title: Patient suicides in psychiatric residencies and post-vention responses: a national survey of psychiatry chief residents and program directors.
abstract: OBJECTIVE
  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.
authors.affiliation: Dept. of Psychiatry, Walter Reed Army Medical Center, Fayetteville, NC, USA. abt135@gmail.com
authors.forename: Al
authors.initials: A
authors.lastname: Tsai
authors.forename: Scott
authors.initials: S
authors.lastname: Moran
authors.forename: Richard
authors.initials: R
authors.lastname: Shoemaker
authors.forename: John
authors.initials: J
authors.lastname: Bradley
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003376:Counseling / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D010820:Physicians; D011159:Population Surveillance / Q000379:methods; D011575:Psychoanalytic Therapy / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000628:therapy; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States