Abstract
ObjectiveIn 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.MethodsProcess 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.ResultsStudy 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).ConclusionsThe 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.
Highlights
Posttraumatic growth was positively correlated with the self-determination subscale of work empowerment (r = 0.79, p = 0.01), but not associated with work empowerment or its other subscales, burnout, and general health measures
One resident shared that they experienced a second patient suicide at another program site and the postvention protocol had not been implemented in this instance
The prevalence of patient suicide in our study shows that residents confront this occupational tragedy at high rates and at all levels of training
Summary
Twenty percent of second year residents (n = 3/14) reported patient suicide between 3 months and 2 years ago. Forty percent of fourth year residents (n = 5/12) experienced patient suicide within the last 3 months to 2 years ago (Table 2). Protocol-related supports ranked highly were as follows: support from an attending who had experienced an adverse event, the program director, and supervising attending. Were not significantly different on measures of mean work empowerment, burnout, mental health, and quality of life scores (p > 0.05, Table 4). Mean subscale scores for burnout did not differ between residents who had not experienced patient suicide and residents who had participated in the postvention protocol (p > 0.05, results not shown). Mean posttraumatic growth score among residents reporting patient suicide was 18 (SD = 7.3), which is considered “low” growth per the literature (Table 4).
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