Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model

Cénat, Jude Mary; Kokou-Kpolou, Cyrille Kossigan; Mukunzi, Joana N.; Dalexis, Rose Darly; Noorishad, Pari-Gole; Rousseau, Cécile; Dérivois, Daniel; Bukaka, Jacqueline; Balayulu-Makila, Oléa; Guerrier, Mireille

doi:10.1016/j.jad.2021.06.047

Cited by 10 publications

(25 citation statements)

References 38 publications

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“…The high rates of substance abuse and depression among all respondents suggest that mental health access is necessary for the entire community. Our rates are consistent with other studies of mental health disorders among survivors, but we include a broader survey of disorders and assess these same disorders among sexual partners of survivors and a comparison sample among community members 4 8–11 16 20 21. It should also be noted that it is difficult to compare mental health symptoms in eastern DRC to those described in other DRC EVD outbreak areas due to the unique context of long-term conflict and insecurity seen in eastern DRC 8 16.…”

Section: Discussionsupporting

confidence: 77%

“…Our rates are consistent with other studies of mental health disorders among survivors, but we include a broader survey of disorders and assess these same disorders among sexual partners of survivors and a comparison sample among community members 4 8–11 16 20 21. It should also be noted that it is difficult to compare mental health symptoms in eastern DRC to those described in other DRC EVD outbreak areas due to the unique context of long-term conflict and insecurity seen in eastern DRC 8 16. Although survivors are offered psychological support at monthly follow-up appointments, lay counsellors, already trained in cognitive processing therapy, could be helpful to this population of survivors, sexual partners and the community in addressing mental health disorders 8 11 28 39–41…”

Section: Discussionsupporting

confidence: 73%

“…Mental health symptoms, especially depression, both exacerbate stigma and are exacerbated by stigmatisation 9 38. Despite sensitisation efforts to decrease stigma among communities in outbreak areas, the prevalence of fear-based stigma, not unlike other studies, will likely impede the quality of care and access to necessary post-EVD mental healthcare and perpetuate the spread of EVD 8 16 37 38 40 50 51. Access to care will be an important factor for educating survivors and partners about data showing long-term sexual transmission of EVD 12 14.…”

Section: Discussionmentioning

confidence: 99%

“…Further outbreaks, since the 10th outbreak, show sexual transmission of EVD occurs much longer than the previously determined 500 days 14. There is some suggestion, among survivors in West Africa and survivors from the 9th DRC EVD outbreak in Equateur province, that stigma was exacerbated by discrimination of survivors due to the understanding that EVD is sexually transmitted 15 16. Stigma, however, was not associated with mental health among survivors or partners in eastern DRC (10th outbreak) 8.…”

Section: Introductionmentioning

confidence: 99%

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Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

Lawry

Stroupe²,

Canteli³

et al. 2022

BMJ Open

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ObjectivesTo understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use.DesignCross-sectional study.SettingBeni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC).Participants223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents.Primary and secondary outcome measuresPost-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour.ResultsMost respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors.ConclusionsThe new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

Lawry

Stroupe²,

Canteli³

et al. 2022

BMJ Open

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“… 34 In addition, different results were observed for psychological distress and post-traumatic stress disorder. 35 36 Both qualitative and quantitative research is needed to better explain these findings.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study

et al. 2022

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ObjectivesHigh mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD.DesignCross-sectional study.SettingThe current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC).ParticipantsA large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC.Primary and secondary outcome measuresParticipants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions.ResultsOverall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms.ConclusionsResults indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

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Assessment of prevalence and determinants of anxiety and psychological distress symptoms in Ebola child and adolescent survivors and orphans in Eastern Democratic Republic of the Congo during the COVID-19 pandemic

Cénat,

Jacob,

Darius

et al. 2024

Journal of Affective Disorders

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Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model

Cited by 10 publications

References 38 publications

Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study

Assessment of prevalence and determinants of anxiety and psychological distress symptoms in Ebola child and adolescent survivors and orphans in Eastern Democratic Republic of the Congo during the COVID-19 pandemic

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