The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone

• Published in: BMJ global health 2024-05, Vol.9 (5), p.e015098
• Main Authors: Schindell, Brayden G, Fredborg, Bev, Kowalec, Kaarina, Shaw, Souradet, Kangbai, Jia B, Kindrachuk, Jason
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Community; Consent; Cross-Sectional Studies; Drug abuse; Drug use; Ebola virus; Epidemics; Epidemiology; Fatalities; Female; Global Health; Health services; Hemorrhagic Fever, Ebola - epidemiology; Hemorrhagic Fever, Ebola - psychology; Humans; Male; Medicin och hälsovetenskap; Mental disorders; Mental Disorders - epidemiology; Mental Health; Mental Health & Psychiatry; Middle Aged; Original research; Pain; Population; Post traumatic stress disorder; Psychiatrists; Public Health; Sierra Leone - epidemiology; Stigma; Stress Disorders, Post-Traumatic - epidemiology; Substance use; Survivor; Survivors - psychology; Viral haemorrhagic fevers; Young Adult
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2024-015098

BackgroundThe West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs.ObjectivesAssess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone.MethodsA cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed.FindingsEVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%–16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35–44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35).ConclusionsConcerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6–8 years after recovery.Clinical implicationsResults can be used to inform policy efforts and target resources to address mental health in EVD survivors.