How Does Surviving Ebola Impact Long-Term Mental Health?

What you need to know

• Almost half of Ebola survivors surveyed in Sierra Leone showed signs of post-traumatic stress disorder (PTSD) 6-8 years after recovery
• Rates of depression and substance use were also higher in Ebola survivors compared to the general population
• Factors like longer illness duration, experiencing stigma, and changing residence were associated with higher rates of PTSD
• There is an urgent need for improved mental health services and support for Ebola survivors in Sierra Leone

Background on Ebola and its impact

The 2013-2016 Ebola outbreak in West Africa was the largest Ebola epidemic in history, infecting over 28,000 people and causing over 11,000 deaths. Sierra Leone was one of the hardest hit countries, with over 14,000 cases.

While the immediate health crisis has passed, the unprecedented number of Ebola survivors has raised questions about the long-term effects on mental health. Previous studies have shown that Ebola survivors often face ongoing physical symptoms, social stigma, and psychological distress in the aftermath of their illness. However, little was known about the mental health status of survivors many years after recovery.

Study details

This study aimed to assess the frequency of mental health issues among Ebola survivors in Sierra Leone 6-8 years after the outbreak, and to identify factors associated with these issues. The researchers conducted surveys with 595 Ebola survivors and 403 of their close contacts between November 2021 and March 2022.

Participants completed validated screening tools to assess for:

• Post-traumatic stress disorder (PTSD)
• Major depression
• Substance use
• Alcohol use

The researchers then compared rates between survivors and contacts, and analyzed factors associated with mental health outcomes in survivors.

Key findings on mental health outcomes

The study revealed concerning rates of mental health issues among Ebola survivors, even years after recovery:

• 47% of survivors showed signs of PTSD related to their Ebola experience
• 3.8% met criteria for major depression
• 12% reported problematic substance use
• 3.8% reported harmful levels of alcohol use

All of these rates were higher than those seen in the close contacts and in the general population of Sierra Leone. For example, baseline rates of PTSD in the region are estimated at 6-16%, compared to the 47% seen in survivors.

Factors associated with PTSD in survivors

The researchers identified several factors associated with higher rates of PTSD among Ebola survivors:

• Longer duration of acute illness (21 days or more)
• Being middle-aged (35-44 years old)
• Changing residence after recovery
• Experiencing stigma related to Ebola
• Having ongoing physical symptoms like headaches and sleep issues

Interestingly, unemployment was very high among survivors (85.5%) compared to contacts (41.4%), but was not directly associated with PTSD. However, the researchers note it may contribute to feelings of low self-worth and stigma that impact mental health.

Implications for care and support

These findings highlight the ongoing mental health burden faced by many Ebola survivors, even years after their physical recovery. The high rates of PTSD are particularly concerning and suggest a critical need for trauma-focused mental health support.

However, Sierra Leone faces significant challenges in providing mental health care. As of 2021, there were only 3 psychiatrists and about 20 mental health nurses in the public health system for a population of 7 million. Many survivors are unaware of any available psychological services.

The researchers emphasize that addressing this issue will require collaboration between the government, health professionals, international organizations, and local communities. Some key recommendations include:

• Expanding mental health services and psychiatric medications
• Training more mental health professionals
• Implementing community-based support programs
• Conducting public education to reduce stigma
• Partnering with community and spiritual leaders

They also suggest using simple screening tools like those used in the study to identify individuals who would benefit most from limited care resources.

Conclusions

This research provides important insight into the long-term mental health impact of surviving Ebola. The high rates of PTSD and other issues seen 6-8 years after recovery demonstrate that the effects of the epidemic are still being felt.

There is a clear need for greater investment in mental health support for Ebola survivors in Sierra Leone. Addressing these issues could significantly improve quality of life for survivors and support the overall recovery of affected communities.

The findings may also have implications for other infectious disease outbreaks. They highlight the importance of considering long-term mental health impacts and implementing support systems that extend well beyond the initial crisis period.

• PTSD and other mental health issues remain prevalent in Ebola survivors years after recovery
• There is an urgent need to expand mental health services and support in Sierra Leone
• Long-term mental health impacts should be a key consideration in planning for future disease outbreaks