The Impact of Patient Suicide on Clinicians



by Eric M. Plakun, MD, and Jane G. Tillman, PhD, ABPP

This article was originally published by Psychiatric Times on May 13, 2016 at: http://www.psychiatrictimes.com/apa-2016-MDD/impact-patient-suicide-clinicians

What are the effects on the clinician when his/her patient dies by suicide? How to respond? Drs Plakun and Tillman have been offering a workshop on responding to the impact of suicide on clinicians as part of the APA Annual Meeting since 2004. 

Eric M. Plakun, MD, DLFAPA, FACPsych, Associate Medical Director and Director of Admissions1. How likely is it that a psychiatrist will experience the death of a patient by suicide? 

The suicide of a patient has been recognized as an occupational hazard for mental health clinicians. Studies have reported that 25% to 60% of psychiatrists will have a patient die by suicide during his or her career. Estimates suggest that the likelihood is closer to 50%.

Psychiatrists often help patients at high risk, treat those with acute psychiatric illness in the ED or inpatient settings, and manage medications for more seriously disturbed patients. In addition, psychiatrists whose practice primarily involves prescription of medication see a high volume of patients and thus have more risk exposure. 

In studies of clinicians who have a patient die by suicide, up to 38% of psychiatrists report severe distress.

The death of a patient by suicide has been shown to have more severe effects on trainees and early career professionals. These young clinicians may not have thought about the possibility of the death of a patient. They may feel vulnerable in terms of their experience and knowledge-base in caring for patients who are suicidal or more severely disturbed in the area of aggression and impulsivity. 

Jane Tillman, PhD, ABPP2. What are the known effects of patient suicide on clinicians?  

Reactions to the death of a patient by suicide vary. Some psychiatrists rationalize that, like colleagues in oncology or cardiology, there are some mental illnesses with a fatal trajectory and thus suicide is an expectable outcome. Unlike other medical specialties, however, the patient who dies by suicide has been both the victim and perpetrator of a fatal event. 

In studies of clinicians who have a patient die by suicide, up to 38% of psychiatrists report severe distress about treatment decisions, failure to hospitalize the patient, concern about negative reactions by the physician’s institution, or fear of a lawsuit. 

Other reactions to a patient death by suicide include: traumatic reactions, anger, sadness, serious self-doubt about one’s choice of profession, fear of negative judgment by colleagues, decisions not to treat more disturbed patients, self-criticism, and experiences of stigma. Studies of those bereaved following a suicide show that survivors often feel more shame, stigma, blaming, and anger than those bereaved from other causes of traumatic sudden death. 

Read the rest of the article on the Psychiatric Times website: www.psychiatrictimes.com/apa-2016-MDD/impact-patient-suicide-clinicians.