A Pilot study of Psychological First Aid for Suicide Loss Survivors in Medical Examiner/Coroners’ Offices

Introduction: Each year the lives of 14 million Americans are touched by suicide loss. Exposure to suicide confers increased risk for suicidal thoughts and behaviors, as well as a variety of poor mental and physical health outcomes. There is a dearth of research focused on suicide postvention interventions that can be deployed in the immediate aftermath of the loss and scaled to the population level. Psychological First Aid (PFA) is an evidence-informed, brief intervention that can be deployed to disaster survivors. PFA provides survivors with distress reduction tools, promotes connection with practical and mental health resources, and explicitly addresses traumatic grief. PFA may be effective in reducing risk for suicide-related and other negative health outcomes if delivered in settings that interface with suicide loss survivors. Medical Examiner/Coroners Offices (ME/CO) may provide a crucial implementation context for acute suicide postvention interventions, as these publicly funded sites identify and provide death notifications to all suicide loss survivors within their jurisdictions. Currently, four ME/CO programs deliver services to American suicide loss survivors. The proposed study aims to: 1) explore key stakeholders’ perspective on the implementation context of ME/CO and adaptions of PFA to support survivors of suicide loss and 2) pilot PFA for suicide loss survivors at the Maryland Office of the Chief Medical Examiner (OCME).

Methods: Approximately 30 key stakeholders will complete qualitative interviews focused on the implementation of PFA in ME/CO. Key stakeholders will include suicide loss survivors, bereavement program providers, ME/CO staff, ME/CO bereavement service staff, and policymakers who can influence the financing of ME/CO affiliated bereavement services. Interviews will be guided by Consolidated Framework for Implementation Research and will also address suicide loss survivors’ bereavement support experiences, needs, and preferences. Grounded theory will be used to identify important themes from the interview. The PFA intervention protocol will be adapted to fit the needs of survivors and the ME/CO context identified by this qualitative work.

An open-label trial will be used to assess the acceptability, feasibility, and effectiveness of PFA for suicide loss survivors who interact with ME/CO. The PI will deliver PFA to 25 adult, suicide loss survivors within one month of their first interaction with the Maryland OCME. The group of suicide loss survivors who receive PFA will be compared to suicide loss survivors who receive enhanced treatment as usual (eTAU) at the Philadelphia OCME (n = 25), as well as waitlist controls at the Maryland OCME (n = 25). Enhanced treatment as usual at the Philadelphia OCME involves active outreach and offers referral resources to all of the next of kin to suicide decedents in their jurisdiction. Participants in the PFA, eTAU, and waitlist control group will complete assessments of suicidal thoughts and behaviors, mental health symptoms, service utilization, and client satisfaction at baseline, 6-month follow-up, and 12-month follow up.

Future Directions: Findings from this study will provide pilot data for an AFSP Linked Standard Research Innovation Grant application proposing the use of a hybrid type II implementation effectiveness trial to simultaneously test PFA and implementation strategies.