Psychological first aid (PFA) is a world-wide implemented approach to helping people affected by an emergency, disaster, or other adverse event. Controlled evaluations of PFA’s training effects are lacking. We evaluated the effectiveness of a one-day PFA training on the acquisition and retention of knowledge of appropriate responses and skills in the acute aftermath of adversity in Peripheral Health Units (PHUs) in post-Ebola Sierra Leone. Secondary outcomes were professional quality of life, confidence in supporting a distressed person, and professional attitude. PHUs in Sierra Leone (n = 129) were cluster-randomized across PFA (206 participants) and control (202 participants) in March 2017. Knowledge and understanding of psychosocial support principles and skills were measured with a questionnaire and two patient scenarios to which participants described helpful responses. Professional attitude, confidence, and professional quality of life were assessed using self-report instruments. Assessments took place at baseline and at three- and six-months post-baseline. The PFA group had a stronger increase in PFA knowledge and understanding at the post-PFA training assessment (d = 0.50; p < 0.001) and at follow-up (d = 0.43; p = 0.001). In addition, the PFA group showed better responses to the scenarios at six-months follow-up (d = 0.38; p = 0.0002) but not at the post-assessment (d = 0.04; p = 0.26). No overall significant differences were found for professional attitude, confidence, and professional quality of life. In conclusion, PFA training improved acquisition and retention of knowledge and understanding of appropriate psychosocial responses and skills in providing support to individuals exposed to acute adversity. Our data support the use of PFA trainings to strengthen capacity for psychosocial support in contexts of disaster and humanitarian crisis. Future studies should examine the effects of PFA on psychosocial outcomes for people affected by crises.

Background.In emergencies and resource-poor settings, non-specialists are increasingly being trained to provide psychosocial support to people in distress, with Psychological First Aid (PFA) one of the most widely-used approaches. This paper considers the effectiveness of short training programmes to equip volunteers to provide psychosocial support in emergencies, focusing particularly on whether the PFA training provided during the Ebola outbreak enabled non-specialists to incorporate the key principles into their practice.Methods.Semi-structured interviews were conducted in Sierra Leone and Liberia with 24 PFA trainers; 36 individuals who participated in PFA training; and 12 key informants involved in planning and implementing the PFA roll-out.Results.Findings indicate that many PFA training-of-trainers were short and rarely included content designed to develop training skills. As a result, the PFA training delivered was of variable quality. PFA providers had a good understanding of active listening, but responses to a person in distress were less consistent with the guidance in the PFA training or with the principles of effective interventions outlined by Hobfoll et al.Conclusions.There are advantages to training non-specialists to provide psychosocial support during emergencies, and PFA has all the elements of an effective approach. However, the very short training programmes which have been used to train non-specialists in PFA might be appropriate for participants who already bring a set of relevant skills to the training, but for others it is insufficient. Government/NGO standardisation of PFA training and integration in national emergency response structures and systems could strengthen in-country capacity.

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Formal measures of subjective well-being are needed to assure that health and psychosocial support services in Sierra Leone are objectively evaluated and evidence-based. The purpose of this study was to evaluate a Krio version of the brief form of the World Health Organization's Quality of Life (WHOQOL-BREF) questionnaire. A convenience sample of 425 adult Sierra Leoneans was verbally interviewed in the northern province of Bombali, using a previously piloted version of the scale, as well as a short demographic survey. Descriptive, correlational, and inferential statistics were used to assess evidence of reliability and validity in a manner similar to the WHOQOL-BREF international field trial. Cronbach's alpha for the four domains ranged from 0.55 to 0.72 and improved when the three negatively phrased items requiring reversed scoring were removed, as well as when all items were treated as a unidimensional scale (alpha = 0.83). Patients scored significantly lower scores on all four subscales and the question assessing overall quality of health question. Persons with no formal education had lower scores on Physical, Psychological, and Environmental domains, as well as the two overall quality of life and health questions. Age was negatively correlated with Physical, Psychological, and Social domains, as well as the questions for overall quality of life and quality of health. Multiple regression analyses found Physical, Psychological, and Environmental domains to be significantly associated with questions assessing overall quality of life and quality of health. Twenty-three out of 24 items correlated highest to their expected domain, but 10 also correlated above 0.40 on another domain. Confirmatory factor analysis allowing for two pairs of error variances to covary showed good fit with the original scale's four domain model (χ 2 /df = 3.02; CFI = .833; RMSEA = .069, 90% CI = 0.063-0.076). The results indicate that the new scale shares many of the same psychometric properties as the original WHOQOL-BREF and is appropriate for health-related research. Future studies with the WHOQOL and other quality of life instruments should use caution when developing negatively phrased items in scale development, particularly when planned for use across multiple settings, as they may yield unwanted method effects and adversely impact test reliability and internal structure.

Arthur Kleinman’s 2009 Lancet commentary described global mental health as a “moral failure of humanity”, asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman’s appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly—especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.