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

In a national sample of Sierra Leoneans after more than a year of the unprecedented Ebola epidemic, nearly half of all respondents reported at least one symptom of anxiety or depression and three quarters expressed PTSD symptoms. Most respondents reported between one and four symptoms. After adjusting for sociodemographic variables, we found that persons with any level of Ebola experience were more likely to report symptoms of anxiety-depression and PTSD. Even though expression of one or more symptoms was widespread among our sample, a lower proportion of respondents met the clinical cut-off scores for anxiety-depression (5%-7%) and probable diagnosis for PTSD (15%-17%). The proportion of respondents who exhibited clinical level symptoms of anxiety-depression may be considered 'lower than expected' given the magnitude and duration of the epidemic, but may also point to a culture of resiliency among Sierra Leoneans. 40 On the other hand, we documented substantial PTSD, which is a public health concern that may require targeted mental health interventions at the individual level and community level for those with some personal Ebola experience. A national assessment of the mental health impact of the 2003 SARS epidemic in Taiwan, using a different scale than in our current study, found 4% prevalence of depression after the epidemic ended. 3 Another population-based survey in Taiwan revealed 12% prevalence of psychiatric morbidity following SARS. 9 In Singapore, a community-based sample detected that a quarter of all respondents had clinical levels of PTSD symptoms. 11 Other mental health assessments with SARS survivors 4 8 and HCWs 5 documented similar or higher clinical PTSD levels compared with our current assessment. One study found that HCWs with a history of mental illness before SARS were more likely to report new onset following the epidemic. 7 In our assessment, we cannot determine how past mental health history of PTSD in Sierra Leone, especially due to the prolonged civil war from 1992 to 2002, may have influenced the levels of clinical PTSD concern we detected.