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.

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.

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.

Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile / Self-managed psychiatry seminars as a model of active student participation in undergraduate education

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

The ABCDE psychological first aid intervention decreases early PTSD symptoms but does not prevent it: results of a randomized-controlled trial.

BACKGROUND: Early Psychological First Aid (PFA) has been widely recommended for preventing posttraumatic stress disorder (PTSD). However, its lack of empirical evidence of safety and effectiveness has been criticized. OBJECTIVES: To assess the effectiveness of PFA-ABCDE, an original PFA protocol, for preventing PTSD one month after the intervention and decreasing PTSD symptoms at one and six months of follow up. METHODS: We assessed the eligibility of 1,140 adult survivors of recent trauma (≤ 72 hours) consulting five emergency departments in Chile. Two hundred twenty-one were randomized to receive either PFA-ABCDE (active listening, breathing retraining, categorization of needs, referral to ancillary services, and psychoeducation) or only psychoeducation. We used the Composite International Diagnostic Interview (CIDI) to assess PTSD diagnosis. The Posttraumatic Checklist (PCL), the Beck Depression Inventory-II (BDI-II), and a 0-10 points analogue visual scale were used to assess PTSD symptoms, depressive symptoms, and immediate distress relief after the intervention. RESULTS: We found no difference between the experimental and control groups in the frequency of PTSD one month after the intervention (PFA-ABCDE = 23/76 [30.3%], psychoeducation = 18/75 [24.0%], adjusted odds ratio = 1.39, 95% confidence interval = 0.63-3.07, p = .408). Immediately after the intervention, participants who received PFA-ABCDE reported greater distress relief (PFA-ABCDE mean = 9.06, psychoeducation mean = 8.55, Cohen's d = 0.30, p = .038). Fewer PTSD symptoms were reported by those who received PFA-ABCDE one month after the intervention (PFA-ABCDE mean = 36.26, psychoeducation mean = 43.62, Cohen's d = 0.42, p = .033). We found no difference in depressive symptoms at one-month follow up (p = .713) nor in PTSD symptoms six months after the intervention (p = .986). CONCLUSIONS: PFA-ABCDE does not prevent PTSD diagnosis, but it provides immediate distress relief and decreases PTSD symptoms in the short term.

Antecedentes: Los Primeros Auxilios Psicológicos (PAP) han sido recomendados para prevenir el Trastorno de Estrés Postraumático (TEPT) en supervivientes de trauma. A pesar de su popularidad, la escasez de evidencia empírica sobre su seguridad y efectividad ha sido criticada.Objetivos: Evaluar la efectividad de los PAP-ABCDE, un protocolo original de PAP, para prevenir el TEPT al mes de seguimiento y disminuir los síntomas de TEPT luego de uno y seis meses de seguimiento.Métodos: Evaluamos elegibilidad de 1.140 adultos supervivientes de trauma reciente (≤ 72 horas) que consultaron cinco servicios de urgencia en Chile. Doscientos veintiún fueron aleatorizados a recibir PAP-ABCDE (escucha activa, reentrenamiento de la respiración, categorización de necesidades, derivación a redes de apoyo, y psicoeducación) o sólo psicoeducación. Utilizamos la Composite International Diagnostic Interview (CIDI) para evaluar el diagnóstico de TEPT. La Posttraumatic Checklist (PCL), la Beck Depression Inventory-II (BDI-II), y una escala visual análoga de 0-10 puntos fueron utilizadas para evaluar síntomas de TEPT, síntomas depresivos, y alivio inmediato de distrés luego de la intervención.Resultados: No encontramos diferencia entre el grupo experimental y el grupo control en la frecuencia de TEPT un mes después de la intervención (PAP-ABCDE = 23/76 [30,3%], psicoeducación = 18/75 [24,0%], odds ratio ajustado = 1,39, intervalo de confianza 95% = 0,63-3,07, p = ,408). Inmediatamente después de la intervención los participantes que recibieron PAP-ABCDE reportaron un mayor alivio de distrés (media en PAP = 9,06, media en psicoeducación = 8,55, d de Cohen = 0,30, p = ,038). Menos síntomas de TEPT fueron reportados un mes después de la intervención por aquellos que recibieron PAP-ABCDE (media de PAP-ABCDE = 36,26, media de psicoeducación = 43,62, d de Cohen = 0,42, p = ,033). No encontramos diferencias en síntomas depresivos al mes de seguimiento (p = ,713) ni en síntomas de TEPT seis meses después de la intervención (p = ,986).Conclusiones: Los PAP-ABCDE no previenen el diagnóstico de TEPT, pero brindan alivio inmediato del distrés y disminuyen la severidad de los síntomas del TEPT en el corto plazo.

[Self-managed psychiatry seminars as a model of active student participation in undergraduate education]. / Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile.

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

Post-traumatic symptoms in the staff of a mental health inpatient unit after the suicide of a patient: a case report in Chile / Síntomas postraumáticos en funcionarios de un servicio de hospitalización psiquiátrica luego del suicidio de un paciente: reporte de un caso en Chile

Multiple studies have shown that the suicide of a patient can produce posttraumatic and depressive symptoms among the mental health care providers, who typically have high levels of baseline burnout. OBJECTIVES: To measure posttraumatic, depressive and burnout symptoms in the staff of an inpatient psychiatric unit after the suicide of a patient. METHODS: Two months after the suicide all the employees were invited to answer, anonymously, the Posttraumatic Check-List (PCL), the Beck Depression Inventory (BDI), and the Maslach Burnout Inventory (MBI), for measuring posttraumatic, depressive, and burnout symptoms, respectively. RESULTS: Over 80% of the staff participated. A total of 17.1% had probable PTSD, 19.5% probable major depression, 24.4% and 14.6% high levels of emotional exhaustion and depersonalization, respectively, and 24.4% low levels of professional accomplishment. The group consisting of nurses, paramedic technicians, and nursing assistants ("nursing staff") had PTSD significantly greater than other workers (p < .001). CONCLUSIONS: Suicide in a psychiatric ward can produce posttraumatic and depressive symptoms among the staff, as high as another kind of traumas. The impact may be greater on the nursing staff. It is essential that organizations involved in the provision or teaching of mental health care incorporate this reality into their agenda, to prevent, mitigate and respond better to this phenomenon.

Múltiples estudios han mostrado que el suicidio de un paciente puede producir síntomas postraumáticos y depresivos en el personal de salud mental, quienes además presentan altos niveles de burnout basal. OBJETIVOS: Medir síntomas postraumáticos, depresivos y de burnout en los funcionarios de una unidad de hospitalización psiquiátrica luego del suicidio de un paciente. MÉTODOS: Dos meses después del suicidio, todos los funcionarios fueron invitados a contestar anónimamente el Postraumatic Check-List (PCL), el Inventario de Depresión de Beck (BDI), y el Inventario de Burnout de Maslach (MBI), para medir síntomas postraumáticos, depresivos, y de burnout, respectivamente. RESULTADOS: Más del 80% de los funcionarios contestaron los cuestionarios. Un total de 17,1% tenía probable Trastorno de Estrés Postraumático, 19,5% probable depresión mayor, 24,4% y 14,6% altos niveles de agotamiento emocional y despersonalización, respectivamente, y 24,4% bajos niveles de satisfacción profesional. El grupo compuesto por enfermeras universitarias, técnicos paramédicos, y asistentes de enfermería ("personal de enfermería") tuvo síntomas de Trastorno de Estrés Postraumático significativamente mayores que otros funcionarios (p < .001). CONCLUSIONES: El suicidio en una unidad de hospitalización psiquiátrica puede producir tantos síntomas postraumáticos y depresivos en los funcionarios de salud como otros tipos de traumas. El impacto podría ser mayor en el personal de enfermería. Es indispensable que las organizaciones involucradas en la provisión o enseñanza de salud mental incorporen esta realidad en sus agendas, para prevenir, mitigar y responder mejor a este fenómeno.