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Randomized Controlled Trial
. 2024;15(1):2364443.
doi: 10.1080/20008066.2024.2364443. Epub 2024 Jul 1.

The effect of a single session of psychological first aid in the emergency department on PTSD and depressive symptoms three months post-intervention: results of a randomised controlled trial

Rodrigo Andrés Figueroa  1   2   3 , Paula Francisca Cortés  3 , Carolina Miller  4 , Humberto Marín  1   3 , Rodrigo Gillibrand  5 , Chris Maria Hoeboer  2 , Miranda Olff  2   6
Affiliations
Randomized Controlled Trial

The effect of a single session of psychological first aid in the emergency department on PTSD and depressive symptoms three months post-intervention: results of a randomised controlled trial

Rodrigo Andrés Figueroa et al. Eur J Psychotraumatol. 2024.

Abstract
in English, Spanish

Background: Despite its popularity, evidence of the effectiveness of Psychological First Aid (PFA) is scarce.Objective: To assess whether PFA, compared to psychoeducation (PsyEd), an attention placebo control, reduces PTSD and depressive symptoms three months post-intervention.Methods: In two emergency departments, 166 recent-trauma adult survivors were randomised to a single session of PFA (n = 78) (active listening, breathing retraining, categorisation of needs, assisted referral to social networks, and PsyEd) or stand-alone PsyEd (n = 88). PTSD and depressive symptoms were assessed at baseline (T0), one (T1), and three months post-intervention (T2) with the PTSD Checklist (PCL-C at T0 and PCL-S at T1/T2) and the Beck Depression Inventory-II (BDI-II). Self-reported side effects, post-trauma increased alcohol/substance consumption and interpersonal conflicts, and use of psychotropics, psychotherapy, sick leave, and complementary/alternative medicine were also explored.Results: 86 participants (51.81% of those randomised) dropped out at T2. A significant proportion of participants in the PsyEd group also received PFA components (i.e. contamination). From T0 to T2, we did not find a significant advantage of PFA in reducing PTSD (p = .148) or depressive symptoms (p = .201). However, we found a significant dose-response effect between the number of delivered components, session duration, and PTSD symptom reduction. No significant difference in self-reported adverse effects was found. At T2, a smaller proportion of participants assigned to PFA reported increased consumption of alcohol/substances (OR = 0.09, p = .003), interpersonal conflicts (OR = 0.27, p = .014), and having used psychotropics (OR = 0.23, p = .013) or sick leave (OR = 0.11, p = .047).Conclusions: Three months post-intervention, we did not find evidence that PFA outperforms PsyEd in reducing PTSD or depressive symptoms. Contamination may have affected our results. PFA, nonetheless, appears to be promising in modifying some post-trauma behaviours. Further research is needed.

Antecedentes: A pesar de su popularidad, la evidencia sobre la efectividad de los Primeros Auxilios Psicológicos (PAP) es escasa.

Objetivo: Evaluar si los PAP, en comparación con la psicoeducación (PsiEd), un control de placebo atencional, reducen los síntomas de PTSD y depresión tres meses después de la intervención.

Método: En dos servicios de urgencia, 166 adultos sobrevivientes de traumas recientes fueron asignados aleatoriamente a una sola sesión de PAP (n = 78) (escucha activa, ejercicios de respiración, categorización de necesidades, derivación asistida a redes sociales y PsiEd) o a PsiEd sola (n = 88). Los síntomas de PTSD y depresión fueron evaluados al inicio (T0), uno (T1) y tres meses después de la intervención (T2) con el PTSD Checklist (PCL-C en T0 y PCL-S en T1/T2) y el Inventario de Depresión de Beck-II (BDI-II). También se exploró el autoreporte de efectos adversos, consumo de alcohol/sustancias, conflictos interpersonales, y uso de psicotrópicos, psicoterapia, licencia por enfermedad y medicina complementaria/alternativa.

Resultados: 86 participantes (51,81% de los aleatorizados) abandonaron en T2. Una proporción significativa de participantes en el grupo PsiEd también recibió componentes de PAP (es decir, hubo contaminación). De T0 a T2, no encontramos una ventaja significativa de PAP en la reducción de síntomas de PTSD (p = .148) o depresión (p = .201). Sin embargo, encontramos un efecto dosis-respuesta significativo entre el número de componentes entregados o la duración de la sesión y la reducción de síntomas de PTSD. No encontramos diferencias significativas en efectos adversos. En T2, una proporción menor de participantes asignados a PAP reportó un aumento en el consumo de alcohol/sustancias (OR = 0.09, p = .003), conflictos interpersonales (OR = 0.27, p = .014), y uso de psicotrópicos (OR = 0.23, p = .013) o licencia por enfermedad (OR = 0.11, p = .047).

Conclusiones: Tres meses después de la intervención, no encontramos evidencia de que los PAP superen a PsiEd en la reducción de síntomas de PTSD o depresión. La contaminación pudo haber afectado nuestros resultados. Sin embargo, los PAP parecen ser prometedores en la modificación de algunos comportamientos postraumáticos. Se necesita más investigación.

Keywords: PTSD; Primeros Auxilios Psicológicos; Psychological First Aid; RCT; emergency department; prevención; prevention; servicio de urgencias; trauma.

Plain language summary

Psychological First Aid (PFA) is widely recommended early after trauma.We assessed PFA's effectiveness for decreasing PTSD symptoms and other problems 3 months post-trauma.We didn't find definitive evidence of PFA’s effectiveness. Still, it seems to be a safe intervention.

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Conflict of interest statement

Rodrigo Andrés Figueroa, Paula Francisca Cortés, and Humberto Marín are paid for teaching in the “Psychological First Aid ABCDE certification workshop” at the Pontificia Universidad Católica de Chile School of Medicine. “PAP-ABCDE” is a trademark of Pontificia Universidad Católica de Chile.

Figures

A flowchart of participants through the study in which the total number of individuals assessed for eligibility, excluded, randomised, allocated into each condition, lost to follow-up, and analysed is shown. Two hundred eighty-eight individuals from 374 assessed for eligibility were excluded due to not meeting inclusion criteria or declining participation. One hundred sixty-six were randomised (78 allocated to Psychological First Aid, and 88 to psychoeducation). Most participants received their allocated intervention. High attrition during follow-up is shown (up to 51.8% three months post-intervention). All participants were analysed according to intention-to-treat.
Figure 1.
Flowchart of participants through the study.
A matrix of 2 × 2 graphs showing predicted values between baseline and three months post-intervention, according to linear mixed-effect models. Top-left: PCL total score by time; negative slope. Top-right: BDI-II total score by time; negative slope. Bottom-left: PCL total score by time, separated by condition. Both conditions show negative slopes, but overlapping shadows show no significant difference. Bottom-right: BDI-II total score by time, separated by condition. Both conditions show negative slopes, but overlapping shadows show no significant difference.
Figure 2.
Predicted values of the PTSD Checklist (PCL) and Beck Depression Inventory-II (BDI-II) in linear mixed-effect models; pfa: Participants assigned to Psychological First Aid (0 = no; 1 = yes). Shadows represent 95% confidence intervals.
See this image and copyright information in PMC

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Publication types

Grants and funding

This work was funded by the Fundación Científica y Tecnológica ACHS (FUCYT) through the Proyectos de Investigación e Innovación en Prevención de Accidentes y Enfermedades Profesionales – Superintendencia de Seguridad Social (SUSESO), Chile. Neither FUCYT nor SUSESO was involved in this study’s design, conduct, or analysis.

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