Abstract
BackgroundThere is limited data available on the long-term mental health impact of Ebola virus disease (EVD) on survivors despite the disease experience of survivors meeting the criteria of a traumatic event as defined in the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM IV). This study aimed to assess the prevalence and predictive factors of anxiety, depression and posttraumatic stress disorder among EVD survivors, approximately 2 years after discharge from the Ebola treatment centre (ETC).MethodsWe conducted a cross-sectional study between May and August 2017 among 197 adults Ebola survivors in Bombali district, Northern Sierra Leone. We collected information about demographics, mental health status and possible predictive factors. The HAD scale was used to measure anxiety and depression. PTSD was measured using the PTSD-checklist (PCL). Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables.ResultsThe mean anxiety, depression and PTSD scores were (5.0 ± 3.9), (7.1 ± 3.8) and (39.5 ± 6.4) respectively. Based on cut-off scores, the prevalence of anxiety (HADs score ≥ 8), depression (HADs score ≥ 8) and PTSD (PCL ≥ 45) among Ebola survivors were (n = 49, 24.9%), (n = 93, 47.2%) and (n = 43, 21.8%) respectively. Older Ebola survivors (≥30 years) were more likely to show symptoms of depression (AOR = 8.5, 95% CI: 2.68–27.01, p = 0.001) and anxiety (AOR = 3.04; 95%CI: 1.2–7.7, p = 0.019) compared to younger ones (< 30 years). In addition, Ebola survivors who experienced a decreased level of exercise post-ETC discharge were more likely to show symptoms of depression (AOR = 2.63; 95%CI: 1.25–5.54, p = 0.011) and anxiety (AOR = 3.60; 95%CI: 1.33–9.72, p = 0.012) compared to those whose exercise remained the same post-ETC discharge.ConclusionOur findings show that anxiety, depression and PTSD are common among the Ebola survivors in Bombali district, Northern Sierra Leone, and that underscores the need to diagnose and manage mental health morbidities among Ebola survivors long after their recovery from Ebola virus disease. Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT) need to be explored as part of overall mental healthcare package interventions.
Highlights
There is limited data available on the long-term mental health impact of Ebola virus disease (EVD) on survivors despite the disease experience of survivors meeting the criteria of a traumatic event as defined in the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM IV)
Our findings show that anxiety, depression and post-traumatic stress disorder (PTSD) are common among the Ebola survivors in Bombali district, Northern Sierra Leone, and that underscores the need to diagnose and manage mental health morbidities among Ebola survivors long after their recovery from Ebola virus disease
Our study indicates that close to a quarter (24.9%) of survivors exhibited a possible case of anxiety which is slightly higher than those reported by Nanyonga et al [31] and Mohamed et al [44] in Kenema, Eastern Sierra Leone
Summary
There is limited data available on the long-term mental health impact of Ebola virus disease (EVD) on survivors despite the disease experience of survivors meeting the criteria of a traumatic event as defined in the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM IV). The West African Ebola virus disease (EVD) outbreak was the largest and worst compared to all previous outbreaks combined since it was discovered in 1976 [1] It recorded an average case fatality rate of 51%, ranging from 41% in Sierra Leone to 61% in Guinea [2]. The psychosocial consequences of the 11-year civil war (1991–2002) in Sierra Leone identified the need for mental health services It created an increased interest in mental health among researchers, policymakers, service users and carers, religious bodies, non-governmental organisations, civil society and healthcare providers. This lead to the establishment of mental health coalition in 2011 [9] and the enactment of the Mental Health Policy in 2012, which serves as a framework for the development of mental health services [10].
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