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

(2) their district; (3) their community; and (4) their household. Participants responded using 4-point Likert Scale items ranging from 1 (strongly agree) to 4 (strongly disagree). Responses were further dichotomised into 'agree' and 'disagree,' and the scores reversed so that higher scores represented more perceived risk. We also created a composite score across all four domains with 1 representing 'any perceived Ebola threat' and 0 representing 'no perceived Ebola threat. ' Symptoms of anxiety and depression were measured by Patient Health Questionnaire-4 (PHQ-4). 31 PHQ-4 was developed by combining two ultrabrief screeners, the PHQ-2 and the Generalised Anxiety Disorder Scale, that have been demonstrated to reliably measure depression and anxiety symptoms. Participants were asked to report their symptoms of depression and anxiety in the past 2 weeks on a Likert Scale from 0 (not at all) to 3 (nearly every day) for a maximum score of 12. The sample was further dichotomised into those who expressed any symptoms compared with those who did not by creating a new composite variable. We also examined the prevalence of anxiety and depression using the established clinical cut-off total score of 6, which represents the proportion of people who would be considered as having clinical BMJ Global Health levels of depression or anxiety if the screener were used for diagnostic purposes. 32 Symptoms of PTSD were measured by the Impact of Event Scale-6 (IES-6), 33 which is a validated, shortened version of the full IES-revised (IES-r). 34 35 The full scale contains 22 items (scored from 0 to 88) with demonstrated reliability and validity to measure PTSD symptoms across different cultures and settings. While IES-r is generally not used to diagnose PTSD in clinical settings, it is widely used for screening at-risk patients with PTSD. The IES-6 includes a total of six items-two items from each of the three subscales of the measure, namely intrusion, hyperarousal and avoidance. 33 Participants were asked to report their PTSD symptoms in the past 7 days on a Likert Scale ranging from 0 (not at all) to 4 (extremely). We dichotomised the sample into those who expressed any symptoms versus those who did not by creating a new composite variable. We evaluated respondents for whom PTSD may be a 'clinical concern' using an inputted 1.09 mean item cut-off score (equivalent to 24/88 on IES-r). 36 In addition, we assessed respondents who met 'probable diagnosis' of PTSD using an inputted 1.5 mean item cut-off score (equivalent to 33/88 total score in IES-r). 37 data collection In June 2015, FOCUS 1000 recruited 75 experienced data collectors, 25 team supervisors and 4 regional supervisors. They were trained for a week on overall assessment protocols and guidelines, informed consent, safety and security precautions, administration of questionnaire, and quality control and assurance. The training included oral translation of each item into local languages (Krio, Mende, Temne and Limba), back translations (orally), group discussions of the translations for accuracy in meaning, role plays to reflect possible range of responses, and group consensus on the final translations to ensure consistent and accurate use of each item. In July 2015, the trained data collectors used Open Data Kit for digital data collection at the household level. Nearly all interviews (>90%) were conducted in Krio.