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

Background: 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. Objective: 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. Methods: 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). Results: 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. Conclusions: 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.