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Toolkit:  Suicide Risk Assessment and Response to Patient Suicide
Typical Reactions to Patient Suicide


Initial Reactions
  • Shock

  • Disbelief

  • Denial

  • Depersonalization (numbness, sense of unreality, spaciness)

Second-phase Reactions
  • Grief (loss of patient, loss of hoped for goals with patient, loss of fantasies related to power, influence and the ability to make a difference)

  • Shame

  • Guilt

  • Fear of blame

  • Anger (feelings of betrayal, a waste of work together, for engendering guilt and shame, for inadequate support, to protect against guilt)

  • Relief

  • Finding of omens (identifying clues before the death may provide an illusory sense of control)

  • Subsequent behavioral changes

  • Conflicting feelings of specialness (isolation vs. rite of passage)

Other Symptoms
  • Anxiety

  • Depression

  • Acute/post-traumatic stress disorder

  • Sleep difficulties

  • Suicidal thoughts

  • Accident Proneness

  • Intrusive thoughts

  • Exaggerated Startle (especially to pagers/late night calls)

Predictors of Stress
  • Younger Age

  • Less Experience

  • Intensity of Involvement

  • Institutional Response

  • Female

  • Decreased flexibility/resilience

  • Pre-existing depression or anxiety


[Adapted from Table 24-1 from Chapter 24: Psychiatrist Reactions to Patient Suicide

by Dr. Michael Gitlin in Simon, RI and Hales, RE. Textbook of Suicide Assessment

and Management. 2006. American Psychiatric Publishing, Inc. Washington, DC.]

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