Patient Suicides in Psychiatric Residencies and Post-Vention Responses: A National Survey of Psychiatry Chief Residents and Program Directors

Objectives: This report focuses on post-vention measures taken by U.S. psychiatry residencies when a resident-in-training experiences a patient suicide. Methods: A survey distributed to program directors and chief residents obtained an estimate of the frequency of psychiatric residents' experiencing a patient suicide and the frequency of numerous post-vention activities utilized by psychiatric residencies in 2008. The survey looked at the presence or absence of a post-vention protocol within a program and determined whether there was an effect on the number of patient suicides and the frequency of post-vention activities within a program. The data were compared with the results of a similar survey from 1994 to determine whether there had been significant progress in the practice of supportive post-vention activities within training institutions. Results: There was a 21% response rate from chief residents (N=54) and a 31.1% response rate from program directors (N=94). Chief residents reported 1.44 suicides per residency, and program directors reported 0.88 suicides per residency for the 2008 calendar year. This corresponded to approximately 1 in 20 residents' experiencing a patient suicide in the 12-month period. Both groups reported approximately 1 in 5 psychiatry residency programs with written post-vention protocols, which was unchanged from the 1994 survey. When a protocol was in place, chief residents reported a statistically significant increase in timely notification of the program director, process groups, therapy or counseling, and emergency leave, whereas program directors reported a statistically significant decrease in post-vention therapy or counseling. Further statistical analysis revealed a tendency for programs with post-vention protocols to have more reported suicides. Conclusions: Post-vention protocols may be developed by residencies as a need to address residents experiencing a patient suicide. Discrepancies in the reports of chief residents and program directors in post-vention activities may reflect a lack of consensus on post-vention training and education within psychiatric residencies.