Long-term psychosocial sequelae of Ebola virus disease among survivors compared with contacts following the 2013–2016 epidemic in Liberia

TL;DR

Ebola survivors in Liberia experienced higher rates of anxiety, depression, PTSD, and food insecurity compared to uninfected contacts up to five years after the 2013–2016 epidemic.

Contribution

This study provides the first long-term comparative analysis of psychosocial outcomes between Ebola survivors and uninfected contacts in Liberia.

Findings

Ebola survivors had higher rates of anxiety, depression, PTSD, and food insecurity compared to contacts.

Survivors had a higher adjusted odds of severe anxiety, PTSD, and food insecurity symptoms.

Age, post-acute symptoms, and non-Ebola trauma were risk factors for psychosocial issues among survivors.

Abstract

Long-term psychosocial sequelae of Ebola virus disease (EVD) survivors are poorly understood. We conducted a cross-sectional study of a cohort of EVD survivors and their uninfected contacts in Liberia. Beginning in November 2019, we consecutively sampled eligible participants until the end of the parent study follow up. Enrolled participants completed a questionnaire administered by trained study staff. Outcome measurements were symptoms of depression (PHQ-8) and anxiety (GAD-7) as well as experiences of trauma (PC-PTSD-5), food insecurity (HFIAS), and social support (Duke-UNC SSQ). Excess prevalence was defined as the difference in prevalence between survivors and contacts. We performed adjusted analyses with logistic regression models and restricted to the survivor population for assessment of risk factors. Our analysis cohort included 1,144 participants among whom 363 were Ebola survivors and 781 were contacts. Participants were sampled a median of 55 months (IQR: 51, 60) after enrollment in the parent study. Excess prevalence was as follows: 7.9% had severe food insecurity by HFIAS (18.5% EVD survivors vs. 10.6% contacts), 6.2% had any anxiety symptoms by GAD-7 (11.6% EVD survivors vs. 5.4% contacts), 3.7% had any depression symptoms by PHQ-8 (8.3% EVD survivors vs. 4.6% contacts), and 3.2% had probable PTSD by PC-PTSD-5 (4.5% EVD survivors vs. 1.3% contacts). Levels of support were similar between survivors and contacts. EVD survivors had a higher adjusted odds of scoring in a more severe category on the GAD-7 scale (adjusted odds ratio [AOR]: 3.60; 95% CI: 1.42, 9.16), PC-PTSD-5 scale (AOR: 3.26; 95% CI: 1.40, 7.58), and HFIAS scale (AOR: 1.84; 95% CI: 1.29, 2.61). Age, history of post-acute symptoms, and non-Ebola related trauma were risk factors for multiple psychosocial outcomes among survivors. We found significant but modest evidence of psychosocial sequelae among EVD survivors compared with contacts between four to five years after the acute illness.

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