Harvard Medical School, Boston, MA, USA.
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Acad Psychiatry. 2021 Jun;45(3):279-287. doi: 10.1007/s40596-020-01394-8. Epub 2021 Feb 11.
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.
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.
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.
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.
自杀是导致 10-34 岁儿童、青少年和年轻人死亡的第二大主要原因，其在美国的发生率仍在上升。据估计，30%-60%的精神科住院医师在培训期间会经历患者自杀。本研究旨在了解住院医师和主管在患者自杀后的经历，以便更好地为这种事件的监督和应对提供信息。
通过标准抽样确定了 27 名参与者，他们来自美国新英格兰地区的普通精神病学住院医师、咨询联络研究员和儿童和青少年精神病学研究员培训计划。对住院医师和主管进行半结构化访谈，并使用归纳主题分析进行分析。
患者自杀死亡被描述为一个显著事件，对参与者的专业生活产生了重大影响。该事件通常表现为对个人有即时的情绪影响，导致自我效能感的变化，并对患者的死亡感到自责。对自杀的反应受到可改变因素的影响，例如：（1）个人、项目和机构的准备不足，以及（2）调解/复杂因素，包括主管的可信度、社会期望和特定患者特征。
对于精神科医生来说，患者的死亡是个人和情感上的经历，他们并不总是感到有充分的准备。机构的反应可能不协调，更多地具有分析性，侧重于评估风险。在为患者自杀死亡做好监督和准备方面，还有很大的改进空间。
