Psychosocial effects of an Ebola outbreak at individual, community and international levels

Abstract

The 2013–2016 Ebola outbreak in Guinea, Liberia and Sierra Leone was the worst in history with over 28 000 cases and 11 000 deaths. Here we examine the psychosocial consequences of the epidemic. Ebola is a traumatic illness both in terms of symptom severity and mortality rates. Those affected are likely to experience psychological effects due to the traumatic course of the infection, fear of death and experience of witnessing others dying. Survivors can also experience psychosocial consequences due to feelings of shame or guilt (e.g. from transmitting infection to others) and stigmatization or blame from their communities. At the community level, a cyclical pattern of fear occurs, with a loss of trust in health services and stigma, resulting in disruptions of community interactions and community break down. Health systems in affected countries were severely disrupted and overstretched by the outbreak and their capacities were significantly reduced as almost 900 health-care workers were infected with Ebola and more than 500 died. The outbreak resulted in an increased need for health services, reduced quality of life and economic productivity and social system break down. It is essential that the global response to the outbreak considers both acute and long-term psychosocial needs of individuals and communities. Response efforts should involve communities to address psychosocial need, to rebuild health systems and trust and to limit stigma. The severity of this epidemic and its long-lasting repercussions should spur investment in and development of health systems.

Social Mobilization and Community Engagement Central to the Ebola Response in West Africa: Lessons for Future Public Health Emergencies

“…At the same time, it was recognized that the approach must be tailored to the context. For example, different information and actions were required for different groups, such as survivors, pregnant women, or fishing communities, 14 and these efforts needed to be well coordinated with community expectations regarding, for example, supplies in quarantine situations or safety concerns regarding “Back to School” initiatives during the later phase. It was not until several months into the epidemic that the national response in the 3 countries had the capacity, coordination mechanisms, and sub-structures in place to manage the necessary decentralized approach.…”

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

“…Specific to EVD illness and death, fear is expected and has been documented internationally throughout the history of EVD outbreaks [17, 18, 19•, 20–22, 23•, 24•]. During the 2013–2016 EVD outbreak, fear was understandable, reality-based, and almost universal [24•]. …”

“…After years of primarily anecdotal accounts that described widespread fear responses, research on psychosocial and mental health consequences of the 2013–2016 outbreak is beginning to emerge, with authors emphasizing that Ebola was a “traumatic illness” [24•, 75••]. A just-published landmark study of 1008 respondents from rural and urban districts of Sierra Leone, surveyed during the peak of the outbreak, found that “individuals reporting greater intensity of depression symptoms and higher rates of PTSD symptoms also reported higher rates of behaviors that increase the risk of spreading EVD” [75••].…”

“…The obverse is equally important to consider; the “survival rate” was 60.5 %; more than 17,000 EVD patients recovered from illness [5•]. All survivors dealt with a life-threatening illness that carried a powerful psychological overlay and qualified as direct trauma exposure for possible development of posttraumatic stress disorder (PTSD) [24•, 75••]. Survivors remained physically weakened long into the recovery period and many continued to experience symptoms of ”post-Ebola syndrome” [76].…”

Red Cross volunteers’ experience with a mobile community event- based surveillance (CEBS) system in Sierra Leone during-and after the Ebola outbreak- A qualitative study

“…During the outbreak, Sierra Leone had 14,124 cases and 3956 deaths confirmed to have been caused by the Ebola virus [12]. Several factors delayed the detection, diagnosing and isolation of patients, hence enabling rapid spreading of the outbreak, which created a complicated and unique context for controlling it [13].…”