Coping Strategies and Support Systems among Psychiatrists and Trainees Following Patient Suicide

Main Article Content

Rajdip Barman, MD, FAPA Anita Kablinger, MD, CPI

Abstract

Background & Aims: Patient suicide, an unpredictable experience in a psychiatrist’s career, precipitates a wide range of emotions. Trainees in the earlier part of their career may be affected differently than the practicing psychiatrists. Our objective was to assess the variety of coping strategies and support systems of psychiatrists and trainees in the aftermath of patient suicide.


Methods: Assessing coping mechanisms and support measures were part of a preliminary study on stress and trauma-related symptoms in psychiatrists and trainees. In this cross-sectional study, data were obtained by sending an online survey to randomly selected residency/fellowship programs and practicing psychiatrists across the United States. The Brief COPE inventory measured various coping strategies, and self-reported questionnaires assessed support measures.


Results: Among 2/3 of the participants (N= 509) who experienced patient suicide, to cope with the trauma, the majority (>80%) used acceptance, followed by emotional and instrumental support, reframing, planning, active coping, religious help, self-blame, and distraction. A significantly higher proportion (p< 0.05) of trainees tried behavioral disengagement, positive reframing, and denial as major coping strategies. Both groups derived the most support from colleagues, family, and friends. Likely due to imminent availability, a higher number of trainees benefited from their supervisors and psychiatrists from family.


Conclusions: Creating a safe and reliable supportive environment in institutions, preparing clinicians for pre- and post-event consequences, and providing training through a structured curriculum may help future generations maximize coping strategies following patient suicide.

Article Details

How to Cite
BARMAN, Rajdip; KABLINGER, Anita. Coping Strategies and Support Systems among Psychiatrists and Trainees Following Patient Suicide. Medical Research Archives, [S.l.], v. 12, n. 7, july 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5509>. Date accessed: 30 dec. 2024. doi: https://doi.org/10.18103/mra.v12i7.5509.
Section
Research Articles

References

1. Lazarus RS. Stress and emotion. New York, NY: Springer, 1994.

2. Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med 1993; 55: 234–247.

3. Lazarus RS & Folkman S. Stress, appraisal, and coping. New York, NY: Springer, 1984.

4. Hirsch JK, Walker KL, Chang EC, et al. Illness burden and symptoms of anxiety in older adults: optimism and pessimism as moderators. Int Psychogeriatr 2012; 24(10): 1614-1621.

5. Folkman S, Moskowitz JT. Coping: Pitfalls and Promise. Annu Rev Psychol 2004; 55(1): 745-774.

6. Koenig HG. Religion and Medicine II: Religion, Mental Health, and Related Behaviors. The Int J Med Psychiat Med 2001; 31(1): 97-109.

7. Eagles JM, Klein S, Gray NM et al. Role of psychiatrists in the prediction and prevention of suicide: A perspective from north-east Scotland. Br J Psychiatry 2001; 178(6): 494-496.

8. Chemtob CM, Hamanda R, Bauer G, et al. Patients suicides: frequency and impact on psychiatrists. Am J Psychiatry 1988; 145(2): 224-228.

9. Rothes IA, Scheerder G, Audenhove CV, et al. Patient Suicide: The Experience of Flemish Psychiatrists. Suicide Life Threat Behav 2013; 43(4): 379-394.

10. Dewar IG, Eagles JM, Klein S, et al. Psychiatric trainees experiences of, and reactions to, patient suicide. Psychol Bull 2000; 24(1): 20-23.

11. Landers A, O’brien S and Phelan D. Impact of patient suicide on consultant psychiatrists in Ireland. Psychiatrist (The) 2010; 34(4): 136-140.

12. Kozlowska K, Nunn K and Cousens P. Adverse Experiences in Psychiatric Training. Part 2. Aust N Z J Psychiatry 1997; 31(5): 641-652.

13. Ruskin R, Sakinofsky I, Bagby RM, et al. Impact of Patient Suicide on Psychiatrists and Psychiatric Trainees. Acad Psychiatry 2004; 28(2): 104-110.

14. Botega NJ, Reginato DG, Silva SVD, et al. Nursing personnel attitudes towards suicide: the development of a measure scale. Rev Bras Psiquiatr 2005; 27(4): 315-318.

15. Hawgood JL, Krysinska KE, Ide N, et al. Is suicide prevention properly taught in medical schools? Med Teach 2008; 30(3): 287-295.

16. Ramberg I-L and Wasserman D. The roles of knowledge and supervision in work with suicidal patients. Nord J Psychiatry 2003; 57(5): 365-371.

17. Gibbons R, Brand F, Carbonnier A, et al. Effects of patient suicide on psychiatrists: survey of experiences and support required. BJPsych Bulletin 2019; 43(5): 236-241.

18. Pieters G, Gucht VD, Joos G, et al. Frequency and impact of patient suicide on psychiatric trainees. Eu Psychiatry 2003; 18(7): 345-349.

19. Alexander DA. Suicide by patients: questionnaire study of its effect on consultant psychiatrists. BMJ 2000; 320(7249): 1571-1574.

20. Barman R and Kablinger A. Prevalence of trauma- and stress-related symptoms in psychiatrists and trainees following patient suicide in the United States. Soc Psychiatry Psychiatr Epidemiol 2021; 56(7): 1283-1288.

21. Carver CS. You want to measure coping but your protocol’ too long: Consider the brief cope. Int J Behav Med 1997; 4(1): 92-100.

22. Giancola JK, Grawitch MJ and Borchert D. Dealing with the Stress of College. AEQ 2009; 59(3): 246-263.

23. Lazarus RS and Folkman. Transactional theory and research on emotions and coping. Eur J Pers 1987; 1(3): 141-169.

24. Holahan CJ, Moos RH, Holahan CK, et al. Social support, coping, and depressive symptoms in a late-middle-aged sample of patients reporting cardiac illness. Health Psychol 1995; 14(2): 152-163.

25. Carver CS and Connor-Smith J. Personality and Coping. Annu Rev Psychol 2010; 61(1): 679-704.

26. Tanner JF, Hunt JB and Eppright DR. The Protection Motivation Model: A Normative Model of Fear Appeals. J Mark 1991; 55(3): 36.

27. Schnider KR, Elhai JD and Gray MJ. Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss. J Couns Psychol 2007; 54(3): 344-350.

28. Carver CS, Scheier MF and Weintraub JK. Assessing coping strategies: A theoretically based approach. J Couns Psychol 1989; 56(2): 267-283.

29. Folkman S, Lazarus RS, Dunkel-Schetter C, et al. Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. J Pers Soc Psychol 1986; 50(5): 992-1003.

30. Brown SP, Westbrook RA and Challagalla G. Good Cope, Bad Cope: Adaptive and Maladaptive Coping Strategies Following a Critical Negative Work Event. J Appl Psychol 2005; 90(4): 792-798.

31. Nydegger R, Nydegger L and Basile F. Post-Traumatic Stress Disorder And Coping Among Career Professional Firefighters. Am J Health Sci 2011; 2(1): 11.

32. Nuttman-Shwartz O and Dekel R. Ways of coping and sense of belonging in the face of a continuous threat. J Trauma Stress 2009. doi:10.1002/jts.20463.

33. Oʼbrien L, Mathieson K, Leafman J, et al. Level of Stress and Common Coping Strategies Among Physician Assistant Students. J Physician Assist Educ 2012; 23(4): 25-29.

34. Aspinwall LG and Taylor SE. Modeling cognitive adaptation: A longitudinal investigation of the impact of individual differences and coping on college adjustment and performance. J Pers Soc Psychol 1992; 63(6): 989-1003.

35. Sniehotta FF, Schwarzer R, Scholz U, et al. Action planning and coping planning for long-term lifestyle change: theory and assessment. Eur J Soc Psychol 2005; 35(4): 565-576.

36. Gall TL, Charbonneau C, Clarke NH, et al. Understanding the Nature and Role of Spirituality in Relation to Coping and Health: A Conceptual Framework. Can Psychol 2005;46(2):88-104.

37. Menninger WW. Patient suicide and its impact on the psychotherapist. Bull Menninger Clin 1991; 55: 216–227.

38. Pilkinton, P. Encountering Suicide: The Experience of Psychiatric Residents. Acad Psychiatry 2003; 27(2): 93-99.

39. Courtenay KP and Stephens JP. The experience of patient suicide among trainees in psychiatry. Psychiatri Bull 2001; 25(2): 51-52.

40. Kleespies PM, Penk WE and Forsyth JP. The stress of patient suicidal behavior during clinical training: Incidence, Impact, and recovery. Prof Psychol Res Pr 1993; 24(3): 293-303.

41. Tanney B. After a suicide: A helper′s handbook. In: B. Mishara, ed. The impact of suicide. New York, NY: Springer; 1995: 85-99.

42. Campbell C and Fahy T. The role of the doctor when a patient commits suicide. Psychiatri Bull 2002; 26(2): 44-49.

43. Gitlin MJ. A Psychiatrist’s Reaction to a Patient’s Suicide. Am J Psychiatry 1999; 156(10): 1630-1634.

44. Prabhakar D, Anzia JM, Balon R, et al. “Collateral Damages”: Preparing Residents for Coping With Patient Suicide. Acad Psychiatry 2013; 37(6): 429-430.

45. Lerner U, Brooks K, Mcniel DE, et al. Coping With A Patients Suicide: A Curriculum for Psychiatry Residency Training Programs. Acad Psychiatry 2012; 36(1): 29-33.

46. Figueroa S and Dalack GW. Exploring the Impact of Suicide on Clinicians. J Psychiatr Pract 2013;19(1):72-77.

47. Hendin H, Lipschitz A, Maltsberger JT, et al. Therapists’ Reactions to Patients’ Suicides. Am J Psychiatry 2000; 157(12): 2022-2027.

48. Hodelet N and Hughson M. What to do when a patient commits suicide. Psychiatri Bull 2001; 25(2): 43-45.

49. Foley SR and Kelly BD. When a patient dies by suicide: incidence, implications, and coping strategies. Adv Psychiatr Treat 2007; 13(2): 134-138.