Medical students' responses to an inpatient suicide: opportunities for education and support

Non-Qualified Staff's Experience of Suicidal Behaviour in Adult Mental Health Inpatient Services

Suicide and attempted suicide of people receiving care in Adult Mental Health Inpatient Services (AMHIS) leads to significant emotions amongst mental health professionals, characterised by guilt and shame. A sense of responsibility occurs due to hospital being seen as a safe place. However, little is known about what it is like for 'non-qualified' staff. This study explored experiences of suicide and attempted suicide on 'non-qualified' staff in AMHIS. Semi-structured interviews explored ten staff's experiences. Participants were recruited online and transcripts were analysed using Reflexive Thematic Analysis. Four themes were identified; 'Direct personal impact', 'Unrealistic expectations', 'Attempting to contain the impact' and 'Acclimatisation'. Ten sub-themes outlined; responsibility for assessing risk, shame and protective strategies to aid acceptance. The results provide insight into the unique experience of non-qualified staff in AMHIS experiencing suicidal behaviour.

Prevalence of trauma- and stress-related symptoms in psychiatrists and trainees following patient suicide in the United States

PURPOSE

Global studies show patient suicides among psychiatrists, including trainees, range from 33 to 80%. To our knowledge, there is no such data in the United States following a single study in 1988 regarding psychiatrists' or resident trainees' emotional response to patient suicide. The objective of our study was to assess the stress- and trauma-related symptoms following patient suicide in practicing psychiatrists and trainees.

METHODS

Data were collected by sending an online version of the survey to randomly selected psychiatrists and residency programs throughout the United States. Program directors were requested to share the questionnaires with their residents and fellows in training. Participants' stress was assessed by the impact of event scale-revised version (IES-R).

RESULTS

Our study shows 324 (63.6%) of the participants experienced patient suicide, which included 292 psychiatrists (76.1%) and 31 trainees (27.2%). Among the respondents, 3.8% of the psychiatrists and 9.7% of the trainees had clinically significant stress- and trauma-related disorders.

CONCLUSION

The presence of higher levels of emotional exhaustion and depression than medical or surgical colleagues depicts the need for training programs, formal and informal support, workshops, or curricular changes to address this almost inevitable issue in a psychiatrist's career.

What is the prevalence of the experience of death of a patient by suicide among medical students and residents? A systematic review

OBJECTIVE

The purposes of this study were to examine the literature on the proportion of medical students and residents who experience the death of a patient by suicide and to identify curricula with data on outcomes that assist medical students or residents in preparing for or managing the psychological stress in dealing with those suicides.

METHODS

The authors searched PubMed, Scopus, Google Scholar, and ScienceDirect databases using search terms patient suicide, trainee, medical student, and resident. They conducted a separate search to identify relevant curricula using the same terms in combination with coping, teaching, programs, and education.

RESULTS

Eight studies met inclusion criteria, all of which concerned psychiatry residents alone. We found no studies that determined the prevalence of the experience of death of a patient by suicide among medical students or residents in specialties other than psychiatry. The prevalences were 31, 33, 43, 47, 54, 61, 68, and 69 %. All studies were cross-sectional, and none collected data prospectively. Limitations of these data included single-site studies, lack of clarity of the specific question asked, low response rates, and uncertain reporting periods. The authors found two curricula with outcome data that assisted medical trainees in managing the psychologically distressing consequences of the death of a patient.

CONCLUSION

Although the data are limited, psychiatry residents commonly experience the death of a patient by suicide. There is a paucity of data on this topic concerning the experiences of medical students and of residents in other specialties.

Suicide intervention skills among Japanese medical residents

OBJECTIVES

Patient suicide is a tragic occurrence, and it can be a demoralizing experience for medical residents. Few studies, however, have assessed suicide management skills among these front-line healthcare professionals. This study evaluated the self-assessed competence and confidence of medical residents with regard to the management of potentially suicidal patients and assessed the correlation with the residents' background characteristics.

METHOD

The authors conducted a multicenter, cross-sectional survey of 114 medical residents in Japan, using a modified version of the Suicide Intervention Response Inventory (SIRI-2), the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8), and a 5-point Likert scale to assess confidence in suicide management.

RESULTS

A majority (89.5%) of the residents rated their confidence in managing suicidal patients as Not At All Confident or Rather Not Confident, although most were close to completing their psychiatric rotation. Results on the SIRI-2 suggested intermediate competence in managing suicidal behavior, as compared with that of other healthcare professionals. Competence as indicated by the SIRI-2 score was weakly and negatively correlated with the score for self-perceived Vitality on the SF-8 scale.

CONCLUSION

Insufficient skills and lack of confidence in the management of suicidal patients was observed in this sample of Japanese medical residents, thus highlighting the need for improved suicide-management programs for junior medical residents in Japanese hospitals.

When a soldier commits suicide in Iraq: impact on unit and caregivers

There have been studies about the impact of a suicide on family members and friends, but none to date on a military unit in a combat zone. This is the first description, to my knowledge, of the effects of the suicide of a U.S. Army soldier deployed to Iraq. A narrative from the treating psychiatrist's perspective describes both the acute and longer-term (four months) effects of the suicide on members of the soldier's unit, other soldiers at the same base, members of the medical team who attempted to resuscitate him, and mental health care providers. This account describes how the suicide affected at least thirteen other soldiers on the base. The effects of the soldier's suicide showed a few similarities to those described in the literature, including stigmatization of the survivors and the stress experienced by the mental health providers. There were additional repercussions that have not been previously described, including the impact on the soldier's peers within his unit and other soldiers on the base, the need for medical evacuation from Iraq of soldiers following the event, and the reported stress on the medical staff due to the attempted resuscitation of someone known to them. Future research is needed to understand the impact of a suicide on the survivors in a deployed military setting and to establish best practices for postvention strategies.