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.

BackgroundThe aim of this paper is to explore women’s perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.MethodsThe study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N = 20).ResultsWomen perceive the causes of IPV to be linked with other difficulties faced by women in these settings, including their financial dependence on men, traditional gender expectations and social changes that took place during and after the wars in those countries. According to respondents, the wars increased the use of violence by some men, as violence became for them a normal way of responding to frustrations and challenges. However, the war also resulted in women becoming economically active, which was said by some to have decreased IPV, as the pressure on men to provide for their families reduced. Economic independence, together with services provided by NGOs, also gave women the option of leaving a violent relationship.ConclusionsIPV was found to be a significant problem for women in Sierra Leone and Liberia.The interactions between war experiences and financial and cultural issues are multi-faceted and not uniformly positive or negative.

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Progress in analyzing and interpreting the concepts of sexual orientation and gender identity in the context of refugee law has contributed to a rise in individuals seeking asylum in such countries as the United States and Canada. However, few studies have examined the victimization experiences of sexual- and gender-identity forced migrants prior to their arrival in North America. This qualitative study used thematic analysis to explore the premigration adult victimization experiences of 26 lesbian, gay, and transgender individuals who obtained refugee, asylee, or withholding-of-removal status in the United States or Canada based on persecution for their sexual orientation and/or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: living on the edge, adopting concealment strategies, routine victimization, and protectors as perpetrators. Participants described living in a constant state of hypervigilance, and they adopted numerous strategies to protect themselves from victimization. Despite the use of such strategies, participants experienced victimization by community members and state actors, leaving them no choice but to flee to ensure their safety and well-being. Findings are discussed using the ecological framework outlined by the World Health Organization (WHO). The discussion concludes with implications for international policy and clinical practice.

This qualitative study examined the "drivers" of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men's substance use, women's separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women's risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.

In 2015, more than 600,000 individuals from Syria, Iraq, and Afghanistan fled to Europe in search of protection. Among the most understudied of this population are individuals who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ). These individuals have not only fled war but also violence due to their sexual and/or gender identities. At the same time, LGBTQ individuals from other parts of the Middle East, Central and South Asia, and North Africa have also fled to Europe to escape persecution. The purpose of this multimethod study was to understand how traumatic stress shaped the experiences of 38 LGBTQ individuals who fled to Austria (n = 19) and the Netherlands (n = 19) from these regions. We assessed participants for posttraumatic stress disorder (PTSD) and conducted qualitative interviews to understand their migration experiences. Of the 37 participants assessed for PTSD, 33 (89.2%) reported that their most distressing event occurred prior to migration. For the 24 (64.9%) participants who met criteria for a provisional diagnosis of PTSD, 15 reported that the precipitating event was related to their sexual and/or gender identities and 9 reported that it was related to another type of event (e.g., war). Grounded theory was used to analyze qualitative data. Themes demonstrated that participants encountered targeted violence and abuse throughout migration and upon their arrival in Austria and the Netherlands. Findings indicate that LGBTQ refugees may be vulnerable to ongoing trauma from other refugees and immigration officials. Recommendations for protecting and supporting LGBTQ refugees during humanitarian emergencies are provided.

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.

In this study, we tested a conceptual model through which lesbian, gay, bisexual, and queer (LGBQ) clients' perceptions of their therapists' affirmative practices and the therapeutic relationship (i.e., working alliance and the real relationship) would correlate with psychological well-being. We hypothesized that the therapeutic relationship would mediate the relation between clients' perceptions of their therapists' affirmative practices and psychological well-being while controlling for precounseling distress, client age, client race/ethnicity, number of psychotherapy sessions, and therapist gender. A nationwide sample of 184 LGBQ individuals was recruited through the Internet. Participants ranged in age from 18 to 64 years old (M age ϭ 27.57; SD ϭ 8.50), and the majority identified as female (65.8%) and White (77.2%). Structural equation modeling showed that participants' perceptions of their therapists' affirmative practices were associated with psychological well-being (␤ ϭ .21, p Ͻ .01). Findings also indicated that the therapeutic relationship mediated the association between clients' perceptions of therapists' affirmative practices and psychological well-being (␤ ϭ .34, p Ͻ .001, 95% confidence interval [.15, .52]). More specifically, practicing affirmatively was correlated with a stronger therapeutic relationship, which was associated with higher levels of psychological well-being for LGBQ clients. Hence, these findings inform and encourage advancements in LGBQ affirmative psychotherapy research, practice, and training. Clinical Impact StatementQuestion: Does the therapeutic relationship mediate the link between the perception of therapist affirmative practices and psychological well-being among LGBQ clients? Findings: The therapeutic relationship was an underlying mechanism through which affirmative practice correlated with psychological well-being among LGBQ clients. Meaning: Engaging in affirmative practice appears to facilitate the therapeutic relationship, which is connected with improved psychological well-being among LGBQ clients. Next Steps: Future research should examine whether connections among affirmative practice, the therapeutic relationship, and psychological well-being vary with respect to client and therapist gender, sexual orientation, gender identity, and presenting problem or diagnosis.