Review of a study into the impacts of exposure to suicide on mental health professionals

Article in Review: Sanford, R., Hawker, K., Wayland, S. & Maple, M. (2020). Workplace exposure to suicide among Australian mental health workers: A mixed-methods study. International Journal of Mental Health Journal. DOI:10.1111/inm.12783

Summary:  A recent (2020) Australian study has combined qualitative and quantitative data to better understand how mental health professionals have been impacted by exposure to the suicide of patients.  The following article, the first of two based on this research, outlines the research context and the quantitative findings.

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Background

Exposure to suicide attempts and deaths is an occupational hazard for workers, yet academic studies in the field rarely refer to the emotional and professional impact of suicide exposure on professionals involved in care provision. An extensive literature review found that just 11% of the published literature referred to the experiences and perspective of medical and therapeutic workers, while even fewer (less than 4%) made this cohort the main focus of research.

How workplace exposure to suicide impacts professionals

One study of psychiatrists found that 95% indicated that their personal lives had been affected by the loss of a patient to suicide. Across numerous other studies, it has been identified that when the suicide of a patient occurs, care professionals may experience a range of complex emotions, including but not limited to:

• Self-doubt, shame, anger, betrayal, guilt, failure
• Self-scrutiny, fear of blame, trauma
• Irritability, preoccupation with suicide, and sleep disturbance

In most cases, these experiences are short-term and lessen in intensity as time goes on. There can also be impacts related to the care providers profession and career.  They may experience a loss of confidence and reduced capacity to work effectively, with concerns about litigation, and an avoidance of other suicidal patients or clients.

It is also noted that the death of a patient by suicide can also encourage reflection and adaptation amongst those who were working with the person before their death. Professionals may notice a heightened awareness of suicide risk, a higher degree of sensitivity and being “in tune” with patients, a more proactive assessment of suicidality and more accurate record-keeping. However, it is not fully known if these practices are a form of overcompensation that does not serve the best interest of the patient in the long run.

Study participants and aims

When finding a sample study group, researchers thought it important not to attract only participants significantly impacted by the death of a patient by suicide and framed the invitation to participate in a more general way. A wide-ranging, online study was promoted by Suicide Prevention Australia, with a total of 3010 participants, to look at the impact of suicide more broadly in a general population. The respondents who reported the most significant exposure to a death by suicide was that of a patient or client totalled 130 and these were the responses on which the research was then based. Participants were primarily non-Aboriginal or Torres Strait Islander ( 95.3%) and female (74.6%) and living in a metropolitan area (49.2%) with an average age of just over 46 years.

Within a workplace context, the study sought to determine the:

• Nature of exposure to suicide attempts and deaths
• Impact of exposure to suicide death
• Ways in which professionals describe their experiences of suicide deaths of patients or clients

Assessment measures

A scale for closeness and perceived impacts developed by Cerel and colleagues (2014) was used to assess how close respondents were to the deceased, ranging from not close (1) to very close (5) in conjunction with an impact score from (1) had somewhat of an effect but did not disrupt my life to (5) death had a devastating effect that I still feel.

The Kessler psychological distress scale (K10) is a measure used to assess stress with good reliability and consistency, by identifying symptoms such as tiredness, nervousness, hopelessness, restlessness, worthlessness and depression from (1) a little of the time through too (5) all of the time.

Tables of results

The below tables are helpful visual representations of the key measures captured.

Closeness

Perceived impact

Frequency of contact prior to death

Findings

Closeness and impact had a positive correlation with each other. Participants had an average score of 16.5 on the Kessler psychological scale. This score is within the moderate severity range within the Australian Bureau of Statistics, with the majority falling in the low severity range (57.9/%), a further 24.6% were in the moderate range while 17.5% were in the high or very high severity range.

This data supports the suggestion that mental health professionals are not homogenous in how they have been affected by the suicide attempts or deaths of patients. They are impacted at all points along the continuum of exposure. Of the 130 participants whose responses were considered in this study, a further 53 provided quantitative data which were themed and studied in order to give greater insight, telling a more nuanced tale than just the statistics might suggest.

Conclusions

Firstly, this is the first part of a two-part review undertaken by SRAA, where we have the opportunity to better understand the impact of suicide death on clinicians. Although results will be examined and reported more extensively in Part 2, we can clearly note that clinicians can be impacted to a significant degree following the death and that while the ongoing impact may progressively reduce over time, for some it remains a significant or ‘devastating’ effect (7.1%) or a loss that is felt daily (7.3%).