Table 1. Literature review summaries.
| Reference Country | Population and sample size | Emotional Impacts (most common) | Professional impacts (most common) | Exposure to suicide | Support sought | Mental Health outcomes |
|---|---|---|---|---|---|---|
| Murphy et al. (2019) Ireland | 179 mental health professionals | Sadness (79.5%, n = 65), shock (74.7%, n = 62) and surprise (68.7%, n = 57). Reactions lasted for < 6 months for most | Increased awareness of suicide risk (by nurses). Reduced professional confidence (66.7%), fear of negative publicity (54.2%), fear of litigation (49.4%). | 46.6% reported patient’s suicide | Support through work (17.7%, n = 23), informal support (71.1%). Professionals more often preferred debriefing as a source of support. | Burnout 47.6%. |
| Awenat et al. (2017) UK | 20 mental health professionals | Guilt, fear of being blamed by patient’s family and colleagues, frustration, and hopelessness on supporting repeat self-harmers | Reduced professional confidence | All reported a patient’s suicide | Formal discussion of the experience, informal support from colleagues, friends, or family | Not reported |
| Gulfi et al. (2015) Switzerland | 713 mental health professionals | 49.6% felt responsible for the deceased | Professionals reported low to moderate reactions. | Professionals facing more than one patient suicide (Mean = 3.7, SD = 4.2) | 38.5% reported a need for social and/or psychological support. 38.8% sought support | Not reported |
| Dransart et al. (2015) Switzerland | 666 mental health professionals | 36.6% moderately impacted and 7.7% highly impacted | Not reported | Professionals facing more than one patient’s suicide (Mean = 2.7, SD = 1.4) | 39.2% sought social and/or psychological support | Not reported |
| Fairman et a. (2014) USA | 186 mental health professionals | Guilt and self-doubt | Increased focus on suicide cues, enhanced care of patients | 32% reported a patient’s suicide | Team-based support and debriefing most common coping strategies. Participants recommended facilitated debriefing, informal group support, and individual counseling | Not reported |
| Draper et al. (2014) Australia | 303 mental health professionals | Shock, sadness, anxiety, feeling upset, grief, anger, and guilt | Increased vigilance and awareness of suicide risk, more assessment and management of at-risk patients, increased referral to a psychiatrist. Sadness at work, loss of professional confidence | Not reported | Suicide-exposed professionals needed support or counseling more often than those exposed to other sudden deaths | Not reported |
| Dransart et al. (2014) Switzerland | 258 mental health professionals | Shock, helplessness, and sadness | Not reported | Not reported | Not reported | One in ten respondents above clinical cut-off for PTSD on the IES-R |
| Finlayson et al. (2019) Australia | 178 psychologists | Not reported | Not reported | 31.5% reported a patient suicide | Peer-support sought following poor workplace support | Not reported |
| Finlayson et al. (2018) Australia | 178 psychologists | Sadness, shock, and helplessness. | Caution with at-risk patients, increased attention to legal aspects, increased focus on suicide cues, increased peer consultation | 31.5% reported a patient suicide | Debriefing with colleagues most helpful coping strategy, followed by talking to supervisors. | Not reported |
| Darden et al. (2011) USA | 6 psychologists | Sadness | Questioned r clinical decisions, increased hypervigilance to suicide risk, concern over legal issues | Not reported | Discussing event was a coping strategy for recovery | Not reported |
| Gulfi et al. (2016) Switzerland | 271 psychologists and psychiatrists | Anxiety about working with at-risk patients and increased concern over professional competence | Increased focus on suicide cues, and hospitalization of patients, concern over legal matters, more consultation with supervisors and colleagues | Not reported | Not reported | Not reported |
| Wurst et al. (2013) Germany | 226 psychologists and psychiatrists | 39.6% of cases of suicide reported by professionals caused severe distress. Shock and sadness. Professionals involved in suicide case review reported higher levels anger and shame | 18.6% reported not being able to continue their work as usual | 72.1% of the sample have had experienced exposure to suicide. | 73.5% felt supported by employer and 87.9% by colleagues | Not reported |
| Leaune et al. (2019) France | 253 psychiatrists | Guilt and sadness were most frequently reported | 92% exposed to a suicide death modified their practice; 72% described this change as positive. 97.1% of those exposed to a serious suicide attempt modified their practice; 60% described this change as positive. | 49.4% of the sample was exposed to a patient suicide and 13.8% were exposed to a severe patient suicide attempt. | 25.6% of professionals exposed to suicide death reported feeling unsupported. Professionals commonly sought support from senior colleagues (56%), peers (38.4%), and informally (37.6%). 97.6% did not seek personal psychotherapy. | 16.8% of the participants scored moderate to high traumatic impact. 8.1% scored high to extremely high traumatic impact after a patient’s suicide. |
| Gibbons et al. (2019) UK | 174 psychiatrists | Sadness (71%, n = 85), worry, anxiety, and fear (40%, n = 40), guilt and self-blame (31%, n = 36) | 98% reported effects on clinical practice. | 72% experienced >1 patient’s death by suicide, 15% >6, and 3% had experienced >10. | Peer-support most helpful (48%, n = 43). Advice and support from senior clinicians (75%, n = 102) and formal support (70%, n = 97) were the supports most desired | 8% (n = 9) felt their symptoms met the clinical threshold for the diagnosis of a psychiatric disorder |
| Erlich et al. (2017) USA | 90 psychiatrists | Not reported | Half reported changing clinical practice, seeking supervision (50.9%, n = 27), using formal measures to assess suicidality (25%). 9.1% began using postvention protocols. 9.8% (n = 5) stopped accepting at-risk patients. | 66% had a client died by suicide. | They coped by reviewing their notes (81%, n = 47), informal supervision with a colleague (71.2%, n = 42), and discussion with a family member or friend (70.4%, n = 38) | Not reported |
| Rothes et al. (2013) Belgium | 107 psychiatrists | Suffering or distress (46.5%), sadness, despair and pain 25.6% felt impotent or powerless. 20% reported guilt and self-blame. 15% described feelings of anger, frustration, disappointment, misunderstanding towards patient, and 19% shock or disbelief | 45% reported changes in clinical practice. 54% of those reported more vigilant about suicide risk and increased accuracy in risk assessment and treatment. 22% improved practice by team conversation. 15% became more insecure toward suicide risk. 12% reported changes in relationship with other patients | 92% experienced a patient’s suicide. Male professionals had more patients’ suicide | 17% discussed case with team or colleagues | 92 reported possible sources of support including colleague consultation with team case review reported as most helpful |
| Scocco et al. (2012) Italy | 34 psychiatrists | Sadness, anger, disbelief, nervousness, and psychological pain. | In 66% of the cases, approach not affected. 18% reported improvement in approach, 3% reported a worsening in approach. 8% reported positive and negative consequences of approach. | 85% refer to a suicide attempt and 15% to a suicide death | 71% discussed event with peer colleagues, team, friends or relatives, patient’s relatives, or senior colleagues. | Not reported |
| Kelleher et al. (2011) Ireland | 50 psychiatrists | 27.5% reported personal lives affected by sadness, low mood, and self-doubt | 32.5% professional life affected by sense of helplessness and reluctance to discharge patients. Increased awareness of suicide risk assessment and documentation | Not reported | 85% reported family support as helpful. 53% reported peer-support as helpful. | Not reported |
| Türkleş et al. (2018) Turkey | 33 nurses | Deep sorrow, anger, frustration, and blame by hospital staff | Increased awareness of suicide risk. | Not reported | Not reported | Not reported |
| Sherba et al. (2019) USA | 121 counselors and social workers | 19.83% (n = 24) Personal distress due to publicity. 44.5% (n = 53) personal distress at the possibility of litigation | 15.0% (n = 18) considering early retirement. 34.2% considering career change. 9.9% (n = 12) of all participants reported taking time off from work | 82,7% (n = 100) had a patient suicide or suicide attempt. | Team colleagues support (n = 114), family/partner support (n = 91), other clinical colleague support (n = 77), friends support (n = 72), other mental health professional support (n = 63). Team colleagues, other clinical colleagues, and other mental health professionals were the most helpful | Clinical risk for burnout moderate (9.2%, n = 11) and high (3.4%, n = 4). Risk for compassion fatigue moderate (12.5%, n = 15), high (16.7%, n = 20) and extremely high (13.3%, n = 16) |
| Hom et al. (2018) USA | 276 firefighters | exposure to suicide significantly associated with lifetime suicide attempts but not ideation or plans. Greater emotional impact associated with symptoms of depression, nightmares, insomnia and PTSD, and severe suicide risk | Not reported | 74.4% of exposure to suicide (personal life). 80.8% of the exposures occurred during their firefighting career | Not reported | Participants with lifetime exposure to suicide reported greater symptoms of depression, insomnia, and PTSD symptoms. Participants with career exposure to suicide reported greater symptoms of depression, nightmares, insomnia, and PTSD symptoms |
| Kimbrel et al. (2018) USA | 61 firefighters | Not reported | Not reported | All exposed to suicide; 34.8% via occupation; 23% most affected by occupational exposure. Mean of 13.1 exposures to suicide attempts and deaths throughout lifetime. | 13% of the firefighters sought treatment with 5% more than n once | 41% reported lifetime suicidal ideation, 11% in past year. 16% not affected by exposure to suicide; 8% reported a lifetime suicide plan; 12% positive screens for significant suicide risk. |
| Stanley et al. (2015) USA | 1027 firefighters | Not reported | Not reported | 92.4% had responded to a suicide attempt and 87.6% to a death by suicide. | Not reported | 46.8% reported suicide ideation, 19.2% suicide plan, 15.5% suicide attempts, and 16.4% non-suicidal self-injury. |
| Cerel et al. (2019) USA | 813 law enforcement | Not reported | Not reported | 95% exposed during work, mean 30.9 suicide scenes attended | Not reported | 14% identified moderate to severe depressive symptoms, 9.1% probable posttraumatic stress, 6.4% suicide ideation, 14.2% moderate to severe anxiety |
| Koch (2010) USA | 8 police officers | Coping strategies included: humor, depersonalization of the victim, faith, telling stories, blocking feelings, anger, reliance upon Police role, deep exploration of the deceased’s life, engaging or disengaging from survivors, and hyper-alertness | Not reported | Not reported | Peer-support | Not reported |
*Authors, country in which the research was conducted, population and sample, summaries of the main findings regarding emotional impacts, professional impacts, exposure to suicide prevalence, support sought/suggested by the participants and mental health outcomes reported.