Establishing core domains in suicide postvention: a Delphi study in Chile

Postvention -structured support for individuals and communities exposed to or bereaved by suicide- is increasingly recognized as a core component of suicide prevention; yet standardized protocols and training frameworks remain scarce, particularly in low- and middle-income countries, leaving healthcare professionals without adequate guidance to respond effectively.

To identify and reach expert consensus on the core domains of suicide postvention to inform a recommendation guide and a training program for healthcare professionals in Chile.

We conducted a Delphi consensus study integrating academic, practice-based, and lived-experience expertise to identify and validate core domains for a postvention guide and online training program. Experts rated items on a five-point Likert scale, and consensus was defined a priori as ≥90% agreement on the two highest positive response options ("Important" + "Essential") or an interquartile range (IQR) ≤1. A complementary online focus group with healthcare professionals from public health services in three Chilean regions assessed the materials' perceived utility and implementation feasibility. Quantitative responses were analyzed with descriptive statistics; qualitative inputs were examined through content analysis (Delphi) and thematic analysis (focus group).

The Delphi panel comprised 28 experts (8 international researchers, 6 national researchers, 3 policymakers, 6 healthcare professionals, and 5 suicide-loss survivors), with 89% retention across two rounds. Consensus was reached on five core domains: (1) the impact of suicide and foundations of postvention; (2) preparedness and immediate response, including safe communication; (3) ongoing response, accompaniment, and recovery; (4) postvention in specific settings (education, workplace, and health services, including support for healthcare teams); and (5) long-term follow-up and prevention. In the complementary focus group (n=5 healthcare professionals), participants endorsed these domains and highlighted the need for early accompaniment within the first days post-suicide, integration of survivor testimonies, and concise asynchronous online modules adapted to the time constraints of public health professionals.

Expert consensus on core suicide postvention domains and content provides the foundation for a recommendation guide and training framework designed for scalable implementation across Chile's public health system and adaptable to other Latin American and resource-constrained contexts.