Los Angeles Medical Center, Los Angeles, CA, USA.
Acad Psychiatry. 2021 Jun;45(3):262-271. doi: 10.1007/s40596-021-01418-x. Epub 2021 Mar 8.
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.
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.
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).
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.
在“零自杀”倡议和自杀率上升的时代，住院医师特别容易受到患者自杀带来的心理和职业影响。一个成人精神病学住院医师培训计划制定并实施了一个事后预防协议，以解决住院医师中患者自杀的影响。本研究是对 2018 年 6 月至 2020 年 4 月期间一项培训计划事后预防协议的正式评估。
确定了过程和结果指标，以评估协议的实施和效果。过程指标包括事后预防协议的遵守情况。结果指标包括事后预防协议相关支持的感知有用性、职业和一般健康指标、创伤后成长以及居民参与事后预防协议后的创伤后应激症状。
研究的回复率为 97%（n=57/59），81%的人完成了整个调查（n=48/59）。20%的住院医师（n=10/48）在住院期间经历了患者自杀。事后预防协议的遵守率在 57%至 100%之间。与其他支持相比，与之前经历过不良事件的主治医生交谈等协议相关的支持更有帮助（p<0.01）。与没有经历过患者自杀的住院医师相比，工作授权、倦怠、心理健康和生活质量评分的平均值没有显著差异（p>0.05）。创伤后成长与工作中的自我决定呈正相关（p=0.01）。
事后预防协议对住院医师有帮助，并可能有效减轻患者自杀带来的心理和职业后果。研究结果可能为精神病学培训计划中事后预防协议的标准化提供信息。
