Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015

Jalloh, Mohamed F; Li, Wenshu; Bunnell, Rebecca E; Ethier, Kathleen A; O’Leary, Ann; Hageman, Kathy M; Sengeh, Paul; Jalloh, Mohammad B; Morgan, Oliver; Hersey, Sara; Marston, Barbara J; Dafae, Foday; Redd, John T

Prevalence of symptoms Figure 1 shows 48% (95% CI 46.8% to 50.0%) of respondents reported at least one symptom of anxiety or depression, with 6% (95% CI 5.4% to 7.0%) meeting the clinical cut-off definition. Of all respondents, 76% (95% CI 75.0% to 77.8%) reported one or more PTSD BMJ Global Health Table 2A ,B describes respondents' experiences with Ebola and the association with anxiety and depression and PTSD symptoms, controlling for age, gender, region and education level. The experience of knowing someone who died from Ebola alone was not independently associated with anxiety and depression symptoms (adjusted OR (AOR) 1.1 95% CI 0.8 to 1.5, p=0.570) but was independently associated with PTSD symptoms (AOR 1.5 95% CI 1.0 to 2.2, p=0.035). Those participants who knew someone quarantined due to Ebola exposure alone were more likely to report symptoms of anxiety and depression (AOR 2.3 95% CI 1.7 to 2.9, p<0.001) and PTSD (AOR 2.0 95% CI 1.5 to 2.8, p<0.001) than those who did not. Respondents who had both experiences (that is, they knew at least one person who died from Ebola and someone quarantined) were also more likely to report symptoms of anxiety and depression (AOR 1.8 95% CI 1.5 to 2.2, p<0.001) and PTSD (AOR 2.3 95% CI 1.8 to 2.8, p<0.001) compared with those who did not report both. Those with any Ebola experience were more likely to report anxiety and depression symptoms than those who had no Ebola experience (AOR 1.8 95% CI 1.6 to 2.0, p<0.001) and were more likely to report PTSD symptoms than those with no Ebola experience (AOR 2.01 95% CI 1.69 to 2.38, p<0.001). Table 3 presents the relationship between perceived Ebola threat and reported symptoms of anxiety and depression and PTSD. Respondents who perceived some ongoing threat of Ebola were more likely to report symptoms of anxiety-depression (AOR 1.69 95% CI 1.44 to 1.98, p<0.001) and PTSD (AOR 1.86 95% CI 1.56 to 2.21, p<0.001) compared with those who did not. Table 4 presents multivariate analyses of the associations between Ebola experience and perceived Ebola threat and symptoms of anxiety and depression and PTSD, adjusting for gender, age, region and education levels. Ebola experience and perceived Ebola threat were independently associated with anxiety and depression symptoms as well as PTSD symptoms. In addition, the interaction between Ebola related experience and risk perception was independently associated with both anxiety-depression and PTSD symptoms: participants who had Ebola experience and also perceived ongoing Ebola