The Therapist’s Reaction to a Patient’s Suicide
Results of a Survey and Implications for Health Care Professionals’ Well-Being
Abstract
Background: A substantial proportion of therapists experience the loss of a patient to suicide at some point during their professional life. Aims: To assess (1) the impact of a patient’s suicide on therapists distress and well-being over time, (2) which factors contribute to the reaction, and (3) which subgroup might need special interventions in the aftermath of suicide. Methods: A 63-item questionnaire was sent to all 185 Psychiatric Clinics at General Hospitals in Germany. The emotional reaction of therapists to patient’s suicide was measured immediately, after 2 weeks, and after 6 months. Results: Three out of ten therapists suffer from severe distress after a patients’ suicide. The item “overall distress” immediately after the suicide predicts emotional reactions and changes in behavior. The emotional responses immediately after the suicide explained 43.5% of the variance of total distress in a regression analysis. Limitations: The retrospective nature of the study is its primary limitation. Conclusions: Our data suggest that identifying the severely distressed subgroup could be done using a visual analog scale for overall distress. As a consequence, more specific and intensified help could be provided to these professionals.
References
2000). Suicide by patients: Questionnaire study of its effect on consultant psychiatrists. British Medical Journal, 320, 1571–1574.
(1987a). The impact of suicide on therapists in training. Comprehensive Psychiatry, 28, 101–112.
(1987b). Patient suicide during residency training (I): Incidence, implications, and program response. Journal of Psychiatric Education, 11, 201–216.
(1972). Survivors of suicide. Springfield, IL: CC Thomas.
(2002). The role of the doctor when a patient commits suicide. Psychiatric Bulletin, 26, 44–49.
(1988). Patients’ suicides: Frequency and impact on psychiatrists. American Journal of Psychiatry, 145, 224–228.
(1994). Mode of death and kinship in bereavement: Focusing on “who” rather than “how”. Crisis, 15, 22–36.
(1993). Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the medical outcomes study. Health Psychology, 12, 93–102.
(1998). Patient suicide in psychiatry residency programs. Academic Psychiatry, 22, 181–189.
(2008). Rates of medication errors among depressed and burnt out residents: Prospective cohort study. British Medical Journal, 336, 488–491.
(2001). Interventions to improve physicians’ well-being and patient care. Social Science and Medicine, 52, 215–222.
(1999). A psychiatrist’s reaction to a patient’s suicide. American Journal of Psychiatry, 156, 1630–1634.
(1984). Psychotherapists as suicide survivors. American Journal of Psychotherapy, 38, 392–398.
(1997). Suicide of a patient: Gender differences in bereavement reactions of therapists. Suicide and Life-Threatening Behavior, 27, 379–386.
(2000). Therapists’ reaction to patients’ suicide. American Journal of Psychiatry, 157, 2022–2027.
(2004). Factors contributing to therapists’ distress after the suicide of a patient. American Journal of Psychiatry, 161, 1442–1446.
(1978). Patient suicide as part of psychiatric residency. American Journal of Psychiatry, 135, 745.
(1968). Suicide among patients in mental hospitals: A study of the psychiatrists who conducted their psychotherapy. Psychiatry, 31, 32–43.
(1991). The psychiatrist’s role, responses, and responsibilities when a patient commits suicide. American Journal of Psychiatry, 148, 739–743.
(1979). The working through of patients’ suicides by four therapists. Suicide and Life Threatening Behavior, 9, 33–46.
(1965). When patients commit suicide. American Journal of Psychotherapy, 19, 570–576.
(1980). When a patient commits suicide. Suicide and Life-Threatening Behavior, 10, 29–40.
(1999). Quantifying the information value of clinical assessments with signal detection theory. Annual Review of Psychology, 50, 215–241.
(1996). Survivors of suicide: A comprehensive bibliography update, 1986–1995. Omega, 33, 147–175.
(2008). Five year outcomes in a cohort study of physicians treated for substance use disorder in the United States. British Medical Journal, 337, 2038.
(1991). Patient suicide and its impact on the psychotherapist. Bulletin of the Menninger Clinic, 55, 216–227.
(1997). After suicide: Who counsels the therapist? Crisis, 18, 128–139.
(1990). Sequelae of bereavement resulting from suicide. American Journal of Psychiatry, 147, 279–285.
(2008). Counseling for burnout in Norwegian doctors: One year cohort study. British Medical Journal, 337, 2004.
(2004). Impact of patient suicide on psychiatrists and psychiatric trainees. Academic Psychiatry, 28, 104–110.
(2002). Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine, 136, 358–367.
(1969). Suicide, lethality, and the psychological autopsy. International Journal of Psychiatry in Clinical Practice, 6, 225–250.
(1971). Prevention, intervention and postvention. Annals of Internal Medicine, 75, 456.
(2006). When a patient commits suicide: An empirical study of psychoanalytic clinicians. International Journal of Psychoanalysis, 87, 159–177.
(2007). Health problems and the use of health services among physicians: A review article with particular emphasis on Norwegian studies. Industrial Health, 45, 599–610.
(2001). Umgang mit dem Patientensuizid in therapeutischen Teams psychiatrischer Kliniken: Ergebnisse einer Umfrage [
(How and to what extent is suicide postvention part of the routine of health care professionals in psychiatric hospitals after inpatient suicide? ]. Psychiatrische Praxis, 28, 323–325.2006). Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. Journal of the American Medical Association, 296, 1071–1078.
(