Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Encountering Patient Suicide During Psychiatric Training

An Integrative, Systematic Review

Leaune, Edouard, MD, MSc; Ravella, Noémie, MD; Vieux, Maxime, MSc; Poulet, Emmanuel, MD, PhD; Chauliac, Nicolas, MD, MSc; Terra, Jean-Louis, MD

doi: 10.1097/HRP.0000000000000208

Background/aim Patient suicide is an adversity that can be considered an “occupational hazard.” It has been identified as one of the most stressful adverse events during psychiatric training. The aim of this study was to systematically review the literature assessing the impact of patient suicide on trainees.

Methods We conducted a systematic review on the MEDLINE, Science Direct, Scopus, and Web of Science databases. Studies that reported prevalence of patient suicide, quantitative or qualitative assessment of psychological and professional impacts, coping strategies, and support or educational and postvention programs were deemed eligible for inclusion.

Results Of the 1994 articles identified, 22 were included. The literature on the topic was scarce, and the quality of the studies was moderate. No article dealt with nonpsychiatric residents. During their training, 46.4% of psychiatric trainees encountered at least one patient suicide. The traumatic impact was significantly more intense in trainees compared to senior physicians. A negative impact on their professional practice was reported by 17% to 39% of trainees. Formal institutional support for the affected trainees was described as having major shortcomings, and informal support from peers and families was reported as the most helpful response. However, 52% of impacted trainees considered encountering patient suicide a useful and beneficial experience.

Conclusion The frequent posttraumatic symptoms and the negative professional consequences following patient suicide are worrying phenomena that highlight the need to improve suicide prevention and postvention programs during psychiatric training. Identifying trainees with personal vulnerability factors should be a major concern during the postvention process.

From the Suicide Prevention Centre, Centre Hospitalier le Vinatier, Bron; Philosophic Research Institute of Lyon, Lyon 3 University (Dr. Leaune); Lyon Neuroscience Research Center (Drs. Leaune and Poulet), Health Services Performance Research Laboratory (Dr. Chauliac), and Parcours Santé Systémique (Dr. Terra), Lyon 1 University; Department of Emergency Psychiatry, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon (Dr. Poulet) (all France).

Original manuscript received 16 January 2018; revised manuscript received 30 April 2018, accepted for publication subject to revision 16 July 2018; revised manuscript received 1 August 2018.

Correspondence: Edouard Leaune, MD, CH le Vinatier - 95, boulevard Pinel - BP 300 39 - 69678 BRON CEDEX, France. Email:

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2019 President and Fellows of Harvard College
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website