Mixed-methods assessment of health and mental health characteristics and barriers to healthcare for Ebola survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

Abstract

Objectives: Health and mental health characteristics of all respondents, barriers to accessing health and mental health services and the characteristics and those most at risk for mental health disorders.

Setting: Beni, Butembo and Katwa health zones in the Democratic Republic of Congo.

Participants: The sample contained 223 Ebola survivors, 102 sexual partners and 74 comparison respondents living in the same areas of the survivors. Survivors were eligible if aged >18 years with confirmed Ebola-free status. The comparison group was neither a survivor nor a partner of a survivor and did not have any household members who contracted Ebola virus disease (EVD).

Primary and secondary outcome measures: Health and mental health characteristics, barriers to care and the association of association of mental health disorders with study population characteristics.

Results: Funding was a barrier to accessing needed health services among all groups. Nearly one-third (28.4%, 95% CI 18.0% to 38.7%) of comparison households avoided getting injections for their children. Although most pregnant women were attending antenatal care, less than 40% of respondents stated EVD precautions were discussed at those visits. Trouble sleeping and anger were the strongest predictors of post-traumatic stress disorder, major depressive disorder (MDD), anxiety and suicide attempts with 3-fold to 16-fold increases in the odds of these disorders. There was a 71% decrease in the odds of MDD if current substance abuse (aOR 0.29; 95% CI 0.13 to 0.67; p<0.01) was reported.

Conclusions: Specialised mental health services were limited. Fear of contracting EVD influenced vaccine compliance. Anger and sleep disorders significantly increased the odds of mental health disorders across all groups. Respondents may be using substance abuse as self-medication for MDD. Ebola outbreak areas would benefit from improved screening of mental health disorders and associated conditions like anger and sleep difficulties and improved mental health services that include substance abuse prevention and treatment.

Keywords: anxiety disorders; epidemiology; public health.