Prevalence and determinants of anxiety, depression and comorbid anxiety-depression symptoms among adolescents in Ebola-affected zones.

BACKGROUND: Ebola virus disease (EVD) has been shown to be associated with poor mental health in affected zones. However, no study has yet explored its impact on adolescents' mental health. AIMS: This study aimed to assess the prevalence and risk factors associated with depression and anxiety symptoms among adolescents in EVD-affected areas in the Equateur Province of the Democratic Republic of the Congo during the COVID-19 pandemic. METHOD: A provincial sample of adolescents aged 12-17 years (M = 14.84, s.d. = 1.49) living in the 18 urban and rural areas affected by the 2018 EVD outbreak completed a two-wave longitudinal survey. Surveys assessed symptoms of depression and anxiety, exposure to Ebola, social support and sociodemographic information. RESULTS: A total of 490 participants completed the baseline and follow-up surveys, 50% of whom were female. Elevated and worsened depressive symptoms were observed among participants from the baseline (56.94%) to the follow-up (91.43%; z = -11.37, P < 0.001), whereas anxiety symptoms decreased from the baseline (36.33%) to follow-up (24.90%; z = 4.06, P < 0.001). The final generalised estimating equation model showed that anxiety symptoms decreased over time (B = -3.92, P < 0.001), while depression symptoms increased (B = 4.79, P < 0.001). Stigmatisation related to Ebola positively predicted anxiety (B = 5.41, P < 0.001) and depression symptoms (B = 0.4452, P = 0.009). Social support negatively predicted anxiety (B = -1.13, P = 0.004) and depression (B = -0.98, P < 0.001) symptoms but only moderated the association between stigmatisation and depression symptoms (B = -0.67, P < 0.001). CONCLUSIONS: Most adolescents living in EVD-affected areas experience mental health issues. Stigmatisation related to EVD and living in urban areas are the most consistent predictors of mental health problems. Nevertheless, social support remains a protective factor for depression and anxiety symptoms and a necessary resource for building resilience.

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.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo.

BACKGROUND: Associated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo. METHODS: Surveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes. RESULTS: Prevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distressT1= 57.04%, Mental distressT2= 40.29%, x2= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001). CONCLUSIONS: Although a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study.

OBJECTIVES: High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD. DESIGN: Cross-sectional study. SETTING: The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC). PARTICIPANTS: A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions. RESULTS: Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms. CONCLUSIONS: Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model.

BACKGROUND: Mechanisms worsening the development of Posttraumatic stress disorder (PTSD) symptoms among individuals affected by high-mortality epidemics are unclear. This study examined the prevalence of PTSD and related risk factors among populations affected by the Ebola virus disease (EVD) outbreak, and investigated whether peritraumatic distress mediates the impact of exposure level to EVD on PTSD symptoms, and the moderation role of stigmatization. METHODS: The sample included 1614 participants (50% women) affected by EVD in Democratic Republic of the Congo (DRC). Participants completed the PTSD Check-List for DSM-5, Peritraumatic Distress Inventory, and measures evaluating levels of exposure and stigmatization related to EVD. Descriptive analyses and a moderated mediation model were computed. RESULTS: A total of 58.81% participants (95% CI: 56.41%; 61.21%) met PTSD diagnostic criteria. Participants living in rural areas presented greater risk, while there is no significant difference between men and women. Peritraumatic distress mediated partially the association between exposure to EVD and PTSD symptoms. Moreover, this relationship was moderated by stigmatization related to EVD. LIMITATIONS: As the design was cross-sectional, this study could not examine the causality of PTSD symptoms among communities affected by EVD. CONCLUSIONS: This study shows high prevalence rates and important risk factors associated with PTSD in populations affected by EVD. It indicates elements that could help to develop and implement prevention and intervention programs in affected communities.

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.

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.