"Working with suicidal patients is inevitable," Dr. Stanley said. "Many clinicians are likely to experience a suicide of at least one of their patients." A suicide can take a considerable toll on all survivors, including the therapist. More than one-third of therapists reported extreme distress after a patient suicide in a survey (Suicide Life Threat. Behavior 2010;40:328-36).
Shock, guilt, shame, grief, and fear of blame are among the typical reactions that clinicians feel in the wake of a patient suicide, Dr. Stanley said. "We want to try to avoid this for our own sake as well as for the sake of our patient."
"When young therapists ask me, ‘How can I work with this population?’ I say, ‘I try my best to attend to their suicidality in each and every moment I’m with them,’ " Dr. Stanley said. "And then if something happens, I did my best."
About 90 people per day, or more than 33,000 people each year, die by suicide in the United States. "This is the third-leading cause of death in young people," Dr. Stanley said. "More people die by suicide in the U.S. than by homicide."
These figures are probably an underestimate, Dr. Stanley said. Determination of cause of death, suicide versus accident, can be difficult. Coroners sometimes leave cause of death as "questionable" to protect surviving family members.
In addition, an estimated 3-10 suicide attempts take place for every completed suicide. Many attempts never come to the attention of mental health professionals or physicians, although attempts are a strong predictor of another attempt and of committing suicide.
Researchers found 62% of adults received medical attention after an attempt, "which means almost 40% did not," Dr. Stanley said. The 2009 National Survey on Drug Use and Health, sponsored by the Substance Abuse and Mental Health Services Administration, also showed that young adults, aged 18 to 25 years, are at highest risk for suicidal ideation, making a plan, and attempting suicide, compared with older adults.
Dr. Stanley said she had no relevant disclosures.