Developing, piloting, and evaluating a psychological first aid training for medical students in South Africa.

BACKGROUND: Common mental disorders are highly prevalent among medical students. One way to ameliorate risk for mental disorders in this group is to improve medical students’ psychological literacy and provide psychoeducation to promote appropriate help seeking, which could potentially be achieved through changes to the formal curriculum. OBJECTIVES: Our aim was to develop, pilot and evaluate a context-sensitive and culturally appropriate Psychological First Aid (PFA) training programme for medical students at a South African University which was delivered as a course module. Methods: 285 students were invited to participate, and 166 (58%) completed the quantitative pre- and post-intervention survey measuring confidence in providing PFA; crisis-related communication skills (appropriateness of responses to a person in suicidal crisis); attitudes towards mental illness; help- seeking intentions; confidence to help someone who is suicidal; and students’ experiences of the PFA course. Qualitative data was collected from the facilitators about their experiences of delivering the PFA training. Changes in knowledge and attitudes pre- and post-intervention were evaluated using paired sample t-tests, and repeated measures ANOVA controlling for baselines scores and self-identified gender. Qualitative data from facilitators were analysed using thematic analysis. RESULTS: There were significant improvements in knowledge about PFA (t(159) = 5.3, p < 0.001), attitudes towards PFA (t(147) = 8.7, p < 0.00), attitudes towards help seeking (t(140) = 3.6, p < 0.001), confidence in providing PFA (t(112) = 4.4, p < 0.001), and confidence to help someone who is suicidal (t(112)9.8, p < 0.001). No significant changes were observed in the attitudes towards mental illness (t(143)=-0.7, p = 0.75) (likely a ceiling effect given high pre-intervention scores). There was also no significant change in scores for competence in respond ing to people in suicidal crisis (t(114) = 4.6, p = 1.00). Facilitators reported that the training is feasible to deliver, and students found it acceptable, but human resource requirements need to be considered if the programme is to be scaled. CONCLUSION: PFA is feasible and could be effectively delivered in SA medical schools, where student burnout, vicarious traumatisation, and CMDs are prevalent. PFA offers a non-stigmatizing approach to equip students to understand, identify, and respond to mental health related phenomena in a way which may be beneficial to them, their peers, and their patients. Importantly, however, PFA may need to be supplemented with greater attention to, or additional specialised content on, evidence-based approaches to respond to suicidal crises, as our data suggests that this PFA training alone does not achieve this outcome.