EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY

2024, VOL. 15, NO. 1, 2364443

https://doi.org/10.1080/20008066.2024.2364443

CLINICAL RESEARCH ARTICLE

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 a,b,c, Paula Francisca Cortésc, Carolina Millerd, Humberto Marín a,c
,
Rodrigo Gillibrande*, Chris Maria Hoeboer b and Miranda Olff b,f
a
Neuroscience Division, Department of Psychiatry, Pontificia Universidad Católica de Chile School of Medicine, Santiago, Chile;
b
Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;
c
Research Centre for Integrated Natural Disaster Management (Cigiden), Santiago, Chile; dPontificia Universidad de Chile School of
Psychology, Santiago, Chile; eHospital Del Trabajador, Asociación Chilena de Seguridad, Providencia, Chile; fARQ National Psychotrauma
Centre, Diemen, The Netherlands

ABSTRACT ARTICLE HISTORY

Background: Despite its popularity, evidence of the effectiveness of Psychological First Aid Received 1 October 2023
(PFA) is scarce. Revised 25 April 2024
Objective: To assess whether PFA, compared to psychoeducation (PsyEd), an attention Accepted 12 May 2024
placebo control, reduces PTSD and depressive symptoms three months post-intervention.
KEYWORDS
Methods: In two emergency departments, 166 recent-trauma adult survivors were randomised Psychological First Aid; PTSD;
to a single session of PFA (n = 78) (active listening, breathing retraining, categorisation of emergency department;
needs, assisted referral to social networks, and PsyEd) or stand-alone PsyEd (n = 88). PTSD trauma; RCT; prevention
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 PALABRAS CLAVE
Depression Inventory-II (BDI-II). Self-reported side effects, post-trauma increased alcohol/ Primeros Auxilios
substance consumption and interpersonal conflicts, and use of psychotropics, Psicológicos; PTSD; servicio
de urgencias; trauma; RCT;
psychotherapy, sick leave, and complementary/alternative medicine were also explored.
prevención.
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. HIGHLIGHTS
contamination). From T0 to T2, we did not find a significant advantage of PFA in reducing • Psychological First Aid
PTSD (p = .148) or depressive symptoms (p = .201). However, we found a significant dose– (PFA) is widely
response effect between the number of delivered components, session duration, and PTSD recommended early after
symptom reduction. No significant difference in self-reported adverse effects was found. At trauma.
T2, a smaller proportion of participants assigned to PFA reported increased consumption of • We assessed PFA’s
alcohol/substances (OR = 0.09, p = .003), interpersonal conflicts (OR = 0.27, p = .014), and effectiveness for
decreasing PTSD
having used psychotropics (OR = 0.23, p = .013) or sick leave (OR = 0.11, p = .047). symptoms and other
Conclusions: Three months post-intervention, we did not find evidence that PFA outperforms problems 3 months post-
PsyEd in reducing PTSD or depressive symptoms. Contamination may have affected our results. trauma.
PFA, nonetheless, appears to be promising in modifying some post-trauma behaviours. Further • We didn’t find definitive
research is needed. evidence of PFA’s
effectiveness. Still, it seems
to be a safe intervention.
Efecto de una única sesión de primeros auxilios psicológicos en el servicio
de urgencias sobre síntomas de Trastorno de Estrés Postraumático y
depresión tres meses después de la intervención: resultados de un
ensayo controlado aleatorizado
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

CONTACT Rodrigo Andrés Figueroa rfiguerc@uc.cl Department of Psychiatry, Pontificia Universidad Católica de Chile School of Medicine, Diagonal
Paraguay 362, Santiago 8330077, Chile
*Present address: Department of Psychiatry, Universidad de Chile School of Medicine.
Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2024.2364443.
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which
permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been
published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
2 R. A. FIGUEROA ET AL.

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.

1. Introduction
About 70% of the world’s population has experienced
trauma (Kessler et al., 2017). Climate change, political
conflicts and epidemiological threats could increase
trauma exposure in the following years (Bowles
et al., 2015). Post-traumatic stress disorder (PTSD) is
a common mental condition after trauma. In a survey
of 68,894 participants from 24 countries, the risk of
developing PTSD after any trauma was 4%, with the
highest risk among victims of rape (19%) (Kessler
et al., 2017). PTSD has been associated with a higher
risk of suicide, secondary comorbidity, role function­
ing disruption, and loss of life course opportunities
(Kessler, 2000).
Psychological First Aid (PFA) is an early psychoso­
cial intervention for reducing initial distress and fos­
tering adaptive functioning in trauma victims
(Vernberg et al., 2008). It has been defined as a
‘humane, supportive response to a fellow human
being who is suffering and who may need support. It
entails basic, non-intrusive pragmatic care with a
focus on listening but not forcing talk, assessing
needs and concerns, ensuring that basic needs are
met, encouraging social support from significant
others and protecting from further harm’ (No authors,
2010). PFA is endorsed by the World Health Organi­
sation (World Health Organization, World Trauma
Foundation & World Vision International, 2011)
and the International Federation of Red Cross and
Red Crescent Societies (IFRC Reference Centre for
Psychosocial Support, 2018), among other inter­
national organisations.
Although there are many models of PFA, all of
them seek to increase safety, calm, self-efficacy, con­
nection, and hope, five empirically supported prin­
ciples widely known as ‘Hobfoll’s essential elements’.
PFA fosters Hobfoll’s elements through active listen­
ing, relaxation, problem-solving, and social connec­
tion (Wang et al., 2024). According to the literature
on trauma and disaster recovery and expert consensus,
Hobfoll’s essential elements should guide early post-
trauma interventions (Hobfoll et al., 2007). They are
aimed at bringing immediate emotional relief, pre­
venting traumatisation, and promoting adaptive cop­
ing through rapid interruption of the traumatic
stimulus, modulation of agitation and hyperarousal,
increase in the notion of self – and collective
efficacy, increase of received and perceived social sup­
port, mitigation of self-defeating thoughts, and foster­
ing positive behaviours (Wang et al., 2024). Notably,
more than complex psychological manoeuvres, PFA
was conceived to enhance Hobfoll’s essential elements
through rapid, simple, and pragmatic actions, such as
normalisation, breathing retraining, ‘problem-sol­
ving’, and ‘practical assistance’, among others. These
actions can be provided even in single sessions. The
notion that such rapid, brief, and simple actions can
be effective is supported by six trials in which PFA
was delivered in just one session, all of them showing
promising results in decreasing PTSD, depressive, and
anxiety symptoms (Wang et al., 2024).
Despite the widespread use of PFA, there is a pau­
city of evidence to support its effectiveness and
safety. Several challenges have hampered PFA
research, such as its inherent flexibility that limits
standardisation and the complexity of conducting
programme evaluation research in emergency and
disaster contexts (Hermosilla et al., 2023). Bisson
and Lewis (2009) published in 2009 the results of
the first meta-analysis on PFA, concluding that
their literature search ‘revealed no randomised-con­
trolled trials (RCT), observational or any other
empirical study of PFA.’ More than one decade
later, a new systematic review by Hermosilla et al.
(2023) found only twelve empirical studies and just
one RCT about PFA. Although all of them showed
a positive effect of PFA, mostly on anxiety,
depression, post-traumatic stress, and distress, sev­
eral limitations, such as inconsistent intervention
components, insufficient evaluation methodologies,

and a high risk of bias, precluded firm conclusions.
Consequently, experts have urgently called for
further research (Hermosilla et al., 2023; Shultz &
Forbes, 2014).
Acknowledged as ‘the most robust trial’ in the last
systematic review of PFA (Wang et al., 2024), Figueroa
et al. studied a sample of 221 adult non-intentional
trauma survivors visiting five emergency departments
in Chile (Figueroa et al., 2022). They showed that a
single 30–60-min PFA session relieved participants’
psychological distress immediately after its delivery
and that PFA was associated with fewer PTSD symp­
toms one – but no six-months post-intervention, com­
pared to psychoeducation. In this study, we aimed to
replicate Figueroa et al.’s trial but assess PFA’s effect
at three months post-intervention, an intermediate
endpoint that was not previously explored. To deter­
mine PFA’s effect, we also used mixed-effects models,
a more robust methodology to deal with longitudinal
data compared to traditional linear regressions
(Oberg & Mahoney, 2007). Additionally, we recorded
the components of the experimental and control con­
ditions that were effectively delivered. This crucial
information about the protocol components that are
truly provided has been absent in most available
PFA trials, hindering the study of PFA mechanisms
(Wang et al., 2024). Furthermore, in this study, we
also explored PFA’s impact on other significant out­
comes besides symptom control, namely self-reported
side effects, increased post-trauma alcohol/substance
consumption, increased post-trauma interpersonal
conflicts, and use of psychotropics, psychotherapy,
sick leave, and complementary/alternative medicine
to deal with post-traumatic emotional distress. We
hypothesised that at three months post-intervention,
PFA would outperform PsyEd in decreasing PTSD
and depressive symptoms, that it would not be associ­
ated with increased odds of self-reported adverse
effects, and that fewer participants assigned to PFA
would report increased post-trauma alcohol/substance
consumption, increased post-trauma interpersonal
conflicts, and post-trauma use of psychotropics, psy­
chotherapy, sick leave, and complementary/alternative
medicine.
2. Methods
2.1. Study design
This study was an RCT with two parallel groups: PFA
and PsyEd. As in Figueroa et al. (2022) and upon dis­
cussing the ethical implications of leaving recent
trauma survivors without any formal support, we
decided to use PsyEd as an attention placebo control
(APC). APC is regarded as a highly valid control con­
dition in social intervention research (Popp & Schnei­
der, 2015). APCs are analogous to pill placebos in drug
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 3
trials, aimed at controlling nonspecific effects of the
intervention, such as attention, treatment contact,
social support, and nonspecific therapist effects
(Pagoto et al., 2013). For an intervention to be con­
sidered a good APC, it needs to mimic the experimen­
tal intervention’s nonspecific, theoretically inactive
components. PsyEd can be regarded as an effective
APC of PFA because it provides attention and treat­
ment contact, like PFA, but has not been shown to
decrease PTSD or depression symptoms as a stand-
alone intervention, according to a recent systematic
review of ten studies in which none of them showed
a significant effect compared to no or other interven­
tions (Brooks et al., 2021). Moreover, as long as PsyEd
has failed to show a significant impact on decreasing
PTSD and depressive symptoms in recent trauma sur­
vivors compared to no intervention, treatment as
usual, or waiting list, it can be reasonably assumed
that the symptomatic trajectories exhibited by partici­
pants assigned to PsyEd are a valid proxy of the natu­
ral course of PTSD and depressive symptoms and,
consequently, any differential effect of PFA vs PsyEd
could be considered a proxy of PFA’s effectiveness
(Laursen et al., 2020).
In this study, participants were randomly assigned
1:1 to the active and control conditions. Recruitment
occurred from June 12th to July 28th, 2017; follow-
ups were completed by October 31st, 2017. The
study was conducted in the emergency departments
(ED) of two academic hospitals in Chile. The ethical
committees of both hospitals approved the protocol.
2.2. Sample size
Based on Figueroa et al. (2022), we aimed to detect a
mean difference of seven points in the PTSD Checklist
(PCL) scores with alpha 5% (two-sided) and beta 80%.
This required a sample size of 166 participants, assum­
ing a standard deviation (S.D.) of 16 points.
2.3. Participants
Participants were 166 adults 18 years or older visiting
an ED as a patient or companion and exposed to
trauma no more than 72 hours before. Events were
considered trauma if they met the PTSD A-criterion
of the DSM-5 (American Psychiatric Association,
2013). Medical conditions were regarded as trauma
only when they were sudden and threatened life or
physical integrity. Companions were invited to par­
ticipate in the study only when they witnessed trauma
in person or learned that a close family member or
friend had experienced an unexpected, violent, or
accidental traumatic event. Exclusion criteria included
not speaking Spanish, illiteracy, agitated, violent, or
disruptive behaviour, physiological instability requir­
ing medical intervention, a close relative in imminent
4 R. A. FIGUEROA ET AL.
agony, amnesia, brain concussion, lack of telephone,
psychosis, or suicide attempt, all of them present at
the time of the recruitment. The inclusion and exclu­
sion criteria were assessed using a self-reported check­
list, the attending physician’s opinion, and medical
records when available.
2.4. Providers
The providers were five psychology students in their
4th year who finished an 8-hour PFA training com­
prising lectures and role-playing. The training
included topics on traumatic stress, the whole PFA
protocol, and self-care. In addition, they received 8
hours of training on enrolment, randomisation, blind­
ing and data collection. The PFA training was compar­
able to other courses (Ni et al., 2023). Providers’
competencies on PFA were ensured with a post-train­
ing test that included alternative questions and a simu­
lation with actors. Further information on providers’
training can be found elsewhere (Figueroa et al.,
2022). Providers received payment for their service.
They were responsible for searching eligible survivors,
enrolling participants, collecting baseline data, and
delivering the allocated intervention. Because stand-
alone PsyEd is also a component of the whole PFA
protocol (step E) and PFA and PsyEd providers were
the same psychology students, PsyEd training was
regarded as a part of the entire PFA training.
2.5. Recruitment and enrolment
Emergency room triage nurses notified providers if a
patient or companion showed psychological distress
(e.g., crying, screaming, yelling, complaining). Provi­
ders approached these individuals and offered an
opportunity to participate in a medical study to evalu­
ate the effectiveness of a ‘psychological intervention’ to
deliver immediate emotional relief and prevent pos­
terior psychological problems. No more explanations
about the study’s hypothesis were given, and technical
explanations were withheld to avoid expectancy. A
brochure outlining the study’s possible benefits and
risks was offered. Those who expressed interest were
registered, and eligibility was assessed. Those eligible
signed an informed consent document. The recruit­
ment finished when the calculated sample size was
reached. The follow-up ended after all participants
were evaluated or declared lost to follow-up. We did
not consider any interim analyses or stopping
guidelines.
2.6. Randomisation
Before starting the study, one author obtained a ran­
dom sequence of digits zero or one in identical pro­
portions from the website random.org. No
restrictions, such as blocking, were set. Two research­
ers kept the allocation sequence concealed. After
enrolment, providers collected baseline data with
paper and pencil at the bedside for patients or in a
quiet and private room for companions. Providers
were allowed to clarify participants’ questions but
not to respond to their questionnaires. After collecting
baseline data, an author randomly allocated partici­
pants to PFA or PsyEd by phone. Participants
remained blind to their allocation during the study.
The same provider who enrolled the participant deliv­
ered the assigned intervention. PFA and PsyEd were
similar in that the same providers provided both inter­
ventions in the same areas and with the same written
material, facilitating blinding. Providers did not know
the study’s hypotheses.
2.7. Interventions
Participants assigned to PFA received a single session
of PFA immediately after allocation, according to the
PFA-ABCDE protocol (Cortés Montenegro & Fig­
ueroa Cabello, 2019). The ABCDE protocol entails
five steps to foster Hobfoll’s essential elements (Hob­
foll et al., 2007). Each step is named after their first
letter, forming a mnemonic. The whole protocol is
delivered in 30–60 minutes. Depending on clinical
needs, steps can be swapped or exceptionally omitted.
The steps are:
A. Active listening (10–20 min), in which the survivor
can talk without interruption, and the caregiver
shows empathy through listening, paraphrasing
and reflection. The goal is to provide reassurance
through empathic companionship.
B. Breathing retraining (5–10 min), which consists of
a breathing exercise to bring calm through pro­
longed exhalation. Recent evidence shows that
prolonged exhalation increases heart rate variabil­
ity, presumably linked to a stimulation of the vagal
tone that may lead to a calming effect (Bae et al.,
2021).
C. Categorisation of needs (5–10 min), which
involves assisting the survivor in identifying and
prioritising their most pressing needs and con­
cerns, such as communication with relatives,
information, legal issues, or social services. The
aim is to help the survivor regain control of the
situation and foster goal-oriented thinking.
D. Referral (equivalent to Derivación in Spanish) (5–
10 min) involves referring survivors to the social
support networks that best meet the needs ident­
ified in step C. To implement step D, providers
personally get survivors in connection with ade­
quate social support networks by making phone
calls or accompanying participants in situ to get
in contact with relatives, friends, or social service

workers. When immediate access to social support
networks is not feasible, a plan is made with the
active participation of the survivor. This step is
facilitated through a booklet containing details
on public health and social protection services,
including a 24/7 telephone line for health-related
matters. The importance of regular social support
and maintaining close relationships with family
and friends is discussed, and those requiring for­
mal mental health are formally referred.
E. psychoEducation (5–10 min) provides information
about common reactions to trauma, warning signs,
adaptive coping strategies, access to mental health­
care, and myths. Step E is also supported with a
booklet. The name of this step is written with
uppercase ‘E’ to signal its place in the ABCDE
mnemonic.
Participants assigned to the control condition were
offered PsyEd as a stand-alone intervention, identical
to PFA’s step E, and delivered by the same providers,
with the same written material, in the same places. For
ethical reasons, we allowed providers to provide other
PFA components besides step E to participants
assigned to PsyEd who explicitly requested them.
Hence, the truly delivered steps and the starting and
ending times of the intervention were registered to
check protocol integrity. The proportion of partici­
pants assigned to PFA or PsyEd who received steps
A, B, C, D, and E was 89.3 vs 30.0%, 74.3 vs 7.8%,
40.5 vs 1.3%, 49.3 vs 24.1%, and 94.7 vs 95.2%, respect­
ively. The mean (S.D.) duration of PFA was 35.3 min
(32.57), whereas PsyEd lasted 16.8 min (13.93). Over­
all, PFA differed from PsyEd in that, on average, it was
about 50% longer and included components A, B, C,
or D in a significantly higher proportion of
participants.
An English version of the intervention manual can
be downloaded for free at the Pontificia Universidad
Católica de Chile School of Medicine website:
https://medicina.uc.cl/publicacion/manual-abcde-la-
aplicacion-primeros-auxilios-psicologicos/.
2.8. Outcomes
The primary outcome was the effect of the interven­
tion on the reduction of PTSD and depressive symp­
toms three months post-intervention. Secondary
outcomes included self-reported side effects, increased
post-trauma alcohol/substance consumption,
increased post-trauma interpersonal conflicts, and
post-trauma use of psychotropics, psychotherapy,
sick leave, and complementary/alternative medicine
to deal with post-traumatic distress.
Baseline data, including demographic information,
vital signs, trauma history, PTSD and depressive
symptoms, and peritraumatic dissociation, were
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 5
collected by providers in the ED immediately after
participants gave informed consent at T0. A team of
specialised operators blind to the participant’s allo­
cation collected data by phone one (T1) and three
months (T2) post-intervention.
2.8.1. Instruments
2.8.1.1. Demographic information. Demographic
information was assessed using the demographics sec­
tion of the WHO World Mental Health Composite
International Diagnostic Interview, Spanish version
2.1 (World Health Organization, 1997).
2.8.1.2. PTSD symptoms. We used the Spanish version
of the PTSD Checklist (PCL) to assess PTSD symp­
toms in the last month (Weathers et al., 1993). The
‘civilian version’ of the PCL (PCL-C), which referred
to any previous traumatic event, including the one
that brought the participant to the ED, was used at
T0. The ‘specific version’ (PCL-S), which referred
exclusively to the trauma that brought the participant
to the ED, was used at T1 and T2. Both versions of the
PCL are a 17-item, self-reported instrument based on
the Fourth Edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV). Each item is
answered on a one (not at all) to five (extremely)
Likert scale, with total scores ranging from 17 to 85
and higher scores indicating higher PTSD symptoms.
For our study, we chose to use the PCL, which is based
on the DSM-IV criteria, instead of the PCL-5, which is
based on the DSM-5, because when the study was
implemented, the PCL was the only option validated
in Chile. For diagnosing ‘probable PTSD’, we used a
cut-point score ≥ 44, assuming a prevalence of PTSD
diagnosis of about 25% at T1 based on Figueroa
et al. (2022), and considering the recommendation
of the National Center for PTSD (https://www.ptsd.
va.gov/professional/assessment/documents/PCL_
handoutDSM4.pdf). The PCL showed excellent
internal consistency in a sample of adults affected by
the 2010 earthquake in Chile (0.89) (Vera-Villarroel
et al., 2011). In our sample, the PCL showed excellent
internal reliability (Cronbach’s alpha = .93 at T0, .93 at
T1, and .92 at T2).
2.8.1.3. Depressive symptoms. To evaluate depressive
symptoms, we employed the Spanish version of the
Beck Depression Inventory-II (BDI-II) (Beck et al.,
1996). The BDI-II is a self-report instrument with 21
items and four possible answers, 0–3, with total scores
ranging from 0 to 63 and higher scores signalling
higher depressive symptoms. It was validated in
Chile, showing Cronbach’s alphas ranging between
.89 and .91 (Melipillán Araneda et al., 2008). In our
sample, the BDI-II showed good to excellent internal
consistency (Cronbach’s alpha = .90 at T0, .89 at T1,
and .86 at T2).
6 R. A. FIGUEROA ET AL.
2.8.1.4. Peritraumatic dissociation. We employed the
Peritraumatic Dissociative Experiences Question­
naire (PDEQ) to measure peritraumatic dissociation
symptoms linked to the traumatic event that
brought the participant to the ED (Marmar et al.,
1997). The PDEQ is a 10-item self-report question­
naire that assesses the following phenomena with a
5-point scale of 1 (‘not at all’) to 5 (‘extremely
true’): losing track of time; acting automatically;
feeling as though time was changing; feeling as
though one was floating above the scene; feeling
disconnected from own’s body; confusion; not
being aware of what is happening; and disorienta­
tion. It yields a 7–35 total score range, with a higher
score reflecting higher peritraumatic dissociation
symptoms. The PDEQ has proven to be discrimi­
nant, predictive, convergent, and reliable, with
Cronbach’s alpha scores ranging from .81 to .85
(Marshall et al., 2002). The similarity between the
English and Spanish versions of the PDEQ was
established by Marshall and Orlando (2002). The
Chilean-Spanish version was validated in a sample
of firefighters (Ramos et al., 2022). In our sample,
its internal consistency (Cronbach’s alpha) was
.84, indicating good reliability.
2.8.1.5. Number of different previous traumas. Life­
time exposure to traumatic events was evaluated
with the Trauma Questionnaire (TQ) (Escalona
et al., 1997) at T0. This self-report questionnaire
assesses lifetime exposure to 18 types of self-experi­
enced or witnessed traumatic events. Each event is
answered ‘yes’ or ‘no,’ independently of the number
of times it occurred. The Spanish version (Bobes
et al., 2000) has demonstrated adequate test-retest
reliability, discriminant validity, and concurrent val­
idity. We calculated a total score by adding the total
number of different previous traumatic events
reported by the participant.
2.8.1.6. Other post-trauma phenomena. We used not
validated, close-ended, yes/no questions at T1 and
T2 to assess self-reported side effects and six post-
trauma behaviours: increased alcohol/substance
consumption, increased interpersonal conflicts, use
of psychotropics, use of psychotherapy, use of sick
leave, and use of complementary/alternative medi­
cine, the last four ‘to deal with post-traumatic dis­
tress’ (see Table 3). We explored these phenomena
only dichotomously (i.e. yes/no); hence, for
example, the number of days off work due to sick
leave or the amount of increased alcohol consump­
tion was not explored. Self-reported adverse effects
were also assessed immediately after the
intervention.
2.9. Analytical methods
All analyses were conducted intention-to-treat with a
significance threshold of p < .05. We performed all cal­
culations using R.
The intervention’s effect on the change of PTSD
and depressive symptom scores from T0 to T2 was
modelled with linear mixed-effect models. Indepen­
dent predictors of PTSD and depressive symptoms
at T2, the experimental condition among them, were
modelled with multiple linear regressions. To increase
statistical power and protect against baseline imbal­
ance (Kahan et al., 2014), we included baseline
depressive symptoms as a covariate in all calculations,
given its large predicting effect on PTSD symptoma­
tology (Worthington et al., 2020) and its previous
use by Figueroa et al. (2022). Baseline PTSD symp­
toms were not included as a covariate due to large
multicollinearity with baseline depressive symptoms
(r = .692, p < .001). In the mixed-effect models, time
(measured in months with 0 representing baseline),
condition, baseline depressive symptoms, and the
interaction between time and condition were included
as independent fixed variables. Random effects were
incorporated to account for the interdependence of
observations within the same individuals. We sensi­
tised our mixed models by adding baseline education,
peritraumatic dissociative symptoms, and the number
of different previous traumas as covariates. We also
modelled the effect of the interaction time × session
duration and time × number of delivered components.
All variables were centred.
Independent predictors of probable PTSD diagno­
sis and PTSD and depressive symptoms at T2 were
modelled with stepwise multiple regressions by back­
ward elimination of the following covariates: baseline
depressive symptoms, condition, education, number
of previous traumas, and peritraumatic dissociative
symptoms.
The intervention’s effect on self-reported side
effects, increased post-trauma alcohol/substance con­
sumption, increased post-trauma interpersonal confl­
icts, and post-trauma use of psychotropics,
psychotherapy, sick leave, and complementary/
alternative medicine was evaluated with logistic
regressions comparing the odds of answering ‘yes’ by
participants assigned to PFA versus PsyEd.
Missingness was handled within mixed-effect
models by Restricted Maximum Likelihood (REML),
assuming missingness at random (MAR). Missingness
in linear and logistic regression models was managed
with multiple imputations of missing data by chain
equations (van Buuren & Groothuis-Oudshoorn,
2011), assuming missingness at random (MAR). We
imputed data using highly correlated coauxiliars
(Spearman’s Rho ≥ .4) with less than 10% missingness
(Hardt et al., 2012). Five datasets were imputed after

70 iterations. Assessment of density plots and the
R-hat statistic showed convergence in all imputed
datasets.
3. Results
A total of 374 individuals were screened for eligibility.
Of them, 166 (44.4%) were randomised to receive PFA
(N = 78, 47%) or PsyEd (N = 88, 53%) (Figure 1).
The attrition rate was high and equivalent in both
groups. A total of 44 participants (26.51% of those ran­
domised) dropped out at T1, and 86 participants
(51.81% of those randomised) dropped out at T2,
with no significant differences between conditions
(OR = 0.920, p = .812 at T1; OR = 0.872, p = .661 at
T2). The main reason for attrition was no traceability.
Most participants were middle-aged (mean = 41.21
years, S.D. = 13.48) females (65.66%), with a mean of
about twelve years of formal education (mean =
12.29, S.D. = 3.45), moderate mean baseline PTSD
Figure 1. Flowchart of participants through the study.
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 7
symptoms (mean = 40.80, S.D. = 16.67), mild mean
baseline depressive symptoms (mean = 14.92, S.D. =
11.19), and lifetime exposure to more than two pre­
vious different types of traumas (mean = 2.60, S.D.
= 2.09). Learning that a close family member or
friend was exposed to actual or threatened death,
serious injury, or sexual violence was the most fre­
quent trauma (25.30%), followed by sudden medical
conditions threatening life or physical integrity
(16.87%) and motor vehicle accidents (15.06%)
(Table 1).
We found a significant decrease of PTSD symptoms
(Β = −3.02, Std. Error = 0.49, β = −.20, p < .001) and
depressive symptoms (B = −1.01, Std. Error = 0.39, β
= −.11, p = .012) between T0 and T2. However, we
did not find a significant interaction between time
and the experimental condition for PTSD (B =
−1.47, Std. Error = 1.01, β = −.05, p = .148) or depress­
ive symptoms (B = 1.21, Std. Error = 0.94, β = .07, p
= .201) (Table 2 and Figure 2). After sensitisation,
8 R. A. FIGUEROA ET AL.

Table 1. Baseline characteristics of participants. At T2 and after backward elimination of covariates

PsyEd PFA in multiple linear regressions, only the experimental
Characteristic (N = 88) (N = 78)
condition and baseline depressive symptoms
Female n (%) 53 (60.2) 56 (71.8)
Age (years) mean (S.D.) 39.28 (13.35) 43.42 (13.38) remained significant predictors of PTSD symptoms
Education (years) mean (S.D.) 12.56 (3.61) 11.99 (3.25) (PFA – PsyEd adjusted mean difference at T2 =
Reports having a romantic partner n 36 (40.9) 36 (46.2)
(%)
−6.41, Cohen’s d = −0.45, p = .03). Baseline depressive
Number of children mean (S.D.) 1.66 (1.43) 1.88 (1.21) symptoms was the only covariate that remained a sig­
Depressive symptoms (BDI-II total 15.53 (11.41) 14.20 (10.96) nificant predictor of depressive symptoms at T2 (B =
score) mean (S.D.)
PTSD symptoms (PCL total score) mean 42.36 (17.61) 40.57 (18.00) 0.27, Std. Error = 0.11, p = .021). Four (10.3%) and 13
(S.D.) (31.7%) participants had ‘probable PTSD’ in the PFA
Peritraumatic dissociation symptoms 23.52 (10.45) 22.39 (9.96)
(PDEQ total score) mean (S.D.) vs PsyEd groups, respectively (PFA OR = .25, p
Number of different previous traumas 2.55 (2.03) 2.65 (2.17) = .028). The experimental condition, peritraumatic
(TQ total score) mean (S.D.)
Heart rate (BPM) mean (S.D.) 84.37 (19.00) 86.86 (17.46) dissociation, and baseline PTSD symptoms were the
Systolic blood pressure (mm Hg) mean 138.90 (24.83) 133.80 (23.26) only variables that remained significant predictors of
(S.D.)
Diastolic blood pressure (mm Hg) mean 78.68 (16.29) 78.69 (15.29)
‘probable PTSD’ diagnosis at T2 after stepwise back­
(S.D.) ward elimination of covariables in logistic regressions
Body temperature (°C) mean (S.D.) 36.19 (0.31) 36.10 (0.21) (PFA OR = .126, Std. Error = 0.81, p = .013).
Session duration (min) 16.79 (13.94) 35.33 (32.57)
Type of trauma n (%) The proportion of participants who reported adverse
Motor vehicle accident 13 (14.94) 12 (16.22) effects at T2 did not differ between conditions immedi­
Other accidents 5 (5.75) 2 (2.70)
A sudden medical condition 13 (14.94) 15 (20.27) ately after the intervention (OR = 1.53, p = .520), at T1
threatening life or physical integrity (OR = 3.13, p = .127), or at T2 (OR = 0.46, p = .402)
Witnessing trauma in person 11 (12.64) 13 (17.57)
Learning that a close family member 22 (25.29) 20 (27.03) (Table 3). Interestingly, at T2, fewer participants in
or friend was exposed to actual or the PFA group reported increased post-trauma alco­
threatened death, serious injury, or
sexual violence
hol/substance consumption (OR = 0.09, p = 0.003),
Victim of sexual violence 2 (2.30) 1 (1.35) increased interpersonal conflicts (OR = 0.27, p = .014),
Victim of physical assault 8 (9.20) 7 (9.46) and having used psychotropics (OR = 0.23, p = .013)
Other traumas 13 (14.94) 4 (5.41)
BDI-II: Beck Depression Inventory-II. BPM: Beats per minute. PsyEd: Psy­
or sick leave (OR = 0.11, p = .047). We did not find a
choeducation. PFA: Psychological First Aid. PDEQ: Peritraumatic Dis­ significant effect of PFA on any binary outcome at
sociation Experiences Questionnaire. PTSD: Post-Traumatic Stress T1, nor self-reported use of psychotherapy or comp­
Disorder. S.D.: Standard deviation. The count can be less than expected
due to missing data. lementary/alternative medicine at T2.

the effect of PFA on PTSD and depressive symptoms

reduction remained not statistically significant.
We found, however, that longer session duration
(B = −0.05, Std. Error = 0.02, β = −.08, p = .033) and
a higher number of delivered components (B =
−0.80, Std. Error = 0.37, β = −.10, p = .030) were
associated with a steeper decrease of PTSD symptoms,
pointing out to a dose–response effect. We did not
find such a dose–response effect in depressive symp­
toms (effect of session duration: p = .837; effect of
the number of delivered components: p = .827).
4. Discussion
In this study, we evaluated the effect of an early single
session of PFA-ABCDE, compared to PsyEd, on
decreasing PTSD and depressive symptoms three
months post-intervention. We also assessed PFA’s
association with self-reported side effects, increased
post-trauma alcohol/substance consumption,
increased post-trauma interpersonal conflicts, and
post-trauma use of psychotropics, psychotherapy,
sick leave, and complementary/alternative medicine
to deal with post-traumatic distress.

Table 2. Fixed effects of time × condition interaction on PTSD and depressive symptoms assessed with Linear Mixed-Effect
Modelsa.
Time × condition
Complementary known unstandardised estimate Time × condition
predictors of PTSD added as (Β) Standard standardised estimate (β) p-
Outcome covariatesb (PFA vs PsyEd) Error (PFA vs PsyEd) df t value value
PTSD No −1.474 1.014 −.05 174.974 −1.454 .148
symptomsc Yes −1.520 1.071 −.05 77.135 −1.420 .160
Depressive No 1.211 0.941 .07 91.486 1.287 .201
d
symptoms Yes 0.812 0.957 .04 88.885 0.848 .399
a
Baseline depressive symptoms were included as a covariate in all PTSD models. All models included random intercepts nested by participants.
b
Baseline education, number of different previous traumas, and peritraumatic dissociation symptoms added to baseline depressive symptoms as covari­
ates. PsyEd: Psychoeducation. PFA: Psychological First Aid. PTSD: Post-Traumatic Stress Disorder.
c
PTSD symptoms assessed with the PTSD Checklist (PCL) total score.
d
Depressive symptoms assessed with the Beck Depression Inventory-II (BDI-II) total score.
 EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 9

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.

Table 3. Post-traumatic behaviours assessed one and three months post-intervention.

PsyEd PFA
Time of N = 88 N = 78 95% CI p-
Affirmative answers (‘yes’) to the following questions assessment n (%)a n (%)a ORb ORb valueb
Have you increased your consumption of alcohol, tobacco, or other licit or T1 8 (12.70) 6 (10.53) 0.85 0.26–2.81 .783
illicit substances after your emergency department visit? T2 16 (39.02) 2 (5.13) 0.09 0.02–0.42 .003
Have you experienced increased interpersonal conflicts after visiting the T1 14 (22.22) 11 (19.30) 0.85 0.35–2.10 .731
emergency department? T2 19 (46.34) 7 (17.95) 0.27 0.09–0.76 .014
Have you used any medication to face the emotional distress that may have T1 20 (31.70) 14 (24.56) 0.80 0.35–1.81 .590
emerged after you visited the emergency department? T2 16 (39.02) 5 (12.82) 0.23 0.07–0.73 .013
Have you obtained official sick leave permission due to any emotional T1 3 (4.76) 1 (1.75) 0.33 0.03–3.42 .351
distress that emerged after the traumatic event? T2 8 (19.51) 1 (2.56) 0.11 0.01–0.97 .047
Have you received regular counselling or psychotherapy to face the T1 5 (7.90) 6 (10.53) 1.41 0.40–5.01 .590
emotional distress that may have emerged after you visited the emergency T2 12 (29.27) 5 (12.82) 0.34 0.10–1.12 .075
department?
Have you received any complementary or alternative therapy to face the T1 7 (11.11) 2 (3.51) 0.29 0.06–1.47 .133
emotional distress that may have emerged after you visited the emergency T2 8 (19.51) 6 (15.38) 0.52 0.14–1.91 .320
department?
‘Have you experienced any distress that you directly associate with the Immediate post- 5 (6.25) 6 (8.45) 1.53 0.42–5.57 .520
intervention you received in the emergency department from the research intervention
team?’ T1 3 (4.76) 7 (12.28) 3.13 0.72–13.55 .127
T2 4 (9.76) 2 (5.13) 0.46 0.08–2.84 .402
a
Percentage calculated ignoring data from lost to follow-up participants.
b
Adjusted by baseline depressive symptoms after multiple imputations. Estimates pooled from five datasets imputed by predictive mean matching with 70
iterations. The potential scale reduction factor, assessed by the R-hat statistic, showed convergence in all multiple imputations (all mean, and variance R-
hats were < 1.1). PsyEd: Psychoeducation. PFA: Psychological First Aid. OR: Odds ratio. T1: One-month post-intervention. T2: Three months post-
intervention.

Contrary to our hypothesis, PFA did not intervention. PFA was not associated with
decrease PTSD or depressive symptoms to a increased odds of self-reported adverse effects at
greater extent than PsyEd three months post- any follow-up. At T2, fewer participants in the
10 R. A. FIGUEROA ET AL.
PFA group reported increased consumption of
post-trauma alcohol/substances, interpersonal
conflicts, and having used psychotropics or sick
leave to deal with post-traumatic emotional dis­
tress. Participants assigned to PFA and PsyEd
exhibited a similar decrease in PTSD and depress­
ive symptoms. Because PsyEd has failed to demon­
strate effectiveness for decreasing PTSD and
depressive symptoms, it is plausible that the equiv­
alent reduction in symptoms observed in both PFA
and PsyEd corresponded to natural recovery.
The lack of a significant effect of PFA on decreasing
PTSD and depressive symptoms between T0 and T2
may be explained by treatment similarity, natural
recovery, an insufficient number of sessions or base­
line noise. As providers were allowed, for ethical
reasons, not to deny support spontaneously requested
by participants assigned to PsyEd, 30.0% and 24.1% of
participants assigned to control also received steps A
and D, respectively. Therefore, contamination may
have obscured the distinction between conditions,
increasing the risk of type 2 error (Magill et al.,
2019). This notion is supported by the significant
dose–response effect that was found between the dur­
ation of sessions, the number of delivered com­
ponents, and the slope of PTSD symptoms between
T0 and T2. Moreover, using an APC instead of a wait­
list may have further increased contamination by pro­
viding the same theoretically inactive and unspecific
components of PFA to participants assigned to the
control group. It is also possible that PsyEd (step E)
was the only active ingredient, although this is unlikely
according to the literature (Brooks et al., 2021). The
substantial number of participants in the control
group who received treatments A and C underscores
the ethical complexities encountered in psychosocial
intervention research with control groups, where bal­
ancing the need to maintain treatment fidelity with
ethical considerations poses a notable challenge (Street
& Luoma, 2002).
As we did not exclude individuals with a low risk of
developing PTSD, it is feasible that most participants
in our study recovered spontaneously because natural
recovery is the norm (Galatzer-Levy et al., 2018).
Hence, in our low-risk sample, the putative benefit
of PFA for decreasing PTSD and depressive symptoms
could have vanished soon after the intervention. Con­
versely, in a high-risk population, PFA’s effect could
be larger and last longer, requiring a smaller sample
size to be detected. This phenomenon highlights the
importance of targeting high-risk survivors in early
intervention research.
In this study, we only delivered a single session of
PFA, although PFA guidelines allow additional ses­
sions (Hermosilla et al., 2023). Hence, insufficient ses­
sions may also explain why we did not find a
significant effect. However, it is not evident that
more sessions would entail higher probabilities of
finding a significant effect. For example, McCart
et al. (2020) found no significant effect of two to
three PFA sessions on decreasing PTSD symptoms
in a sample of 172 crime survivors assessed four
months post-intervention. More research will be
needed to explore whether more than a single session
of PFA is required to reduce PTSD and depressive
symptoms.
Importantly, measuring baseline PTSD symptoms
with the PCL-C, which referred to any previous trau­
mas, including the recent incident leading to ED pres­
entation, instead of using the PCL-S for specifying the
scope to only the recent incident that brought the par­
ticipant to the ED, may have introduced noise. This
variability could have compromised the precision of
our baseline measurements, thus diminishing our stat­
istical power. Nonetheless, the significant effect of PFA
on ‘probable PTSD’ and PTSD symptoms at the T2
follow-up – outcomes that remain unaffected by the
baseline noise introduced by the PCL-C – suggests a
meaningful effect. This implication is nuanced by
the fact that baseline imbalances, better adjusted in
longitudinal analyses, are still possible in the cross-
sectional evaluation of follow-up scores despite adding
baseline covariates in the models. These differences
between change and follow-up scores may account
for the observed discrepancies between both
approaches. Additionally, the initial use of the PCL-
C might have led to elevated PTSD symptom scores
at baseline in comparison with follow-up assessments.
However, we have no compelling evidence to suggest
that this potential inflation of baseline scores system­
atically favoured one experimental group over
another.
The significant effect of PFA on alcohol/substance
consumption, interpersonal conflicts, use of psychotro­
pics, and use of sick leave is noteworthy. It is plausible
that active listening (step A), breathing retraining
(step B), an assisted categorisation of needs (step C),
or an assisted referral to social networks (step D) may
have increased perceived and received social support
(Uchino, 2009; Bodie et al., 2015) and emotional regu­
lation (Bae et al., 2021; Ma et al., 2017; Sahar et al.,
2001). These factors have been linked to increased
self-efficacy and adaptive coping (Amstadter & Vernon,
2008; Schwarzer & Knoll, 2007), which, in turn, may
lead to a reduced need for alcohol/substances, psycho­
tropics, or sick leave to cope with post-traumatic distress
(Hawn et al., 2020). Moreover, an enhanced emotional
regulation might appease post-traumatic hyperarousal,
a factor that seems to mediate increased interpersonal
conflicts in PTSD (Beck et al., 2009). These ideas are
speculative and should be cautiously approached,
requiring additional research for validation.
This study has significant limitations that warrant
careful consideration of our results. Our high attrition

rate may have produced systematic bias and reduced
our statistical power. To address this limitation, we
used mixed models and multiple imputations. We
also added baseline depressive symptoms as a covari­
ate in all models and sensitised them with additional
baseline predictors of PTSD symptoms as covariates.
Although these approaches are robust methodologies
for mitigating the effect of missingness, they can be
insufficient with large attrition rates like in this study
(Siddique et al., 2008).
Using unvalidated, self-reported, close-ended,
dichotomous questions to explore side effects and
post-trauma behaviours without assessing them at
T0 may have impacted the precision of our esti­
mations. Further research examining these phenom­
ena should use validated instruments with adequate
baseline assessments.
Furthermore, although we used PsyEd as an APC to
control the unspecific ingredients of PFA, the duration
of both interventions differed. Hence, we cannot dis­
card that the significant effect of PFA on PTSD fol­
low-up scores and other exploratory outcomes is
explained by the increased duration of the intervention
and no one or more specific factors. Further research
will be needed to learn if any effect of PFA is the result
of unspecific factors or one or more active components.
It is essential to acknowledge that the external val­
idity of our results is limited by the characteristics of
the sample, providers, delivery format, and model of
PFA investigated. Our sample did not include
trauma survivors of war, disasters, school crises
(Brymer et al., 2012), occupational crises (Reynolds
& Wagner, 2007), or children and adolescents.
Additionally, our providers were psychology students
who received eight hours of PFA training. So, it is
still being determined if our results can be generali­
sable to layperson providers who may require more
extensive instruction (Horn et al., 2019). Further­
more, our assessment only focused on one of many
models of PFA (Ni et al., 2023), so the generalizabil­
ity of our results to other protocols requires further
investigation. Finally, the validity of our results in
digitally delivered PFA cannot be ensured (Frankova
et al., 2022).
This study’s strengths include a randomised con­
trolled design with APC, participants and telephone
operators blind to allocation, and using the same pro­
viders, written material, and places to provide PFA
and PsyEd. These characteristics may have helped to
reduce the effect of baseline imbalance, control the
nonspecific effects of the intervention, and mitigate
the allegiance effect. Furthermore, the rigorous regis­
try of delivered components addresses a significant
limitation in PFA literature: the lack of consistent
documentation of the intervention components pro­
vided (Hermosilla et al., 2023). This information is
crucial for understanding PFA mechanisms of action.
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 11
In conclusion, our results do not support the notion
that PFA is effective for decreasing PTSD or depressive
symptoms three months post-intervention. However,
as we found a significant dose–response effect, it is
possible that contamination could have obscured the
distinction between the experimental and control con­
ditions. PFA seems to be a safe intervention with
promising effects on avoiding increased post-trauma
alcohol/substance consumption, interpersonal confl­
icts, use of psychotropics, and use of sick leave. Impor­
tant limitations, however, warrant cautious
consideration of our results. As a significant burden
of trauma is mediated by post-trauma problematic
behaviours that can be independent of PTSD or
depression symptomatology (Beck et al., 2009; Cerdá
et al., 2011; Kartha et al., 2008), modifying post-
trauma behaviour should be a clinically valuable goal
by itself, even if not accompanied by a reduction of
PTSD or depressive symptoms. Notably, given that
PFA is a brief, single-session intervention, its capacity
to produce large-scale effects might be inherently lim­
ited. However, the minimal effort and time required to
implement PFA make it a highly feasible option. Con­
sequently, even modest benefits derived from PFA
should be considered valuable, given its ease of
implementation.
Further research should explore the effect of deli­
vering more PFA sessions in high-risk survivors,
avoiding contamination and attrition, and using vali­
dated instruments to assess post-trauma behaviours
with comparable baseline assessments. Exploring the
effect of PFA in other settings and with other sample
characteristics, protocols, providers, and delivery for­
mats is crucial. Furthermore, expanding the scope of
outcomes beyond diagnoses prevention or symptom
control, adding early intervention’s effect on enhan­
cing adaptive coping and modifying post-trauma
behaviours, is urgent.
Acknowledgements
To Hospital Dr. Sótero del Río and Hospital del Trabajador
de Santiago, where this study took place.
Disclosure statement
Rodrigo Andrés Figueroa, Paula Francisca Cortés, and Hum­
berto Marín are paid for teaching in the “Psychological First
Aid ABCDE certification workshop” at the Pontificia Univer­
sidad Católica de Chile School of Medicine. “PAP-ABCDE” is
a trademark of Pontificia Universidad Católica de Chile.
Funding
This work was funded by the Fundación Científica y Tecno­
lógica ACHS (FUCYT) through the Proyectos de Investiga­
ción e Innovación en Prevención de Accidentes y
Enfermedades Profesionales – Superintendencia de
12 R. A. FIGUEROA ET AL.
Seguridad Social (SUSESO), Chile. Neither FUCYT nor
SUSESO was involved in this study’s design, conduct, or
analysis.
Data availability statement
The database and scripts used in this study can be down­
loaded from https://osf.io/s5wr8/?view_only=04b77e879d
0049e0b7d215e3c69f386e. DOI: 10.17605/OSF.IO/S5WR8.
ORCID
Rodrigo Andrés Figueroa http://orcid.org/0000-0002-
4040-8946
Humberto Marín http://orcid.org/0000-0001-5839-1575
Chris Maria Hoeboer http://orcid.org/0000-0002-5991-
1963
Miranda Olff http://orcid.org/0000-0003-1016-9515
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