TY - JOUR
T1 - Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo
AU - Lieberman Lawry, Lynn
AU - Stroupe Kannappan, Nancy
AU - Canteli, Covadonga
AU - Clemmer, William
N1 - Publisher Copyright:
©
PY - 2022/2/2
Y1 - 2022/2/2
N2 - Objectives To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use. Design Cross-sectional study. Setting Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC). Participants 223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents. Primary and secondary outcome measures Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour. Results Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors. Conclusions The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.
AB - Objectives To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use. Design Cross-sectional study. Setting Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC). Participants 223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents. Primary and secondary outcome measures Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour. Results Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors. Conclusions The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.
KW - epidemiology
KW - infectious diseases
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85124058652&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-052306
DO - 10.1136/bmjopen-2021-052306
M3 - Article
C2 - 35110316
AN - SCOPUS:85124058652
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 2
M1 - e050731
ER -