Academic journal article Bulletin of the World Health Organization

Psychosocial Effects of an Ebola Outbreak at Individual, Community and International levels/Effets Psychosociaux D'une Flambee De Maladie a Virus Eboia Aux Echelles Individuelle, Communautaire et internationale/Efectos Psicosociales De Un Brote De Ebola a Nivel Individual, Comunitario E Internacional

Academic journal article Bulletin of the World Health Organization

Psychosocial Effects of an Ebola Outbreak at Individual, Community and International levels/Effets Psychosociaux D'une Flambee De Maladie a Virus Eboia Aux Echelles Individuelle, Communautaire et internationale/Efectos Psicosociales De Un Brote De Ebola a Nivel Individual, Comunitario E Internacional

Article excerpt

Introduction

The 2013-2016 Ebola virus disease epidemic was the largest ever recorded with over 28000 cases and 11 000 deaths. (1) Guinea, Liberia and Sierra Leone experienced the most widespread transmission. It is essential that the global community is not complacent as continued efforts are needed to ensure that the virus transmission is controlled in the short term and that longer-term consequences of the epidemic are addressed.

A person infected with Ebola virus has well recognized signs and symptoms of fever, headache, joint and muscle pain, widespread bleeding, diarrhoea and other physical symptoms leading to high mortality. An Ebola epidemic does not only affect physical health, but also has psychosocial implications at individual, community and international levels, both acutely and in the long term (Table 1). Here we examine the psychosocial consequences of Ebola on these three levels.

Individual level

To understand the psychosocial effects of the Ebola epidemic at the individual level, we considered three groups: survivors, contacts and carers. (2)

Survivors

Ebola is a traumatic illness both in terms of symptom severity and mortality rates. Those affected are likely to experience psychological effects due to the traumatic course of the infection, fear of death and experience of witnessing others dying. (3) Survivors can also experience psychosocial consequences due to feelings of shame or guilt (e.g. from transmitting infection to others) and stigmatization or blame from their communities. (3-5) Some survivors were threatened, attacked, evicted, left behind by, or excluded from, their families and communities because they were seen as tainted and dangerous. Fear and stigma of Ebola are contributed to by cultural beliefs (e.g. being a bewitched disease with those affected at fault or deserving their illness), (6,7) widespread fears due to high infection risk, lack of information and misinformation.

Contacts

Contacts of those infected with Ebola also experience stigmatization and isolation. (3,6) Witnessing the traumatic course of the infection in others can result in fear and anxiety about falling ill or dying themselves, in addition to feelings of loss and grief from losing loved ones. (5)

Since Ebola is transmitted through contact with bodily fluids, loved ones are often separated from the sick upon showing symptoms and are unable to be with them as they suffer or die. This can increase feelings of grief, loss or distress and feelings of guilt or helplessness for being unable to comfort or care for loved ones. (5) In the authors' experiences, quarantining protocols to reduce Ebola transmissions also led to stigma and community isolation.

Since the infection can be transmitted after death, traditional mourning practices, which involve cleaning and touching dead bodies while preparing them for burial, are very risky. In many cases, bodies of the deceased are removed and buried by trained burial teams to prevent transmission, which might compound the loss experienced by loved ones, preventing traditional rites or coping processes for grieving, paying respects or gaining closure. These disruptions to traditional practices can result in feelings of resentment, anger or fear (e.g. beliefs about misfortune when not paying respect to the deceased) and can reduce access to community support usually associated with traditional mourning practices. Loss of support resources further limits ability to cope and increases distress. (5,8)

Carers

Those treating the sick (e.g. community or family carers, traditional healers and health workers) can also experience psychological effects. Witnessing the traumatic course of the infection and their patients' death puts carers at risk of poor psychological outcomes, including anxiety, depression and post-traumatic stress disorder. (2,3,9) Often, those assuming carer responsibilities are family members, particularly young people, who can experience increased anxiety, frustration and grief because of their relationship with the patient. …

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