Routine treatment pathways in a cohort of patients with major depression and suicidality in Italy: the ARIANNA observational study.

BACKGROUND: Major Depressive Disorder (MDD) with suicidal ideation, intent, or behavior is a psychiatric emergency with controversial care management. Our study describes the comprehensive treatment pathways of this population in Italian routine clinical practice. METHODS: ARIANNA [NCT04463108] is an observational prospective and retrospective cohort study involving both primary data collection and secondary data extract. A total of 137 adult MDD patients with suicidality were enrolled from 24 Italian care sites and followed for 90 days. Other than the description of treatment patterns, the impact of treatment on depressive symptoms and suicidality, the burden on the patient's and caregiver's quality of life, healthcare resource utilization and costs were described. RESULTS: Of the 133 eligible patients, 68.4% were female, and the median age was 47. Approximately half of the study population had a current severe major depressive episode. Treatment strategies at the time of active suicidal ideation with intent definition/confirmation (t0) were heterogeneous, increasing in complexity during observation. According to the MADRS, patients with remission at t0+1 day were 2.6%, with the mean total score decreasing from 37.2 at t0 to 32.3. LIMITATIONS: The study sites were not randomly selected. CONCLUSIONS: To the best of our knowledge, this is the first cohort study that prospectively describes the characteristics of patients with MDD and suicide risk in Italy, and how they are treated in clinical practice. The study confirms this is a difficult-to-treat population. In addition, a lack of rapid, effective treatment for reducing depressive symptoms and suicidality is observed.

[Psychiatrists' emotional reactions to a patient's suicide: a case series]. / Reazione emotiva dello psichiatra al suicidio di un paziente: una serie di casi.

AIM: The aim of this study is to describe the emotional reactions experienced by a group of psychiatrists following the suicidal death of a patient. METHODS: The study was carried out between February 2005 and January 2006 within the Mental Health Department of Padova. Data were collected through a questionnaire administered to the reference psychiatrist at least two weeks after the suicide of a patient. The aim of the tool was to assess emotional reaction when told about the suicide and when filling in the questionnaire. RESULTS: All the interviewed psychiatrists (n = 11) reported emotions, mostly self-doubt, sadness, disbelief, guilt, fear, shock and helplessness. Some differences were found between residents and consultant psychiatrists. Of the 11 psychiatrists, 7 did not blame anyone for their patient's death, and 6 of them judged the suicide to have been unpreventable. All the therapists sought conversation about the event; a team case review was conducted in 8 cases. DISCUSSION: A patient's suicide is a significant event in a psychiatrist's professional life, particularly among resident psychiatrists. The emotional process only partly overlaps the usual grief process. Discussions with peer/senior colleagues and team case reviews are helpful tools in the grief process of psychiatrists and should become part of the working practice of every Mental Health Department.

How the psychiatrists of a mental health department managed their patients before an attempted suicide.

AIMS: The aim of this survey was to describe patients in care at a large mental health department in northern Italy who attempted suicide, and the clinical management adopted by their psychiatrists before the event. METHODS: Data collection was based on a questionnaire administered to the reference psychiatrists. RESULTS: Over a period of 12 months, 166 catchment area residents attempted suicide. Sixty-six (40%) had contacted the mental health department in the previous two years and completed data were obtained on 63. Twenty-nine (46%) suffered from mood, 26 (41%) from personality and 11 (18%) from schizophrenic disorders. Thirty-four attempts occurred within one year of psychiatric ward discharge, mostly in the first quarter. The reference psychiatrists reported that, at the last evaluation, 38 of 63 patients (60%) presented no change in clinical conditions, and 41 of 63 (68%) were considered at no immediate risk of suicide. Most of the attempted suicides in question (45, 72%) were judged to be unpreventable. In the two logistic regression analyses carried out, no independent variables were able to statistically significantly explain the variance in judged suicidal risk or the preventability of the index attempted suicide. CONCLUSIONS: According to the psychiatrists' descriptions of their last contact with the patients, most attempted suicides have not been preceded by a change in clinical conditions. Moreover, psychiatrists, irrespective of their age and gender, and of patient diagnosis, frequently judged the attempts to have been unpreventable.

Psychiatrists' emotional reactions to patient suicidal behavior.

BACKGROUND: Psychopathology is a risk factor for suicidal behavior. It is likely that psychiatrists will have to deal with an attempted or completed suicide by a patient at some point in their careers. The goal of this study was to assess psychiatrists' emotional reactions to patients' suicidal behavior. METHODS: Data were collected using a questionnaire that was administered to psychiatrists after a completed or attempted suicide by one of their patients. RESULTS: Thirty-four psychiatrists participated in the study and reported on 62 attempted suicides and 11 completed suicides. All of the participants reported at least one emotion following the event. After an attempted suicide, trainees were more likely than consultants to experience psychological pain, guilt, self-doubt, and frustration. Being a trainee was also associated with psychological pain, guilt, fear, self-doubt, and frustration in regression analysis. Shock, disbelief, fear, self-doubt, and embarrassment were associated with completed rather than attempted suicides. CONCLUSIONS: Attempted and completed suicides have a significant impact on psychiatrists. The impact of an attempted suicide is usually less severe. The patterns of reaction differ between consultant and trainee psychiatrists.