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

primarily in Sierra Leone, Liberia and Guinea. 1 In Sierra Leone alone, there were reports of more than 14 100 Ebola cases, resulting in over 3900 deaths, and more than 30 000 individuals were quarantined due to possible Ebola exposure. 2 Little is known about the epidemic's effects on the mental health of the general population in the affected countries. Numerous studies have examined the mental health effects associated with other infectious disease outbreaks including the 2003 severe acute respiratory syndrome (SARS) epidemic [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] and 2009 novel influenza A (H1N1) pandemic. [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] The mental health impact of other emergencies, such as bioterrorism, have also been documented among survivors. 23 Psychological distress, anxiety, depression and post-traumatic stress disorder (PTSD) have been recorded among populations exposed to mass conflict and displacement 24 including those affected by the civil conflict in Sierra Leone between 1992 and 2002. 25 26 Known risk factors for anxiety, depression and PTSDincluding experience with ill individuals, perceptions of threat, high levels of mortality, food and resource insecurity, stigma and discrimination, and intolerance of uncertainty-may have been experienced by people in Sierra Leone during the Ebola epidemic. Adverse mental health outcomes could be expected in the general population given the magnitude of the epidemic. 15 27 High levels of distress have been documented among Ebola survivors in Guinea and Sierra Leone 28 29 and healthcare workers (HCWs) in all three affected countries. 29 30 There are few mental health resources in Sierra Leone; for example, when the Ebola outbreak began, there was only one trained psychiatrist for the population of over 7 million. Assessments of mental health and of risk factors for mental illness can support policy efforts to improve resources to address mental health and inform how resources can be targeted most efficiently-especially in the aftermath of a devastating Ebola epidemic.