Table 1.

Attributes of included studies.

Author and Date	Location of Research	Participant Population and Number	Aim of Study	Data Collection	Data Analysis	Results/Findings
Bohan and Doyle (2008) [20]	Ireland	Psychiatric nurses on acute inpatient units within three large hospitals N = 9	To describe psychiatric nurses’ experience of suicide and suicide attempts in an acute unit and explore their perceptions of the support they received after the incident.	Semi-structured interviews—audio taped and transcribed	Burnard’s [39] method of data analysis – detailed systematic description of themes.	Four themes: Nurses’ experiences of patient suicide/suicide attempts Nursing care following an incident of suicide/suicide attempt Feelings experienced by nurses following a suicide/suicide attempt Support for nurses following a suicide/suicide attempt
Christianson and Everall (2008) [21]	Canada	School Counsellors N = 7	To gain an in-depth understanding of school counsellors experiences of client suicide from their perspective.	Telephone semi-structured interviews. Digitally recorded and transcribed.	Grounded Theory	Three themes related to training, resources and self-care: National training/practice standards Support resources Self care
Christianson and Everall (2009) [22] Reports the same study as Christian and Everall (2008) [21]	Canada	School Counsellors N = 7	To explore the experiences of school counsellors who had lost clients to suicide. Qu’s = ‘What are school counsellors’ experiences of client suicide?’ ‘What impact do participants believe client suicide had on their lives?’	Telephone interviews (geographically diverse population) – two interviews per participant.	Grounded Theory	Four themes: Taming the control beast Wearing the mask Interpreting the dance Staying in the game
Darden and Rutter (2011) [23]	US	Clinical Psychologists N = 6	An in-depth exploration of the clinician’s experience in losing a client to suicide.	In-person semi-structured interview.	Consensual qualitative research (CQR) methods followed—themes, domains and categories.	Six domains: Psychologist’s view of suicide Clinical aspects of the case The suicide Impact Recovery Client’s Family
Davidsen (2010) [24]	Denmark	General Practitioners N = 1 4	To investigate how GPs were affected by patients’ suicides and whether their reaction was linked to their inclination to explore suicide risk in the patient who died by suicide, and whether the GP’s current inclination to explore suicide risk has been influenced by their experience of a patient death by suicide.	Semi structured interviews—conducted as part of larger study (Davidsen, 2009) [40]	Interpretative Phenomenological Analysis (IPA)	Super-ordinate theme: patients’ suicides. Underlying themes: Emotional impact Self-scrutiny Talking about suicide
Kim (2019) [25]	Korea	School Teachers N = 5	To explore the bereavement experiences of teachers and the challenges they face in coping with student suicide.	Semi-structured interviews	Colaizzi’s [41] Phenomenological approach	Four themes: Examination of the suicide Suspension of grief Tolerance of the suicide Renewed perception of role in preventing student suicide
Matandela and Matlakala (2016) [26]	South Africa	Nurses in General Hospital N = 6	To present the experience of nurses who cared for patients who died by suicide while admitted in a general hospital	Interviews audio recorded and transcribed	Manual general qualitative content analysis.	Five themes: Experience of disbelief and helplessness Feelings of blame and condemnation Feelings of guilt and inadequacy Emotional reaction Fear of reprisal
Saini et al., (2016) [27]	England	General Practitioners N = 198	To explore GPs views on how they are affected by a patient suicide and the formal support available to them following a patient suicide.	Semi-structured interviews, audio recorded and transcribed.	Descriptive statistics and a framework thematic approach	Three inter-related themes: Part and parcel Failing patients Informal support systems
Sanders et al., (2005) [28]	US	Mental Health Social Workers N = 145 Sample taken from a larger quantitative study—this sample being all participants who responded that they had experienced a completed client suicide.	To expand the understanding of the reactions of social workers to client suicide. Three research questions: 1. What professional and personal reactions do social workers experience immediately following a client suicide completion? 2. What professional and personal reactions do social workers experience long term, following a client suicide completion? 3. What is the relationship between time since the client suicide completion and the social workers’ reactions? The first two being relevant for this study.	Two open-ended questions at the end of a questionnaire. • Please describe how you felt in the seven days immediately following the client suicide. • Please describe how you feel now when you think about the client suicide.	Coding and constant comparative methods by two researchers working independently and comparing their results. Reviewed by third researcher.	Major themes immediately following client suicide: Deep sadness and depression Trauma and shock Feelings of professional failure Anger and Irritability Self blame Worries and Fear Major themes at time of survey: Continued emotional reactions Changes in practice Reconciliation Power and control issues Nothingness
Tillman (2006) [29]	US	Psychoanalysts/psychoanalytic psychotherapists N = 12	Interview question: ‘I am conducting a study about the effect of patient suicide on clinicians; I am interested in how this event has affected you. Would you tell me, in as much detail as possible about you’re your experience?’	Semi-structured interviews. Transcribed and audio recorded.	Coded by two researchers—using a psychoanalytic lens—‘a synthesis was made of the categories to arrive at a ‘best fit’ thematic analysis.’	A research vignette is presented in the paper to ‘illustrate the depth and range of experiences reported by the clinicians’ Eight themes: Traumatic responses Affective responses Treatment specific relationship Relationships with colleagues Risk management Grandiosity, shame, humiliation, guilt, judgement, blame A sense of crisis Effect on work with other patients Sit within three domains Traumatic loss and grief Interpersonal relationships Professional identity concerns
Ting et al., (2006) [30]	US	Mental Health Social Workers N = 25	What are the reactions experienced by a group of mental health social workers after a client suicide.	Semi-structured telephone interviews. Audio recorded and transcribed.	Constant comparative method with open coding.	Twelve Themes: Denial and Disbelief Grief and Loss Anger at client Agency and society Self-blame and guilt Professional failure and Incompetence Responsibility Isolation Avoidant behaviours Intrusion Change in professional behaviour changes in practice Changes in the professional environment Justification Acceptance
Wang et al., (2016) [31]	China	Nurses in a General Hospital N = 15	To explore the impact of inpatient suicides on nurses working in front-line, the patterns of regulation and their needs for support.	Semi-structured in-depth interviews	Colaizzi’s seven-step phenomenological method by two interviewers.	Four ‘centre themes’ and associated ‘sub-themes’ were identified. Nurses’ cognition about inpatient suicide Inpatients are at a high risk of suicide Inpatient suicide is difficult to prevent Shortage of suicide preventing skills Psychological reaction Shock and panic Sense of fear Self-accusation or guilt Frustrated or self-doubt Impact on practice Stress Excessive vigilance Burnout Patterns of regulation Pouring out bitterness Avoidance