Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping.

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.

Prevalence and correlates of depression during the COVID-19 pandemic and the major role of stigmatization in low- and middle-income countries: A multinational cross-sectional study.

OBJECTIVES: Currently, there is little data on the mental health consequences of the COVID-19 pandemic in low- and middle-income countries (LMICs). This study aims to examine the pooled and separate prevalence and determinants of depression during the pandemic in samples from four LMICs. METHODS: Participants (N= 1267, 40.9% women) were recruited from the Democratic Republic of the Congo (DRC), Haiti, Rwanda, and Togo. They completed an online cross-sectional survey on sociodemographics, exposure and stigmatization related to COVID-19, the Hopkins Symptom Checklist depression subscale, and the Connor-Davidson Resilience Scale-2. RESULTS: The pooled prevalence for depression symptoms was 24.3% (95% CI: 22.08-26.79%), with significant differences across countries. Younger age, gender (women), and high levels of exposure and stigmatization related to COVIID-19, and resilience were associated with depression in the pooled data. There were significant variations at the country level. Stigmatization (but not exposure to COVID-19 and resilience) was a strong predictor among the four countries. CONCLUSIONS: The prevalence of depression symptoms in the LMICs are similar to those reported in China and in most high-income countries during the pandemic. The findings emphasize the need for implementing non-fear-based education programs during epidemics to reduce stigmatization.

Knowledge and misconceptions related to the Ebola Virus Disease among adults in the Democratic Republic of the Congo: The venomous snake under the table of prevention.

Objectives: On July 24, the Ministry of Health of the Democratic Republic of the Congo declared the end of the 2018 Ebola Virus Disease (EVD) outbreak in the Equateur Province. Conducted seven months after, this study aimed to examine knowledge and misconceptions related to EVD in a representative sample of affected communities in order to develop evidence-based prevention programs. Study design: Cross-sectional study with a two-stratified representative sample. Methods: A sample of 1,614 participants (50% of women) was recruited between March and April 2019 in the three affected health zones. Participants completed a questionnaire assessing knowledge, perception, practices and misconceptions related to EVD. Results: One-third of the 1,614 participants did not know that EVD is transmitted through bodily fluids of infected people. Only 39.85% and 45.99% were aware that EVD cannot be transmitted through air and mosquitoes. Only 44.93% declared a salty and hot bath cannot prevent EVD; and only 43.78% answered that spiritual or traditional healers cannot cure EVD. Results also indicated that although participants with high levels of education had more knowledge of EVD, they did not differ significantly from less educated ones for misconceptions. Hierarchical linear regression models showed interactions of sociodemographic characteristics that predicted EVD knowledge. Conclusions: The pervasive lack of knowledge, misconceptions and attitudes related to EVD constitute a major concern for prevention. Instead of basing awareness programs on the fear of EVD, health authorities, World Health Organization and NGOs should co-develop culturally sensitive and inclusive community evidence-based programs to educate the populations.

Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in low- and middle-income countries: A multinational study.

OBJECTIVE: Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic. METHODS: A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety. RESULTS: Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x2 = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (ß = 0.06, p = .005), stigmatization related to COVID-19 (ß = 0.03, p < .001), and resilience (ß = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (ß = 0.02, p < .00; ß = 0.05, p = .013; ß = 0.03, p = .021; ß = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo). CONCLUSIONS: The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.

Prevalence of mental health problems in populations affected by the Ebola virus disease: A systematic review and meta-analysis.

Studies have shown that, in addition to being associated with a high mortality rate, Ebola Virus Disease (EVD) is also related with mental health problems. This study aimed to determine prevalence of mental health problems and associated factors among survivors and individuals affected by EVD. A systematic review of peer-reviewed empirical studies was conducted using EMBASE, PubMed, PsycINFO and PsyARTICLES. A random effects meta-analysis was performed on the proportions of people diagnosed with depression after an EVD outbreak. Of 205 studies initially identified, 21 were included in the systematic review and 10 in the meta-analysis. Results indicated that EVD is associated with depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, among others. Results revealed that one person out of five affected to EVD has been diagnosed with depression (standardized mean difference 19.92%, 95% CI 10.43%; 34.70). The I2 provided evidence of heterogeneity in the results. This study demonstrated the evidence of the impact of EVD on the mental health of survivors and individuals affected by EVD. Further studies should consider the mental health consequences of EVD to plan culturally sensitive prevention and intervention programs based on the experience of communities affected by EVD.

The mental health professional at the feet of the Ebola virus: individual treatment and global mental challenges.

SummaryMental health professionals form an important component of the response teams currently working in the Democratic Republic of the Congo to treat what is historically the second-largest Ebola outbreak. They provide psychological treatment to patients under extraordinary conditions, helping them cope with anxiety and the daily death of other patients.Declaration of interestNone.