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

Similar to SARS, the 2009 H1N1 pandemic was associated with psychological distress among the general population, 13 14 20 family members of hospitalised patients with H1N1 21 and HCWs. 18 In some instances, prevalence of H1N1-related anxiety was higher among those who had greater intolerance of uncertainty. 15 17 Additional research is required to better understand the relationship between intolerance of uncertainty and quarantine experience during large-scale infectious disease outbreaks. An assessment with HCWs in China found that being quarantined and having perceived threat of SARS were associated with high depressive symptoms several years after BMJ Global Health the epidemic ended. 10 In a separate study, H1N1 quarantine experience did not predict elevated PTSD levels while dissatisfaction with control measures was a better predictor. 16 To the best of our knowledge, no prior study has assessed the mental health impact of the protracted Ebola epidemic at population levels in Sierra Leone, Liberia or Guinea. A limited number of studies have examined population-level mental health in other African countries. One such study in a predominantly rural community in Ethiopia found that 14% of the population expressed clinical levels of mild depressive, anxiety and somatic symptoms. 41 On the other hand, a wide variety of studies have examined anxiety and depression in highrisk populations in Africa, including patients with tuberculosis in Ethiopia 42 and Angola, 43 Rwandans who had experienced genocide, 44 and Nigerian prison inmates. 45 Findings of varying levels of mental health symptomology from these studies suggest that further investigations may be required to better understand specific mental health impact of the Ebola epidemic on directly affected persons such as Ebola survivors.