BMJ 2000;320:1571-1574 ( 10 June )

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Suicide by patients: questionnaire study of its effect on consultant psychiatrists

David A Alexander, professor in mental health, ^a Susan Klein, Thompson research fellow, ^a Nicola M Gray, research assistant, ^a Ian G Dewar, senior registrar in psychiatry, ^b John M Eagles, consultant psychiatrist. ^b

^a Department of Mental Health, Medical School, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, ^b Royal Cornhill Hospital, Aberdeen AB25 2ZH

Correspondence to: D A Alexander, Centre for Trauma Research, Bennachie, Royal Cornhill Hospital, Aberdeen AB25 2ZH d.a.alexander{at}abdn.ac.uk

Objective: To identify the effect of patients' suicide on consultant psychiatrists in Scotland.
Design: Confidential coded postal questionnaire survey.
Participants: Of 315 eligible consultant psychiatrists, 247 (78%) contributed.
Setting: Scotland.
Main outcome measures: Experience of patient suicide; the features and impact of "most distressing" suicide and what helped them to deal with it.
Results: 167 (68%) consultants had had a patient commit suicide under their care. Fifty four (33%) reported being affected personally in terms of low mood, poor sleep, or irritability. Changes in professional practice were described by 69 (42%) of the psychiatristsfor example, a more structured approach to the management of patients at risk and increased use of mental health legislation. Twenty four (15%) doctors considered taking early retirement because of a patient's suicide. Colleagues and family or friends were the best sources of help, and team and critical incident reviews were also useful.
Conclusions: Suicide by patients has a substantial emotional and professional effect on consultant psychiatrists. Support from colleagues is helpful, and professional reviews provide opportunities for learning and improved management of suicide and its aftermath.

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© BMJ 2000
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