Received: 15 September 2022 | Revised: 25 April 2023 | Accepted: 17 May 2023

DOI: 10.1002/pcn5.107

REVIEW ARTICLE

Effectiveness of psychological first aid in infectious disease

pandemics: An overview of systematic reviews

Masahide Koda MD, PhD1 | Toru Horinouchi MD, PhD2 |

3
Nozomu Oya MD, PhD | Morio Aki MD | Akihisa Iriki MD5
4
|
6 7
Kazufumi Yoshida MD, MSc | Yusuke Ogawa MD, PhD, MPH |
8
Hironori Kuga MD, PhD, MPH | Tomohiro Nakao MD, PhD9
1
Co‐Learning Community Healthcare Re‐Innovation Office, Graduate School of Medicine, Okayama, Japan
2
Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
3
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
4
Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
5
Osaka Psychiatric Medical Center, Osaka, Japan
6
Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
7
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
8
National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
9
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Correspondence Abstract
Masahide Koda, MD, PhD, Co‐Learning
Community Healthcare Re‐Innovation Office,
There is insufficient research on the usefulness of psychological interventions, such as
Graduate School of Medicine, Dentistry and psychological first aid (PFA), during outbreaks. We searched for and critically appraised
Pharmaceutical Sciences, Okayama University,
2‐5‐1 Shikata‐cho, Kita‐ku, Okayama
systematic reviews that examined the effectiveness of PFA during infectious disease
700‐8558, Japan. outbreaks, such as the novel coronavirus disease (COVID‐19). Systematic reviews that
Email: [email protected]
examined the efficacy of PFA in the severe acute respiratory syndrome, Middle East
Funding information respiratory syndrome coronavirus, Ebola virus disease, and COVID‐19 outbreaks were
Japan Agency for Medical Research and
searched through PubMed on February 19, 2021. The three included systematic
Development, Grant/Award Number:
JP21dk0307099; Ministry of Health, Labour reviews were critically appraised and assessed using AMSTAR‐2. One review's overall
and Welfare, Grant/Award Numbers:
confidence in its findings was evaluated as “high,” which suggested that PFA training
JPMH20CA2074, JPMH21GC1014
had a favorable effect on healthcare personnel. Furthermore, the review also
demonstrated that PFA was commonly used during outbreaks and could be delivered
through multiple methods, such as a phone or video call. Although it was anticipated
that PFA would improve subjective well‐being, reports showed no evidence of
reduced depression or insomnia. Future studies should examine additional numbers of
PFA recipients and conduct quasi‐experimental studies to better understand the
effectiveness of PFA. Evidence on its effectiveness in infectious disease outbreaks is still
lacking, along with research and evaluation methods. Quasi‐experimental studies, such

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and
Neurology.

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2 of 11 | AN OVERVIEW OF PSYCHOLOGICAL FIRST AID

as comparisons with other psychological interventions, are required to better

understand the effectiveness of PFA.

KEYWORDS
mental health, pandemic, psychological first aid, psychosocial support

I NTR O D U C TI O N METHODS

Infectious diseases outbreaks can significantly impact the mental We conducted a literature search using the overview method and
health of individuals who are infected. Psychological distress due to searched the PubMed database on February 19, 2021 for articles on
exposure to infectious diseases can cause various mental health the effectiveness of PFA, regardless of language or publication
problems, including anxiety, depression, and post‐traumatic stress year.13 An overview of systematic reviews was selected as it
disorder, in both the general population and healthcare workers.1–3 considered the broad range of available evidence, could assess the
Additionally, the tension, fear, and anxiety caused by an outbreak can risk of bias, and provide a comprehensive perspective.14 While
disrupt civil society and have adverse economic, political, psychologi- systematic reviews answered specific research questions, overviews
cal, and physical effects.4,5 Given the potentially serious effects of offered a further extensive examination of the existing literature,
psychological distress during an infectious disease outbreak, inter- which we deemed was more suitable for the current research on PFA
ventions that alleviate psychological discomfort and encourage during infectious disease outbreaks, which included the COVID‐19
adaptive coping mechanisms are necessary. We chose psychological pandemic. We aimed to examine multiple systematic reviews,
first aid (PFA) as the focus of this review owing to its unique potential synthesize the diverse evidence available, identify gaps in knowledge,
for widespread implementation, particularly during a global crisis, and provide a further informed foundation for future research on
such as the coronavirus disease (COVID‐19) pandemic. Unlike some PFA in this context. Studies were included if they mentioned
other psychological interventions, PFA can be delivered by various “psychological first aid” in either the title or abstract and were
individuals, including nonprofessionals, after receiving appropriate related to major infectious disease outbreaks since 2000. There are
training. This flexibility makes PFA especially valuable in situations several existing PFA models, such as the World Health Organization's
where mental health resources may be scarce or inaccessible. PFA (WHO‐PFA), the National Child Traumatic Stress Network PFA
Moreover, it is designed to address immediate psychological needs (NCTSN‐PFA), and the Johns Hopkins Guide to PFA (RAPID‐PFA)
and foster resilience, crucial aspects of mental health support during model.15 These models aimed to provide immediate support to
infectious disease outbreaks.6 individuals who were distressed; however, they differed in their
PFA, an intervention to alleviate psychological discomfort,7–10 specific approaches and guidelines. In this overview, we conducted a
offers compassion and help to people in need who have survived a search, regardless of the type of PFA employed, to gain a broader
natural disaster or catastrophic economic crisis. It involves a range of understanding of its effectiveness during infectious disease out-
activities, including listening, offering consolation, and facilitating breaks. A pandemic was classified as an outbreak that affected
interpersonal connections. Furthermore, it is open to both the people worldwide, crossed international borders, and involved many
general population and mental health professionals. Research on PFA people.16 The severe acute respiratory syndrome (SARS), Middle East
interventions in general disasters, excluding infectious diseases, has respiratory syndrome (MERS), Ebola virus disease (EVD), and
shown mixed results, with some studies reporting positive outcomes, COVID‐19 outbreaks were included. The complete search list is
6
such as reduced psychological distress. In contrast, other studies shown in Table 1.
report limited or inconclusive evidence of its effectiveness.11 Given To incorporate reproducible methods, we included systematic
these inconsistent findings, examining the effectiveness of PFA reviews of randomized controlled trials (RCTs) or prospective or
during infectious disease outbreaks, such as the COVID‐19 pan- retrospective cohort studies. We also accepted qualitative reports,
demic, is important for crisis‐response strategies and optimizing with or without meta‐analysis, and did not have language restrictions.
psychological support for the affected populations. This study did not consider the participants' sexes, nationalities, or
However, the extent to which PFA was effective during an races. Before the review began, psychological interventions were
infectious disease outbreak was unknown. The worldwide COVID‐19 deemed to have been performed in one of the following infectious
pandemic increased stress and anxiety levels, even though its long‐ disease environments: SARS, MERS, EVD, or COVID‐19. Therefore,
term effects on stress levels were unclear.10–12 Social isolation, due we also included other psychological interventions. M.A. confirmed
to the COVID‐19 pandemic, has had a significant psychological the methods, M.K. and T.H. performed the screening, and A.I.
4,5
impact on people globally. Therefore, this study aimed to extracted data. M.K. and K.Y. independently evaluated the studies via
determine the value of PFA in an infectious disease pandemic AMSTAR‐2.17 The Preferred Reporting Items of Systematic Reviews
and whether it contributed against mental illness caused by the and Meta‐Analysis (PRISMA) guidelines were followed.18 An ethical
COVID‐19 pandemic. review was not required since this was a secondary data study.
 27692558, 2023, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/pcn5.107 by Cochrane Philippines, Wiley Online Library on [21/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
AN OVERVIEW OF PSYCHOLOGICAL FIRST AID | 3 of 11

RESULTS A critical appraisal of the review articles using the AMSTAR‐2 is

provided in Table 2. Review article (1) Pollock et al.19 was rating
The flowchart of this study is shown in Figure 1. In total, three “high,” which implied that the findings were accurately and
systematic reviews were identified during the screening phase. After comprehensively summarized. However, the other two review
an evaluation for their eligibility, all were judged consistent with the articles, (2) Yue et al.,20 and (3) Cénat et al.,21 were rated “critically
study's objectives. low” as one or more fatal flaws existed. Hence, they were deemed
unreliable for providing an accurate and comprehensive summary.
In total, 16 studies were included in Pollock et al.,19,22–37 32 in
TABLE 1 Search syntax. Yue et al.,20,35–68 and 11 in Cénat et al.21,65–75 All the reviews
included PFA as an intervention; however, various other interven-
(psychological first aid[Title/Abstract]) AND ((severe acute respiratory
syndrome OR SARS OR middle east respiratory syndrome* OR tions, such as cognitive behavioral therapy (CBT) and counseling,
Middle East Respiratory Syndrome Coronavirus OR Mers OR were also practiced. (1) Pollock et al.19 and (2) Yue et al.20 included
Middle Eastern Respiratory Syndrome* OR MERS‐CoV OR the COVID‐19 pandemic, while (3) Cénat et al.21,65–75 dealt only with
MERSCoV* OR coronavirus OR coronavirus* OR coronavirus
the Ebola outbreak. Populations targeted by the interventions varied
infections OR COVID‐19 OR 2019‐nCoV OR SARS‐CoV‐2 OR
Ebola)) AND ((((systematic review[ti] OR systematic literature between (2) Yue et al.20 and (3) Cénat et al.,21 which included various
review[ti] OR systematic scoping review[ti] OR systematic narrative people, while Pollock et al.19 only included healthcare workers who
review[ti] OR systematic qualitative review[ti] OR systematic worked at the front lines (Table 3).
evidence review[ti] OR systematic quantitative review[ti] OR
systematic meta‐review[ti] OR systematic critical review[ti] OR
systematic mixed studies review[ti] OR systematic mapping review
[ti] OR systematic Cochrane review[ti] OR systematic search and DIS CUSSION
review[ti] OR systematic integrative review[ti]) NOT comment[pt]
NOT (protocol[ti] OR protocols[ti])) NOT MEDLINE [subset]) OR
This study overviewed three systematic reviews to determine the
(Cochrane Database Syst Rev[ta] AND review[pt]) OR systematic
review[pt])))) effectiveness of PFA during infectious disease outbreaks. Although
three systematic reviews were identified, only (1) Pollock et al.19 had
Abbreviations: 2019‐nCoV, 2019 novel coronavirus; COVID‐19,
an AMSTAR‐2 overall confidence rating of “high.” Meanwhile (2) Yue
coronavirus disease 2019; MERS‐CoV, Middle East respiratory syndrome
coronavirus; SARS, severe acute respiratory syndrome; SARS‐CoV‐2, et al.,20 and (3) Cénat et al.21 were rated “critically low.”
severe acute respiratory syndrome coronavirus‐2. The AMSTAR‐2 was used to appraise the methodological quality of

F I G U R E 1 Flow chart. The PubMed database was systematically searched on February 19, 2021, using the terms “psychological first aid” in
the title or abstract, restricted to articles published since 2000 related to major infectious disease outbreaks. In total, three systematic reviews
were examined for eligibility and judged to be consistent with the study's objectives.
 27692558, 2023, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/pcn5.107 by Cochrane Philippines, Wiley Online Library on [21/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 of 11 | AN OVERVIEW OF PSYCHOLOGICAL FIRST AID

TABLE 2 The AMSTAR‐2 assessment.

Item Overall
SRs 1 2a 3 4a 5 6 7a 8 9a 10 11a 12 13a 14 15a 16 quality

Pollock et al.17 Y Y Y Y Y Y Y Y Y Y NMC NMC Y Y NMC Y High

Yue et al.18 Y N Y PY Y Y N PY PY N NMC NMC N Y NMC Y Critically

low

Cénat et al.19 Y N Y N N N N PY N Y NMC NMC N Y NMC Y Critically

low

Notes: Item 1, “Did the research questions and inclusion criteria include components of the clinical question (patients, intervention, comparison, and
outcome)?”; Item 2, “Did the report contain an explicit statement that the review methods were established prior to the review being conducted and
justify any significant protocol deviations?”; Item 3, “Did the authors explain their selection of the studies for inclusion?”; Item 4, “Did they use a
comprehensive literature search strategy?”; Item 5, “Did they perform study selection in duplicate?”; Item 6, “Did they perform data extraction in
duplicate?”; Item 7, “Did they provide a list of excluded studies and justify them?”; Item 8, “Were the included studies described in adequate detail?”; Item
9, “Was a satisfactory technique used to assess the risk of bias (RoB) in the individual included studies?”; Item 10, “Did they report the sources of funding
for the studies included?”; Item 11, “If a meta‐analysis was performed, did they use appropriate methods for statistical combination of the results?”; Item
12, “If a meta‐analysis was performed, did they assess the potential impact of the RoB in individual studies on the results of the meta‐analysis or other
evidence synthesis?”; Item 13, “Did they account for the RoB in individual studies during the interpretation/discussion of the results?”; Item 14, “Did they
provide a satisfactory explanation for and discussion of any heterogeneity in the results?”; Item 15, “If they performed quantitative synthesis, was an
adequate investigation of publication bias (small study bias) conducted and its likely impact on the results discussed?”; Item 16 “Did they report any
potential sources of conflict of interest, including any funding they received for conducting the review?”
Abbreviations: N, no; NMC, no meta‐analysis conducted; PY, partial yes; Y, yes.
a
Critical domains.

the identified systematic reviews, which included the Cochrane literature overview revealed that many systematic reviews also
review by Pollock et al. This evaluation tool was widely recognized discussed other interventions, such as CBT, which we have included
for assessing the quality of systematic reviews.14 Although the in our discussion for a comprehensive understanding of the field.
Cochrane review had the highest quality, the inclusion of other
systematic reviews, along with their AMSTAR‐2 assessments,
provided a further comprehensive understanding of the available PFA
evidence on PFA during infectious disease outbreaks. Furthermore, it
enabled us to identify the potential biases and limitations in the The main goal of the (1) Pollock et al. study19 was to evaluate the
additional reviews and allowed for a further cautious interpretation efficacy of treatments intended to improve resilience among frontline
of their findings. As a result of possible bias, (2) Yue et al.20 and (3) healthcare personnel. The study found that training healthcare
Cénat et al.21 should be interpreted with caution. Both failed to workers to practice PFA that measured burnout was effective.
develop and report on the review process before the study was However, confidence in the effectiveness was low.30 Nevertheless,
executed, did not compile a list of the excluded studies, and failed to this study showed that healthcare workers could experience positive
apply the bias risk effectively in the interpretation and discussion. changes through PFA techniques. These included an improved ability
However, it was important to consider their findings as they may to understand people's reactions and control one's emotions;
provide valuable insights on the investigated topic. improved relationships with friends, family, and colleagues; and
In the context of general disasters not related to infectious development of better self‐care strategies. PFA was also commonly
diseases, the effectiveness of PFA remains debatable. Some studies used in other settings, such as in Sierra Leone where 14 nurses were
demonstrated positive outcomes, such as reduced psychological trained in PFA for Ebola,68 as well as teams of food providers, contact
distress and improved coping mechanisms.6 However, others yielded tracers, and transportation operators to households during quaran-
limited or inconclusive evidence regarding PFA's effectiveness in tine.72 In Guinea, 46 traditional healers and 154 imams were trained
11
these situations. This inconsistency underscored the need for in PFA and psychosocial support by the Red Cross.71 Other
further investigation and for methodologically rigorous studies to interventions included a combination of PFA and group‐based
better understand the potential benefits and limitations of PFA CBT.67 However, while PFA was beneficial as an early intervention
interventions across various disaster contexts, which included for individuals in distress, its effectiveness was not always particular.
infectious disease outbreaks, such as the COVID‐19 pandemic. While trainers received training to conduct PFA, this training was
We included other interventions, such as CBT, to provide a often shorter and incomplete compared with the standard.76 In the
further comprehensive view of the existing literature on psychologi- systematic reviews included in our study, the specific PFA model
cal interventions during outbreaks and highlight potential alternative employed was not always clearly identified. However, most studies
or complementary approaches explored in the context of infectious may have focused on the WHO‐PFA model, given its widespread
disease outbreaks. Although our primary focus was on PFA, our recognition and use.15 The RAPID‐PFA model, a more recent
 TABLE 3 Overview of the key characteristics of the included reviews.

A limited
selection of Infectious Mental healthcare/
Included databases Search date Included study design studies (if any) disease Target population psychological intervention Outcomes

Pollock Cochrane Database of May One mixed‐method design All articles from Four Health and social care Interventions at the General mental health
et a- Systematic Reviews, 28, 2020 described the 2002 COVID‐19 professionals who workplace, including and resilience,
l.17 Global Index Medicus implementation and onwards, Nine EVD worked at the front line training, structure, and psychological signs
databases, CENTRAL, evaluation of an with no One MERS during infectious communication (six of anxiety,
MEDLINE, Embase, intervention and included language Two SARS disease outbreaks studies); approaches for depression, or
Web of Science, a qualitative interview restrictions. (epidemics and psychological support, stress, burnout,
PsycINFO, CINAHL, component and a cohort pandemics). including counseling other mental health
WHO Institutional study, while two and psychological disorders, workplace
Repository for quantitative study designs services (eight studies); staffing, and adverse
AN OVERVIEW OF PSYCHOLOGICAL FIRST AID

Information Sharing, included some descriptive and multimodal events resulting

Trials Registrations, data. Six qualitative study interventions (two from the
and Google Scholar designs, one mixed‐ studies). interventions were
method design that examined to
reported results from determine the
quantitative impact of work‐
questionnaires and based interventions.
qualitative interviews, one The results provided
that described the very low‐certainty
implementation and evidence regarding
evaluation of an the impact of
intervention, and five that training frontline
did both. healthcare workers
to provide
psychological first
aid on a measure of
burnout.

Yue PubMed, Web of May 5, 2020 One RCT, one quasi‐ Excluded non‐ 23 COVID‐19 Healthcare workers, Group‐based cognitive To improve mental
et a- Science, Embase, experimental intervention, English Seven EVD psychiatric patients, behavioral therapy, health response
l.18 PsycINFO, WHO four pre–post publications One MERS individuals who were PFA, community‐based capacity for ongoing
Global Database on interventions, one One SARS quarantined, family psychological art and upcoming
COVID‐19, and intervention development, members, older adults, program, and other infectious disease
MedRxiv one quantitative and children. culturally adapted outbreaks, culturally
interview, eight reports, interventions. appropriate,
14 commentaries, and two financially viable,
reviews. and easily accessible
strategies integrated
into the local and
national public
|

health emergency
response and
5 of 11

(Continues)

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 TABLE 3 (Continued)
6 of 11

A limited
|

selection of Infectious Mental healthcare/

Included databases Search date Included study design studies (if any) disease Target population psychological intervention Outcomes

established medical
systems were likely
to be effective.
Although tele‐
mental healthcare
services were
important essential
elements of care for
managing infectious
disease outbreaks
and providing
routine assistance,
the value and
constraints of
distant healthcare
delivery should also
be acknowledged.
Cénat EMBASE, PsycINFO, Not stated Any research plan, analysis, or Those launched 11 EVD Those who have Five programs incorporated Findings indicated
et a- PubMed, MEDLINE, summary of successfully between experienced EVD the concepts of PFA. improvements in
l.19 Cochrane Library, and implemented and 2013 (survivors, health both children's and
PILOTS assessed psychosocial and 2019. workers, volunteers, adults' mental
treatments (no statement). other frontline workers, health. (Culturally
children, adults, etc.). tailored MHPSS
Two programs focused programs may
on impacted children benefit both adults
and families, while four and children
programs offered afflicted by EVD and
MHPSS to employees have a positive
and volunteers. influence on the
Communities and ETCs relationship
established other between the
unique programs. emotional
consequences of
EVD and use of
preventative
measures.)

Abbreviations: COVID‐19, coronavirus disease 2019; ETCs, Ebola treatment centers; EVD, Ebola virus disease; MERS, Middle East respiratory syndrome; MHPSS, mental health and psychosocial support; PFA,
psychological first aid; RCTs, randomized controlled trials; SARS, severe acute respiratory syndrome.
AN OVERVIEW OF PSYCHOLOGICAL FIRST AID

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AN OVERVIEW OF PSYCHOLOGICAL FIRST AID | 7 of 11

development, has not been as extensively documented, and its disasters, terrorist attacks, and other traumatic events. Understand-
effectiveness during infectious disease outbreaks should be further ing its effectiveness in these situations can provide valuable insights
investigated.10 Future research should explore the potential benefits into its overall utility across different types of crises. Some studies
and limitations of the different PFA models, including the RAPID‐ demonstrated the positive impact of PFA on coping, resilience, and
PFA, to gain a better understanding of their applicability and mental health outcomes in noninfectious settings.15 However,
effectiveness in various contexts. evidence remains limited, especially in the context of infectious
disease. Furthermore, methodological issues in the existing literature
must be addressed to draw further robust conclusions.11
CBT

Another strategy supported by evidence was CBT. A study on 253 What providers should be aware of when
staff members from an Ebola treatment center found that small‐ implementing interventions
group CBT delivered in eight sessions over 6 weeks improved staff
anxiety, depression, and dysfunction.37 Another study, which According to the high‐quality (1) Pollock et al.19 review, there
administered PFA to staff who worked at an Ebola treatment center were two reported barriers to intervention for frontline healthcare
and CBT intervention to a group that exhibited high anxiety and workers. Healthcare workers and their organizations lacked
depression, found that stress, anxiety, depression, and anger all the necessary knowledge to assist their mental health. Furthermore,
improved. Furthermore, the interventions protected the staff from healthcare workers lacked the tools, staff time, and expertise
adverse psychological outcomes. However, they also found that the required to perform the intervention, as mentioned above.
team lacked the motivation to participate in CBT, which underscored
the importance of motivation.66,67 Given the availability of online and
mobile application platforms in addition to in‐person encounters, CBT Social relations
20
has the potential to be accessible to a wide audience. Some tele‐
mental health services were offered in China during the COVID‐19 It is essential to be aware of how society views patients with
pandemic, and online self‐help psychotherapy, such as CBT for infectious diseases, as this can significantly influence their hospital-
insomnia and depression, was also provided.63 ization and reintegration into the community. During the Ebola
epidemic, previous studies found that stigma, discrimination, and
social rejection were significant problems for patients.77,78 Although
Other interventions there has been no particular research on this during the COVID‐19
pandemic, patients could have had comparable problems. Therefore,
The SMART group debriefing (Strength‐Focused and Meaning‐ it is essential to be mindful of this when working with patients with
Oriented Approach for Resilience and Transformation) included 51 infectious diseases and encourage society to reduce the related
patients who were chronically ill from Hong Kong after the SARS stigma.
outbreak. Participants' depressive symptoms decreased, and their
attitudes regarding SARS underwent an adaptive change.57 In
addition, during the Ebola epidemic in Sierra Leone, a model was Limitations
developed to help healthcare workers manage psychological risk and
resilience.34 The model was based on self‐triage, in which healthcare This study has several limitations. First, the review compiled was
providers anticipated their own stress experiences, developed a plan limited to studies that implemented PFA interventions, such as PFA
to increase resilience, and deterred stress reactions by activating the for outbreaks. Furthermore, limited studies with substantial evi-
program when exposed to stress. Self‐triage was a promising method dence, such as RCTs, were identified. Moreover, evaluation methods
to avoid dysfunction, and preliminary studies showed that it was across studies were heterogeneous. Hence, it was challenging to
feasible. Other interventions adapted to different cultures, such as construct a meta‐analysis or other high level of evidence. Second, a
Playing to Live in Liberia,65 ultra‐brief psychological intervention in significant challenge was the need for further research on PFA
Malaysia,54 and peer support among university students in Iran using during infectious disease outbreaks and in disaster situations. PFA
social media platforms,55 also alleviated psychological malaise during was anticipated to be a practical approach for mental health and
infectious disease outbreaks. psychosocial support during infectious disease outbreaks; however,
there was insufficient evidence to substantiate this approach.
Additional evidence should be gathered in the future. Nevertheless,
PFA in the context of general disasters the limited time and resources available during disasters made it
difficult to conduct rigorously controlled studies. Consequently, it
In addition to its use in infectious disease outbreaks, PFA has also was essential to further accumulate findings from various research
been employed in various noninfectious contexts, including natural designs, such as quasi‐experimental and controlled intervention
 27692558, 2023, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/pcn5.107 by Cochrane Philippines, Wiley Online Library on [21/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
8 of 11 | AN OVERVIEW OF PSYCHOLOGICAL FIRST AID

studies. Additionally, in regions where English was not the native for Medical Research and Development (AMED) (Grant Number
language, the number of publications in English may be limited, JP21dk0307099). The authors' opinions and viewpoints are their
which could result in an evidence gap if only English‐language own, and may not necessarily reflect the official positions or
literature was considered.79 Therefore, a comprehensive survey that guidelines of the funding organizations.
encompassed non‐English‐language literature should be conducted.
Third, a key issue in conducting research during a disaster was CONFLIC T OF INTEREST STATEM ENT
80,81
ethical considerations. Given a disaster's chaotic and often Masahide Koda received a Grant‐in‐Aid for Early‐Career Scientists
dangerous nature, researchers are required to take extra care and (JP19K19462) from the Japan Society for the Promotion of Science
ensure that the participants understand what they have consented (JSPS), and a medical research grant from Pfizer Health Research
to and that they are not being coerced into participating. Foundation. Toru Horinouch received a scholarship to study abroad
Researchers should be sensitive to participants' potential mental from the Japan Epilepsy Research Foundation. Morio Aki received
and emotional distress and take steps to minimize any risks honoraria for lectures from Sumitomo Pharma Co., Ltd. Nozomu Oya,
associated related to their participation. Therefore, quasi‐ Akihisa Iriki, Kazufumi Yoshida, Yusuke Ogawa, Hironori Kuga, and
experimental studies on PFA that consider the ethical aspects of Tomohiro Nakao have nothing to disclose. The authors declare no
the people who are affected are desirable. Quasi‐experimental conflicts of interest.
studies that compare the results of PFA interventions with other
types of interventions, examine medium‐ and long‐term effects, or DATA AVAILABILITY STATEMENT
compare the results of PFA administered by different providers (e.g., None.
mental health professionals or nonprofessionals) would be useful in
understanding its multifaceted effects. E T HI C S A P P R O V A L S T A T E M E N T
Since this study was a review, ethical approval was not necessary.
This study followed the PRISMA guidelines.
CONCL US I ON
PATIENT C ONSE NT STATEM ENT
PFA is becoming more widely used in infectious disease out- None.
breaks. Although the results of high‐quality systematic reviews
are limited, many reports have demonstrated its effectiveness. C L I N I C A L T RI A L RE G I S T RA T I O N
During implementation, it is essential for providers to be aware of None.
the mental well‐being of COVID‐19 patients and behave in a way
that reduces the social stigma attached to them. However, ORC I D
evidence on PFA being an effective tool for mental health and Masahide Koda http://orcid.org/0000-0002-4652-6994
psychosocial support in outbreaks is still insufficient due to Toru Horinouchi http://orcid.org/0000-0002-8376-6700
lacking studies, designs, and evaluation methods. While consider- Nozomu Oya http://orcid.org/0000-0003-3745-1270
ing the ethical considerations of the people who are affected, Kazufumi Yoshida http://orcid.org/0000-0003-4475-8043
quasi‐experimental analyses, such as comparisons with other Yusuke Ogawa http://orcid.org/0000-0001-9256-5102
psychological interventions, are required to better understand the Hironori Kuga http://orcid.org/0000-0003-3649-5781
effectiveness of PFA. Tomohiro Nakao http://orcid.org/0000-0002-4420-6903

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