Peyton Attaway, BS, RTI International; Jennifer Rineer, PhD, RTI International; Crystal Daye, MPA, RTI International

Medicolegal death investigators (MDIs) are routinely exposed to stressful and traumatic events, which impacts their own wellbeing and their ability to efficiently complete their investigations, collaborate within the criminal justice system, and interact with families of decedents. Yet relatively little is known about how stress and trauma impact these professionals and how to improve their wellbeing. To meet this need, we developed a national survey to assess health, stress, and stress management among MDIs. This poster will focus on findings of a qualitative analysis of responses to an open-ended question on this survey.

Employees who experience traumatic events in the course of their workday are at an increased risk for mental health problems (1-6). In their daily activities, MDI professionals are exposed to trauma both directly (e.g., through identification of humans, working mass causality or child fatality scenes) and indirectly (e.g., via speaking with family members of deceased victim, photographing images of evidence; 4,7,8). Although MDIs’ roles at the intersection of criminal justice and public health systems expose them to highly traumatic environments, only a few select studies have focused on the MDI community. Of these, most have predominately focused on post-traumatic stress disorder (PTSD) and PTS symptoms (4,5).

The few studies that have examined the impact of stress and trauma on this population more broadly have demonstrated the severity and complexity of work-related stress in the MDI community. For example, Brondolo (6,7) found that aspects of medical examiners’ and coroners’ work present risks for the development of depression, anxiety, and post-traumatic stress symptoms and that there are variations by job title, with investigators, administrative staff, and coroners reporting the highest levels of symptoms.

The extant research has been limited by its relatively narrow scope and failure to examine supports and resources (e.g., workplace trainings, coping skills) that can ameliorate their negative effects. The need for additional research is particularly important given current trends in MDIs’ work including daunting caseloads and depleted funding, staffing, and resources due to COVID-19 and other major challenges, such as the opioid crisis (9-12). This survey addresses this need, by collecting data on a broader set of work-related stressors, resources, and outcomes to better understand the challenges that MDIs face today.

The Understanding Work-Related Stress among Medicolegal Death Professionals survey was developed in collaboration between the research team and members of professional organizations in this field. We utilized extant occupation-specific scales (e.g., the Medical Examiner and Coroner Job Stressor Scale; Brondolo et al., 2012) and adapted other validated stress and wellness measures from adjacent fields (e.g., policing). We also included scales to measure relevant constructs from the occupational health psychology literature, such as burnout, compassion fatigue, and mental health outcomes such as depression. We consulted with our practitioner partners to get feedback on these draft measures, as well as create new occupation-specific scales where necessary. We included one open-ended question at the end of the survey: “What else would you like to tell us about work-related stress in your profession that we haven’t already covered?” The responses help to shed light on major health and wellness issues among this workforce and will be used to inform future research and practice in this area.

The survey invitation was sent to all certificants and members of the three largest professional organizations for MDIs. To date, approximately 600 MDIs have completed the survey. Data collection closes in July 2021; final survey data will be analyzed and presented in this poster.

Open-ended responses were thematically coded to identify common ideas. Some respondents expanded on topics asked about in the closed-ended questions. Others presented new ideas. The top five categories of stressors shared were: 1) lack of management/coworker support; 2) lack of understanding of what their work entails from the government or other administrating agency; 3) inadequate staffing or other resources; 4) being underpaid; and 5) lack of mental health support and mental health resources within one’s agency. Other emergent stressors included having to hold secondary jobs and not fully understanding the nature of the job before entering the field.

These preliminary results highlight the breadth of work-related stressors that negatively impact MDIs. Previous research on this workforce focused mostly on the operational aspects of the job, such as exposure to graphic or disturbing case materials and difficult interactions with decedents’ family members. In contrast, these results highlight the impact of organizational stressors, or aspects of the work internal to the agency. Understanding how these stressors impact MDIs is a key first step to improving work-related wellbeing for this critical workforce.

Along with the quantitative components of this survey, these qualitative findings shed light on the breadth of challenges faced by MDIs. In future research and practice, it will be important to conduct interventional research to implement and evaluate both individual and organizational solutions to alleviating MDIs’ work-related stress.

Tags: Applied research, COVID-19, Empirical study, Hazardous Work Environments and Safety, Organization- and Job-Level Environments and Practices, Public safety, Workplace Stress; Outcomes; and Recovery