Toolkit: Suicide Risk Assessment and Response to Patient Suicide
Typical Reactions to Patient Suicide
Initial Reactions
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Shock
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Disbelief
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Denial
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Depersonalization (numbness, sense of unreality, spaciness)
Second-phase Reactions
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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)
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Shame
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Guilt
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Fear of blame
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Anger (feelings of betrayal, a waste of work together, for engendering guilt and shame, for inadequate support, to protect against guilt)
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Relief
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Finding of omens (identifying clues before the death may provide an illusory sense of control)
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Subsequent behavioral changes
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Conflicting feelings of specialness (isolation vs. rite of passage)
Other Symptoms
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Anxiety
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Depression
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Acute/post-traumatic stress disorder
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Sleep difficulties
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Suicidal thoughts
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Accident Proneness
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Intrusive thoughts
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Exaggerated Startle (especially to pagers/late night calls)
Predictors of Stress
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Younger Age
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Less Experience
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Intensity of Involvement
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Institutional Response
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Female
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Decreased flexibility/resilience
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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.]