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

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

doi:10.1136/bmjopen-2021-053375

Cited by 12 publications

(14 citation statements)

References 35 publications

(33 reference statements)

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“…Using the Statistical Package for the Social Sciences (SPSS), version 27, we computed the prevalence of severe symptoms of PTSD and anxiety using the above-mentioned cut-off across sociodemographic characteristics including gender, age category, education level, employment status, categories of exposure to EVD and COVID-19, and categories of stigmatization due to EVD and COVID-19. To compare levels of exposure to EVD and COVID-19 and stigmatization related to EVD and COVID-19, their scores were classified in four categories with values below the 25th percentile, between the 25th and 50th percentile, between 50th and 75th, and values beyond the 75th percentile according to past studies (13)(14)(15)20). Subsequently, a multivariable linear regression was conducted separately to examine the association between mental health symptoms (PTSD and anxiety) and exposure to EVD, exposure to COVID-19, and stigmatization due to EVD and COVID-19.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…This double crisis could reignite both the fear of survivors and HCWs, and the stigmatization to which they have been subjected to according to a process of retraumatization (12). Studies conducted during the first wave of the COVID-19 pandemic in several countries, including the DRC, showed that stigmatization related to the disease was the most significant predictor of mental health problems, including anxiety and depression (13)(14)(15). In addition, the eastern region of the DRC has been facing armed conflicts for over 20 years (16).…”

Section: Introductionmentioning

confidence: 99%

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Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo

et al. 2022

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Ebola virus disease (EVD) survivors and healthcare workers (HCWs) face stress, fear, and stigma during the COVID-19 pandemic that can induce severe symptoms of anxiety and post-traumatic stress disorder (PTSD). We examined the prevalence and factors related to severe PTSD and anxiety symptoms, using a representative sample of survivors of the 2018–2020 EVD epidemic in DR Congo in comparison HCWs. Five hundred sixty-three participants (55.25% women, 309 survivors, 202 HCWs, and 52 HCWs and survivors) completed questionnaires assessing anxiety, PTSD, exposure to EVD and COVID-19, stigmatization related to EVD and COVID-19, interpersonal traumas, social support. During the COVID-19 pandemic, 45.6 and 75.0% of survivors and HCWs reported severe symptoms of PTSD and anxiety. Significant difference was observed among the three groups for both PTSD (53.7% survivors, 37.1% HCWs, and 30.8% HCWs-survivors, χ2= 18.67, p < 0.0001) and anxiety (88.3% survivors, 56.9% HCWs, and 65.4% HCWs- survivors, χ2= 67.03, p < 0.0001). Comorbidity of severe PTSD and anxiety symptoms was 42.3% between the three groups. Results revealed that exposure to EVD (b = 0.53; p = 0.001; b = 0.12; p = 0.042), EVD-related stigmatization (b = 0.14; p = 0.018; b = 0.07; p = 0.006), COVID-19-related stigmatization (b = 0.22; p < 0.0001; b = 0.08; p = 0.0001) and social support (b = −0.30; p < 0.0001; b = −0.14; p < 0.0001) predicted severe PTSD and anxiety symptoms. The last models explained 63.8 and 56.4% of the variance of PTSD and anxiety. Symptoms of PTSD and anxiety are common among EVD survivors and HCWs during the COVID-19 pandemic. Culturally-sensitive programs that address stigma are necessary to mitigate the cumulative effects of EVD and the COVID-19 pandemic on EVD survivors and HCWs.

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Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo

et al. 2022

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“… 5. Cenat J. M. 2022 34 Equateur, DRC. 1614 adults affected by the ninth month of Ebola outbreak Investigate the prevalence of, and risk factors associated with, depressive symptoms among individuals affected by Ebola Virus Disease (EVD) Multivariable logistic regression EVD exposure level, stigmatization related to EVD and Beck Depression Inventory-Short Form (BDI-SF) Adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…Stressful life events were assessed using the Impact of Event Scale revised version (IES-R) 29 . To assess stigma, a 20-item scale that measures 20 possible forms of stigmatization related to Ebola Virus Disease (EVD) was used 34 . Most instrument measures used multiple items to assess participants’ mental health and other conditions.…”

Section: Resultsmentioning

confidence: 99%

Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo

Ngamaba,

Lombo,

Makopa

et al. 2024

npj Mental Health Res

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In the Democratic Republic of the Congo (DRC), the prevalence of mental health issues could be greater than in other low-income and middle-income countries because of major risk factors related to armed conflicts and poverty. Given that mental health is an essential component of health, it is surprising that no systematic evaluation of mental health in the DRC has yet been undertaken. This study aims to undertake the first systematic review of mental health literacy and service provision in the DRC, to bridge this gap and inform those who need to develop an evidence base. This could support policymakers in tackling the issues related to limited mental health systems and service provision in DRC. Following Cochrane and PRISMA guidelines, a systematic (Web of Science, Medline, Public Health, PsycINFO, and Google Scholar) search was conducted (January 2000 and August 2023). Combinations of key blocks of terms were used in the search such as DRC, war zone, mental health, post-traumatic stress disorder (PTSD), anxiety, depression, sexual violence, war trauma, resilience, mental health systems and service provision. We followed additional sources from reference lists of included studies. Screening was completed in two stages: title and abstract search, and full-text screening for relevance and quality. Overall, 50 studies were included in the review; the majority of studies (n = 31) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence. Different instruments were used to measure participants’ mental health such as the Hopkins Symptoms Checklist (HSCL-25), The Harvard Trauma Questionnaire, Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7), and Positive and Negative Symptoms Scale (PANSS). Our study found that wartime sexual violence and extreme poverty are highly traumatic, and cause multiple, long-term mental health difficulties. We found that depression, anxiety, and PTSD were the most common problems in the DRC. Psychosocial interventions such as group therapy, family support, and socio-economic support were effective in reducing anxiety, depression, and PTSD symptoms. This systematic review calls attention to the need to support sexual violence survivors and many other Congolese people affected by traumatic events. This review also highlights the need for validating culturally appropriate measures, and the need for well-designed controlled intervention studies in low-income settings such as the DRC. Better public mental health systems and service provision could help to improve community cohesion, human resilience, and mental wellbeing. There is also an urgent need to address wider social issues such as poverty, stigma, and gender inequality in the DRC.

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“…Stigma associated with infectious disease outbreaks reduces affected persons’ opportunities for physical, social, and psychological well-being, contributing to social and health inequalities ( 8 – 11 ). COVID-19 and Ebola virus disease (EVD) stigmatization have specifically been proven predictors of severe psychological distress, depression, anxiety, and posttraumatic stress disorder symptoms ( 1 , 11 – 13 ). Stigma can also impede efforts to control disease outbreaks by fueling fear, decreasing uptake of preventive measures (including vaccination), discouraging health-seeking behavior such as seeking testing and treatment, and reducing adherence to care ( 6 , 8 , 10 , 14 ).…”

mentioning

confidence: 99%

Systematic Review of Scales for Measuring Infectious Disease–Related Stigma

Paterson,

Cheyne,

Jones

et al. 2024

Emerg. Infect. Dis.

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Infectious disease outbreaks are associated with substantial stigma, which can have negative effects on affected persons and communities and on outbreak control. Thus, measuring stigma in a standardized and validated manner early in an outbreak is critical to disease control. We reviewed existing scales used to assess stigma during outbreaks. Our findings show that many different scales have been developed, but few have been used more than once, have been adequately validated, or have been tested in different disease and geographic contexts. We found that scales were usually developed too slowly to be informative early during an outbreak and were published a median of 2 years after the first case of an outbreak. A rigorously developed, transferable stigma scale is needed to assess and direct responses to stigma during infectious disease outbreaks.

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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

Cited by 12 publications

References 35 publications

Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo

Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo

Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo

Systematic Review of Scales for Measuring Infectious Disease–Related Stigma

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