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Work-Related Stress Among Medicolegal Death Investigators (MDIs): A National Survey and Impact Study

Understanding stress-inducing experiences among MDIs to improve public heath reporting and forensic practices


To increase knowledge about work-related stress, stress management, and overall mental health and well-being across individuals working in the field of Medicolegal Death Investigations (MDIs).


We partnered with the American Board of Medicolegal Death Investigators and the International Association of Coroners & Medical Examiners to conduct the first ever national-wide study of mental health and well-being among MDIs. The team is now analyzing data from the second phase of the project, an impact study to collect daily self-report measures and biometric data from MDIs over a 6-week period, to learn more about the types of activities that impact stress among MDIs.


Through our survey, MDIs reported multiple factors negatively affecting their mental health, including fatigue, lack of understanding from political stakeholders or community leaders about their work, and aspects of interacting with family members of decedents. Specific to COVID-19, they reported higher caseload, increased staffing shortages, less first responder accommodations, exposure to COVID-19, and unclear guidance on new procedures. The findings from the survey and impact study will be used to inform MDIs and their employing organizations of how to better understand and support health and wellness, improve organizational outcomes and personal wellbeing, and inform future programs and preventative training to reduce and alleviate work-related stressors.

MDIs report high levels of work-related stress

Medicolegal death investigators (MDIs) experience daily exposure to stressful and traumatic events with what they see, hear, smell, and document. MDIs investigate death scenes, which includes examining and taking pictures of the deceased; collecting evidence; interviewing family members, friends, and bystanders; preparing reports; and delivering information and personal belongings to families, among many other tasks. The job is intense in the best of circumstances, but the COVID-19 era ushered in new and heightened stress for many MDIs.

RTI International is leading a project to increase knowledge about work-related stress management and overall mental health and well-being of MDIs. Funded by the National Institute of Justice, the project is conducted in two phases: (1) a national survey of MDI professionals and (2) an impact study.

This is the first project of this scope to shed light on MDI well-being and mental health, which is surprising given the field’s challenging and intense nature. The results from this project will help improve MDI workplaces, better support MDIs, and inform programs and trainings to reduce work-related stress.

Survey results: Stressors extend beyond decedents and their family members

In 2021, RTI completed the first phase of the project: a survey of 1,000 MDIs to examine the breadth and frequency of exposure to stressful and traumatic events, conditions, and outcomes in this workforce. RTI’s project partners, the American Board of Medicolegal Death Investigators and the International Association of Coroners & Medical Examiners, were instrumental in reaching many MDIs across the United States.

The survey results revealed several interesting takeaways. Four out of 10 MDIs experience moderate to high levels of stress related to their employer and the nature of their work. Importantly, work-related stressors were not limited to responsibilities around decedents and their family members. Nealy half reported a lack of understanding from political decision-makers and community leaders about their work, and they also reported that a lack of management and coworker support added to their stress. Participants also cited staff shortages as a top source of stress, exacerbating their fatigue and long work hours. Finally, MDIs expressed dissatisfaction with their pay — insufficient pay required some MDIs to work multiple jobs, which added to their fatigue.

These chronic stressors impact MDIs’ health over the long term. Nearly half (42%) of respondents reported experiencing symptoms of depression some of the time, and 10% reported experiencing moderate to high levels of depression.

Despite the stressful nature of the job, 18% of respondents reported that they did not have access to any health and wellness resources at work. Those who did have access found peer support programs to be most beneficial.  

Survey results: COVID-19 had an impact on MDI well-being

One in five respondents said that their work-related stress was impacted by COVID-19. The top five COVID-19-related stressors were:

  1. Higher caseload (48%)
  2. More staffing shortages (44%)
  3. Receiving less accommodations than other first responders (40%)
  4. Direct exposure to COVID-19 (30%)
  5. Unclear guidance on new procedures (27%)

As one respondent summarized, “A significant amount of the stressors addressed in this survey existed prior to COVID-19 for me; however, they have been exacerbated by the pandemic – whether it is new policies and procedures, dealing with others’ stress, or feeling that you no longer have the fallback of your normal coping mechanisms [e.g., opportunities to unwind with friends] due to COVID-19.”

Supporting these workers leads to better health and public safety outcomes

RTI’s project team is currently conducting an impact study with MDIs to collect daily self-report measures and biometric data on work activities, sleep, and stress indicators over a 6-week period to learn more about the types of activities that trigger stress among MDIs. In the impact study, the team is also testing the effectiveness of MDI Align, a wellness app developed through this project that is tailored to the needs and experiences of MDIs.

The critical information collected in this study will result in a comprehensive data set and report that will be used to:

  • Improve understanding of and support for MDIs’ health and wellness.
  • Improve organizational practices among MDI employers.
  • Inform future programs, preventive trainings, and research to reduce and alleviate work-related stress.

MDI services are critical to effective public safety and public health practices; they provide vital evidence and are often the launching point for investigations. A lack of support for MDIs results in increased turnover and reduced job performance, ultimately affecting forensic practices and public health reporting. RTI’s survey results and impact study will provide important feedback to MDI employers to inform system-wide investments in MDI mental health and well-being.

To listen to a podcast on this subject, visit https://soundcloud.com/just_science/just-workforce-resiliency-for-mdis. For updates on this project, including findings as they become available, visit https://forensicrti.org/understanding-work-related-stress-mdi-professionals/.

Learn more about RTI’s work in forensic sciences.