TY - JOUR T1 - Fear and culture: contextualising mental health impact of the 2014–2016 Ebola epidemic in West Africa JF - BMJ Global Health DO - 10.1136/bmjgh-2018-000924 VL - 3 IS - 3 SP - e000924 AU - Ann O’Leary AU - Mohamed F Jalloh AU - Yuval Neria Y1 - 2018/06/01 UR - http://gh.bmj.com/content/3/3/e000924.abstract N2 - The 2014–2016 Ebola virus disease (Ebola) outbreak in West Africa was the largest, longest, deadliest and most geographically expansive Ebola outbreak since the virus was first discovered in the Democratic Republic of Congo in 1976.1–5 Given the unprecedented escalation of the outbreak, the WHO declared it a Public Health Emergency of International Concern in August 2014,6 a designation that lasted for 20 months until March 2016.7By the time the epidemic was controlled, it affected 10 countries through locally acquired or imported Ebola cases, resulting in 28 652 Ebola cases and 11 325 deaths from the disease reported to WHO.8 When comparing the 2014–2016 epidemic with the combined 24 previous Ebola outbreaks, there were 12 times more cases, 7 times more deaths and 21 times more patients with Ebola who recovered from and survived the disease.While Nigeria was more prompt in containing its Ebola outbreak, compared with Sierra Leone, Liberia and Guinea, fear-driven behaviours aggregated adverse consequences on its economy and healthcare utilisation—described as fearonomic effect.9 10 Misinformation caused people to ingest large amounts of salt water (a rumoured curative), breaking quarantine to obtain ‘holy water’ in Lagos, also rumoured to cure the disease, and casual transmission beliefs caused people to avoid crowded areas—causing many businesses to fail—and health facilities. Ebola survivors and health workers were particularly affected by fear-driven stigmatisation. In Sierra Leone, Ebola survivors reported acute fear and depression when they initially suspected Ebola, as well as experiencing stigmatisation in the community after release from Ebola treatment centres.11 In Guinea, some Ebola survivors avoided disclosing their Ebola survivorship status to sexual partners, possibly due to the fear of stigmatisation and rejection.12Few studies have attempted to assess the mental health impact of Ebola on directly affected populations such as Ebola survivors,11–15 … ER -