Post-Traumatic Stress Reactions in Ebola Virus Disease Survivors in Sierra Leone

Abstract

Introduction: The current Ebola outbreak represents the largest in history. Understanding psychological reactions among EVD survivors may provide relevant information about post-treatment adjustment and possible psychological preventative measures. We therefore studied the psychological reactions in Ebola Virus Disease survivors following their discharge from an Ebola treatment centre in Sierra Leone. Methods: Immediately following discharge, survivors met with the psychologist to discuss their experiences in the case management centre and the challenges they may face returning to their communities. Of 74 survivors discharged in the study period, 24 were followed up at home for a psychological consultation three to four weeks after discharge. During the home visit the psychologist applied an adaptation of the trauma screening questionnaire and explored number of family deaths from Ebola Virus Disease, stigma, the meaning they attached to the causation of their illness and general post illness adjustment. Results: All survivors had lost immediate family members to Ebola Virus Disease. Most (16; 67%) had also witnessed their deaths. Eight (32%) survivors had experienced stigma when returning to their communities. Seventeen (71%) survivors experienced arousal and re-experiencing reactions during the first two days post discharge. Five (21%) reported clinically important post traumatic reactions between three and four weeks post discharge predicting a risk of developing post-traumatic stress disorder. Conclusion: Although this study represents a snapshot of post-traumatic stress reactions observed in Ebola survivors, it does demonstrate the need to consider the likelihood of psychological sequelae in EVD survivors. Long term follow-up of is needed to understand psychological care needs of Ebola survivors.

An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study

“…One key finding from our study is that EVD survivors report high levels of internalised and enacted stigma since discharge from an Ebola treatment centre which is in line with findings from a longitudinal Liberian study that reported high levels of stigma at baseline but lower levels at subsequent follow-up visits [21,23]. Our finding also resonates with similar short term and smaller sample size cross-sectional studies in Sierra Leone [24,25,48], Liberia [20], Guinea [49], and DR Congo [19,40],which reported that EVD survivors experience several forms of internalised and enacted stigma. Our result identifies higher occurrence of internalised stigma when compared with the occurrence of total enacted stigma experienced by EVD survivors.…”

“…Liberian research also suggests EVD survivors are reported to be more likely to experience stigma compared to their close contacts who were not infected with EVD virus [22] however the degree of EVD-related stigma may decline among survivors over time [21,23]. In Sierra Leone, stigmatisation is reported in approximately one third of EVD survivors [24,25].…”

Post‐Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review

“…The remaining three were cohort studies. Eighteen studies were from the 2013 to 2016 outbreak in West Africa the remaining six are from 1995 to 2012 outbreaks in Eastern Africa . Of the 24 papers, 23 were published in English and one published in French .…”

The Role of Fear-Related Behaviors in the 2013–2016 West Africa Ebola Virus Disease Outbreak

“…Heaped upon the trauma of experiencing EVD illness and the loss of family members to the disease, Rabelo and team [29••] described a harsh homecoming marked by ostracism, rejection, isolation, humiliation, and exclusion. Unable to regain their lives and livelihoods, survivors were very likely to experience symptoms of depression and posttraumatic stress disorder [29••, 75••, 79]. Recognition of the extreme difficulties faced by persons attempting to return to their home communities following discharge from the ETUs, CDC and other humanitarian actors developed “reintegration” and support programs to assist survivors [80, 81].…”