicide attempt, and 48.3% did not encounter any suicidal events. The most frequently utilized sources of support were colleagues (48.9%), team discussions (41.3%), and supervisors (29.3%). Only 21.4% received formal education in coping with a patient's suicide. Approximately 94.9% reported a lack of support systems within their institution. The study highlighted the coping strategies most commonly employed by psychiatrists/trainees and revealed that the majority of participants reported no changes in their daily habits. The findings underscore the need for a structured support system and formal educational resources to address the existing deficit. Mental health organizations must take action to ensure adequate resources for healthcare providers.

Scoping Review of Postvention for Mental Health Providers Following Patient Suicide

INTRODUCTION

As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention).

MATERIALS AND METHODS

We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach.

RESULTS

Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels.

CONCLUSIONS

The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.

Psychiatric trainees as second victims after exposure to patient suicide: a French qualitative study

Background

The exposure to patient suicide (PS) has been identified as one of the most frequent and troubling professional experience for psychiatric trainees. Further studies are needed to better understand how residents cope with these experiences and the association between perceived support and the impacts of PS.

Method

In this qualitative study, we aimed to assess the impact of exposure to PS during psychiatric residency on trainees' professional career and practical experience. A total of 19 French psychiatric residents participated in 4 focus-groups performed between November 2017 and May 2019.

Results

A total of 4 thematic clusters were identified through a five-step content analysis, namely: (a) reactions to the exposure; (b) coping strategies; (c) professional impact; and (d) prevention and postvention proposals. All participants described the critical impact of the support provided after PS, especially by their senior staff. Those who felt supported by their superior reported less negative impact, both in emotional and professional dimensions. Participants also shared proposals to improve the prevention and postvention issues related to the exposure to PS.

Conclusion

We performed the first qualitative study based on focus groups on the impact of PS on psychiatric residents, which allowed for an in-depth understanding of the participants' lived experiences of the exposure to PS. The narratives inform the need and means to implement prevention and postvention strategies designed to buffer the negative impact of the exposure to PS in psychiatric trainees.

A cross sectional survey of provider experiences with patient drug overdose death

INTRODUCTION

A record number of drug overdose (OD) deaths occurred in the United States in 2021. We know little regarding the impact of patient drug OD deaths on providers within health care settings. The aim of this study was to assess provider preparedness and experience with patient drug OD death.

METHODS

The study distributed an email invitation to individuals in the Provider Clinical Support System database in December 2020 to complete an anonymous web-based survey. We used multiple choice questions to assess provider demographics, preparedness to cope with patient OD death, and experience with patient OD death. The study evaluated stress associated with patient OD death using the Impact of Event Scale-Revised. We summarized responses using descriptive statistics. Associations between high stress after patient OD death and the impact of the death on clinical practice and the helpfulness of individuals and processes were assessed using Chi-square and Fisher's Exact tests.

RESULTS

Among the 12,204 individuals who read the email invitation, 1064 opened the survey link, and 523 completed the survey. Participants were predominantly physicians (40.2 %) and counselors (25 %), 70 % female, 78.4 % white, with a mean age of 52 years. Among the participants 26.4 % felt at least very well prepared to cope with an OD death, and 27.7 % felt at least very well prepared to support a colleague with a patient OD death. Most respondents (55.1 %) had a history of a patient OD death. Many patient OD deaths were not discussed by providers with other colleagues, but when providers did discuss these deaths providers identified colleagues as being very helpful. Compared to providers with low stress after patient OD death, those with high levels of stress were more likely to refer patients to a higher level of care (p = 0.035).

CONCLUSIONS

Many providers did not feel prepared themselves to cope with a patient OD death or support a colleague following this type of event. Patient OD deaths were a common experience, and providers did not frequently discuss their patient's deaths with others. A patient OD death can change clinical decision-making for providers experiencing high levels of stress related to the OD death.

What Sustains Residency Program Directors: Social and Interpersonal Factors That Foster Recruitment and Support Retention

Residency program directors' careers follow several trajectories. For many, the role is relatively short term, lasting 3 to 5 years, during which time the program director may gain educational and administrative experience. However, a sizeable cohort of program directors have remained as program directors for a decade or more, and some have filled the role for the majority of their careers. Over the years, the role of the academic residency program director has become increasingly affected by administrative responsibilities, including scheduling, documentation, and reporting requirements, along with increasing clinical demands that may conflict with ensuring resident wellness and lead to insufficient time to do the job. Burnout in this role is understandable. Given these obstacles, why should any young faculty member choose to become a training director? The authors of this commentary have each served as a residency program director for decades, aggregating approximately 150 years of program director experiences. Based on their collective reflections, the authors describe social and interpersonal aspects of the program director role that have enhanced their professional satisfaction and well-being. These include overseeing residency cycle events from initial interviews through graduation and certification; assuming leadership and social roles in academic departments; counseling, mentoring, and assisting residents with work-personal life difficulties; and helping trainees and programs weather a variety of traumatic circumstances. These life-enriching experiences can compensate for the challenging aspects of these roles and sustain program directors through exceptionally rewarding careers.

Inpatient Suicides in Late Life: A Retrospective Analysis of a Hospital Group with Nine Psychiatric Clinics

OBJECTIVE

Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation.

METHODS

Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included.

RESULTS

From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods.

CONCLUSIONS

In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.

"You Really Never Forget It!" Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient

OBJECTIVE

Suicide is the second leading cause of death in children, adolescents, and young adults ages 10-34 and the rates continue to rise in the USA. An estimated 30-60% of Psychiatry Residents experience patient suicide during their training. This study aimed to understand trainee and supervisor experiences after the suicide of a patient in order to better inform the supervision and response to such an event.

METHOD

Twenty-seven participants were identified by criterion sampling and recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child and Adolescent Psychiatry fellowship training programs in the New England region of the USA. Semi-structured interviews of trainees and supervisors were conducted and analyzed using inductive thematic analysis.

RESULTS

The death of a patient by suicide was described as a notable event with a significant impact on the professional lives of the participants. The event was typically characterized as having an immediate emotional impact, led to changes in self-efficacy, and a sense of responsibility for the patient's death. Responses to suicide were influenced by modifiable factors such as (1) unpreparedness of individuals, program, and institution and (2) mediating/complicating factors, including the credibility of the supervisor, societal expectations, and specific patient characteristics.

CONCLUSIONS

The death of a patient is a personal and emotional experience for the psychiatrist, for which they do not consistently feel well prepared. The institutional response may be misaligned, more analytical in character and prioritize assessment of risk. There is significant room to improve supervision and preparedness for the death of a patient by suicide.

Increasing Resident Support Following Patient Suicide: Assessing Resident Perceptions of a Longitudinal, Multimodal Patient Suicide Curriculum

OBJECTIVE

Patient suicide is a common experience in psychiatry residency, and its effects on trainees can be profound. There are currently no ACGME Common Program Requirements for education about patient suicide, and a need exists for evidence-based curricula to prepare residents for this difficult outcome.

METHODS

A comprehensive patient suicide curriculum was developed utilizing multiple modes of delivering content, including a training designed to foster built-in support among peers in the healthcare workplace. The content was delivered at intervals over the course of the 2019-2020 academic year for 43 psychiatry residents at The Ohio State University Wexner Medical Center. Pre- and post-curriculum surveys were obtained to assess the resident experience of the new curriculum.

RESULTS

Twenty-seven residents completed the pre-curriculum survey and 25 completed the post-curriculum survey. Results demonstrated statistically significant improvements in ratings of preparedness to deal with the loss of a patient by suicide, preparedness to support a co-resident who has experienced the death of a patient by suicide, program-level support for residents, understanding systems-level and quality processes, and knowledge of what steps to take if finding out a patient has completed suicide.

CONCLUSIONS

A multimodal approach incorporating understanding emotional reactions, provision of support, delineation of procedural issues, and education regarding quality and risk management considerations was effective at improving resident preparedness to cope following a patient suicide.

Responding to a Tragedy: Evaluation of a Postvention Protocol Among Adult Psychiatry Residents

OBJECTIVE

In a time of "zero suicide" initiatives and rising suicide rates, resident physicians are particularly susceptible to the psychological and professional ramifications of patient suicide. An adult psychiatry residency program developed and implemented a postvention protocol to address the impact of patient suicide among resident physicians. The current study is a formal evaluation of a training program's postvention protocol from June 2018 to April 2020.

METHODS

Process and outcome indicators were identified to assess protocol implementation and effectiveness. Process indicators included were postvention protocol adherence. Outcome indicators were perceived helpfulness of postvention protocol-related supports, occupational and general health measures, posttraumatic growth, and posttraumatic stress symptoms following resident participation in the postvention protocol.

RESULTS

Study response rate was 97% (n = 57/59) and 81% completed the entire survey (n = 48/59). Twenty percent of residents (n = 10/48) experienced patient suicide during residency. Postvention protocol adherence was between 57 and 100%. Protocol-related supports, such as speaking with attendings who had previously experienced an adverse event, were more helpful than other supports (p < 0.01). Compared to residents who had not experienced patient suicide, mean work empowerment, burnout, mental health, and quality of life scores were not significantly different from residents who participated in the postvention protocol (p > 0.05). Posttraumatic growth was positively correlated with self-determination at work (p = 0.01).

CONCLUSIONS

The postvention protocol was helpful to residents and potentially effective at mitigating the psychological and professional consequences of patient suicide. Study findings may inform standardization of postvention protocols among psychiatry training programs.

From Burnout to Wholehearted Engagement: A Qualitative Exploration of Psychiatry Residents' Experience of Stress

PURPOSE

Physician burnout is endemic across medical education and has numerous deleterious effects. Given the prevalence and negative effects of burnout, there is an urgent need to understand how residents experience and cope with stress and develop explanatory models that inform the development of more effective interventions.

METHOD

Using a qualitative, constructivist approach informed by grounded theory, the authors conducted semistructured interviews from March to April 2019, in which psychiatry residents were asked about their experiences of stress and how they coped. First- through fourth-year trainees at Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, were invited. Two authors independently and inductively coded deidentified transcripts. A constant comparative approach was used to analyze data and support construction of themes. Theoretic sufficiency was observed after 14 interviews.

RESULTS

The authors constructed an explanatory model for how residents cope with stress and whether they tended toward burnout or wholehearted engagement. The model included 3 themes: self-care, work relationships, and meaning making. Self-care, including time spent with others, provided connection and belonging that bolstered physicians' developing identities. Interpersonal relationships at work profoundly influenced the experience of residents. Positive peer and supervisor relationships enhanced confidence and perseverance. Negative role models and conflict engendered feelings of inadequacy. The ability to shift perspective and build meaning through examining moral values in the face of challenges was crucial for residents who reported success at coping with stress. Residents identified personal psychotherapy as an especially important strategy to facilitate meaning making.

CONCLUSIONS

These findings provide guidance for how residency programs may help residents cope with stress and move away from burnout toward wholehearted engagement. Strategies may include reducing barriers to self-care and to accessing help early in training, creating spaces that promote peer connection and providing training in addressing conflict, and facilitating engagement in meaning-making activities.

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.

Impact of exposure to severe suicidal behaviours in patients during psychiatric training: An online French survey

AIM

Patient suicide (PS) has been identified as a frequent and stressful "occupational hazard" for mental health professionals. Studies are needed to assess the impact on psychiatric trainees of the exposure to severe patient suicidal behaviours.

METHODS

Our cross-sectional study aimed to measure the prevalence of exposure to PS and severe patient suicide attempts (SPSA) in French psychiatric trainees. We also assessed the emotional, traumatic and professional impacts and perceived support in the aftermath through a 62-item online questionnaire that included the French version of the IES-R, a composite emotional score and questions about professional practice and perceived support. All French psychiatric trainees were contacted regarding participation in the study through email and social networks between November 2017 and March 2018.

RESULTS

A total of 409 trainees participated in the survey (response rate = 16.4%). 253 trainees fully completed the questionnaire. Of the 253 trainees, 43.2% were exposed to PS and 13.8% to SPSA. The exposure mostly occurred in the early stage of the training period. Ten to 15% of exposed trainees showed a high level of traumatic and emotional impact and 8.1% exhibited clinically relevant symptoms of post-traumatic stress disorder (PTSD). We found that 21.6% received no support in the aftermath, especially after PS.

CONCLUSION

A large proportion of psychiatric trainees encounter severe suicidal behaviours of patients, and a substantial part of them is highly impacted. Our results thus stress the need for programmes dedicated to the prevention of the deleterious effects of the exposure to PS or SPSA in psychiatric trainees.

The development of patient suicide post-vention guidelines for psychiatry trainees and supervisors

OBJECTIVES

Patient suicide is one of the most stressful events for psychiatrists and psychiatry trainees. However, there is often a lack of consistent guidance and support available to clinicians, including post-vention. The aim of this paper is to describe the development of a resource that could support psychiatry trainees following patient suicide.

METHODS

Following a literature review, we adapted two US patient suicide post-vention guidelines to reflect local processes and support systems available by consulting a number of key stakeholders in the training programme and district health boards.

RESULTS

The first part of the post-vention guidelines included procedural processes such as the serious incident review process and reporting to coroner's office. The second part included a checklist for trainee, supervisor, local training facilitator and director of training according to the following time frame: first 24 hours, first 1-2 weeks and following months.

CONCLUSIONS

Post-vention guidelines and teaching about patient suicide and its effects could improve the training experience of psychiatry trainees and facilitate the development of resilience as they progress through training.

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.

Encountering Patient Suicide During Psychiatric Training: An Integrative, Systematic Review

BACKGROUND/AIM

Patient suicide is an adversity that can be considered an "occupational hazard." It has been identified as one of the most stressful adverse events during psychiatric training. The aim of this study was to systematically review the literature assessing the impact of patient suicide on trainees.

METHODS

We conducted a systematic review on the MEDLINE, Science Direct, Scopus, and Web of Science databases. Studies that reported prevalence of patient suicide, quantitative or qualitative assessment of psychological and professional impacts, coping strategies, and support or educational and postvention programs were deemed eligible for inclusion.

RESULTS

Of the 1994 articles identified, 22 were included. The literature on the topic was scarce, and the quality of the studies was moderate. No article dealt with nonpsychiatric residents. During their training, 46.4% of psychiatric trainees encountered at least one patient suicide. The traumatic impact was significantly more intense in trainees compared to senior physicians. A negative impact on their professional practice was reported by 17% to 39% of trainees. Formal institutional support for the affected trainees was described as having major shortcomings, and informal support from peers and families was reported as the most helpful response. However, 52% of impacted trainees considered encountering patient suicide a useful and beneficial experience.

CONCLUSION

The frequent posttraumatic symptoms and the negative professional consequences following patient suicide are worrying phenomena that highlight the need to improve suicide prevention and postvention programs during psychiatric training. Identifying trainees with personal vulnerability factors should be a major concern during the postvention process.

Adverse Events in Obstetrics: Impacts on Providers and Staff of Maternity Care

Objective

To determine the frequency of maternity health employee experiences with maternal and perinatal/neonatal adverse outcomes and gain a deeper understanding of how these experiences impact the providers. 

Design

Single-institution observational study from 2016.

Setting

The George Washington University Hospital.

Population

Labor and delivery, postpartum, and neonatal intensive care staff.

Methods

An anonymous survey was distributed to maternity staff inquiring about feelings surrounding maternal and perinatal/neonatal adverse outcomes. Predictors included demographics and job-related variables. Associations were examined using univariable and multivariable analyses.

Main Outcome Measures

Outcomes included depression, post-traumatic stress disorder symptoms, and work-related problems following the event.

Results

 A total of 105 employees of approximately 230 eligible employees answered the survey, including obstetrics and gynecology and anesthesia physicians (residents and attendings), midwives, nurses, nurse practitioners, and medical technicians with a response rate of 46%. Being a physician was protective against symptoms of depression and post-traumatic stress disorder symptoms. Resident physicians had higher levels of anxiety/depression compared to attendings. Statistically significant variables predictive of negative repercussions included non-physician status (p=.045), substance use (p=.0036), considering a career change (p<.0001) and seeking mental health treatment (p=.0005). About half of the respondents were aware that processes exist to help them cope with adverse outcomes.

Conclusions

Non-physicians, those using substances, those considering career change, and those seeking mental health treatment are more likely to experience anxiety/depression and post-traumatic stress symptoms after a maternal or perinatal/neonatal loss. These individuals should be identified and offered additional support.

Clinician Response to a Child Who Completes Suicide

Although suicide is a leading cause of death for children and adolescents, there is a dearth of literature on clinician responses to suicides in that age group. However, most psychiatrists experience the death of a patient by suicide, with resulting grief reactions including shock, isolation, rumination, self-doubt, and impact on clinical decision making. The impact is more pronounced in trainee clinicians. Postvention is the clinical, administrative, legal, and emotional processes following a suicide. These processes are discussed in detail, with recommendations for policies and training that assist clinicians with this tragic, but common, professional crisis.

The Impact of Patient Suicide on the Professional Practice of Swiss Psychiatrists and Psychologists

OBJECTIVES

Many psychiatrists and psychologists are likely to experience a patient suicide at a point in their professional career. The present paper examines the effects of patient suicide on psychiatrists' and psychologists' professional reactions and working practices and investigates factors that may affect the severity of repercussions on their professional lives.

METHOD

Data from 271 psychiatrists and psychologists working in various institutional settings and in private practice in French-speaking Switzerland were collected by a written questionnaire.

RESULTS

Psychiatrists and psychologists reported a range of professional reactions and changes in working practices following a patient suicide. Professional reactions and changes in working practices were more significant among women. The length of therapy and the emotional closeness with the deceased patient were predictive of a greater impact. In contrast, social and psychological support served as a protective factor by reducing negative repercussions on professional practice. Finally, the impact of losing a patient to suicide did not differ between psychiatrists and psychologists in institutional settings and those in private practice.

CONCLUSION

Although patient suicide affected the professional life of psychiatrists and psychologists, it also encouraged them to review and adjust their working practices.

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.

Suicide Response Guidelines for Residency Trainees: A Novel Postvention Response for the Care and Teaching of Psychiatry Residents who Encounter Suicide in Their Patients

Suicide is an event that is almost universally encountered by psychiatrists and psychiatry residents. Because psychiatric patients are at a higher risk for completing suicide than patients of other specialties, psychiatry residents are at risk for experiencing the suicide of a patient during their training. A review of the literature shows that there is continually growing research into the negative emotional effects of patient suicides on psychiatry residents and the need for clear response protocols when a suicide occurs, also known as postvention protocols. However, there are no Graduate Medical Education requirements to specifically train psychiatry residents about this, even with a well-voiced desire by residents to receive this training. In the National Capitol Consortium Psychiatry Residency, encounters with patient suicides by residents in a time of war led us to a place in which interventions were designed and instituted to care for the caregiver, in this case focusing on psychiatry trainees. Our process and product, described here, offers an example of a systematic postvention response. It addresses aspects of what is known in the research base, combined with acknowledgement of the human response and the institutional need for a consistent and objective response.