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Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015
  1. Mohamed F Jalloh1,
  2. Wenshu Li1,
  3. Rebecca E Bunnell1,
  4. Kathleen A Ethier2,
  5. Ann O’Leary2,
  6. Kathy M Hageman2,
  7. Paul Sengeh3,
  8. Mohammad B Jalloh3,
  9. Oliver Morgan1,
  10. Sara Hersey1,
  11. Barbara J Marston1,
  12. Foday Dafae4,
  13. John T Redd1
  1. 1Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
  2. 2National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
  3. 3Office of the Chief Executive Officer, FOCUS 1000, Freetown, Sierra Leone
  4. 4Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
  1. Correspondence to Mohamed F Jalloh; yum8{at}


Background The mental health impact of the 2014–2016 Ebola epidemic has been described among survivors, family members and healthcare workers, but little is known about its impact on the general population of affected countries. We assessed symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population in Sierra Leone after over a year of outbreak response.

Methods We administered a cross-sectional survey in July 2015 to a national sample of 3564 consenting participants selected through multistaged cluster sampling. Symptoms of anxiety and depression were measured by Patient Health Questionnaire-4. PTSD symptoms were measured by six items from the Impact of Events Scale-revised. Relationships among Ebola experience, perceived Ebola threat and mental health symptoms were examined through binary logistic regression.

Results Prevalence of any anxiety-depression symptom was 48% (95% CI 46.8% to 50.0%), and of any PTSD symptom 76% (95% CI 75.0% to 77.8%). In addition, 6% (95% CI 5.4% to 7.0%) met the clinical cut-off for anxiety-depression, 27% (95% CI 25.8% to 28.8%) met levels of clinical concern for PTSD and 16% (95% CI 14.7% to 17.1%) met levels of probable PTSD diagnosis. Factors associated with higher reporting of any symptoms in bivariate analysis included region of residence, experiences with Ebola and perceived Ebola threat. Knowing someone quarantined for Ebola was independently associated with anxiety-depression (adjusted OR (AOR) 2.3, 95% CI 1.7 to 2.9) and PTSD (AOR 2.095% CI 1.5 to 2.8) symptoms. Perceiving Ebola as a threat was independently associated with anxiety-depression (AOR 1.69 95% CI 1.44 to 1.98) and PTSD (AOR 1.86 95% CI 1.56 to 2.21) symptoms.

Conclusion Symptoms of PTSD and anxiety-depression were common after one year of Ebola response; psychosocial support may be needed for people with Ebola-related experiences. Preventing, detecting, and responding to mental health conditions should be an important component of global health security efforts.

  • health systems
  • public health
  • viral haemorrhagic fevers
  • kap survey

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  • Handling editor Seye Abimbola

  • Contributors MFJ, RB, AOL and PS led the overall study design with substantial contributions made by the other coauthors. PS, MFJ and MBJ were responsible for training the data collectors and supervised all data collection and data management efforts. WL led all data analyses. All authors contributed equally to the iterative interpretation of the results and the writing and preparation of the manuscript.

  • Funding This study was funded by the Centers for Disease Control and Prevention (10.13039/100000030).

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention or the Sierra Leone Ministry of Health and Sanitation.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Sierra Leone Ethics and Scientific Review Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing agreement has been developed for the Ebola KAP Assessments in Sierra Leone. All requests to access the data must be processed through the multi-partner data sharing mechanism. Reasonable data accessibility requests should be directed to the corresponding author.

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