Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone.
Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone.
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DOI：
10.1371/journal.pmed.1002073
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发表时间：
2016-08
期刊：
影响因子：
15.8
通讯作者：
Pham P
中科院分区：
文献类型：
--
作者：
Betancourt TS;Brennan RT;Vinck P;VanderWeele TJ;Spencer-Walters D;Jeong J;Akinsulure-Smith AM;Pham P
很少有人关注心理健康，创伤和个人暴露于埃博拉病毒病（EVD）和冲突后西非的健康行为之间的潜在关系。我们测试了一个将心理健康和创伤与EVD风险行为和EVD预防行为联系起来的概念模型。利用塞拉利昂西部城市和西部农村地区代表性样本的调查数据，本研究探讨了战争暴露、创伤后应激障碍（PTSD）症状、抑郁、焦虑和个人EVD暴露（例如，在EVD流行高峰期（2015年1月至4月）随机抽样的西部农村和西部城市地区63个人口普查点查地区的1，008名成年人（98%应答率）中进行EVD相关健康行为的调查。主要结局为EVD危险行为（14项，Cronbach α = 0.84）和EVD预防行为（16项，Cronbach α = 0.88）。主要预测因子为战争暴露（8项，Cronbach's α = 0.85）、焦虑（10项，Cronbach's α = 0.93）、抑郁（15项，Cronbach's α = 0.91）和PTSD症状（16项，Cronbach's α = 0.93）。使用两水平、群体加权分层线性模型分析数据，其中有20个多重插补数据集。EVD危险行为与抑郁症状的强度相关（B = 0.05; 95% CI 0.00，0.10; p = 0.037），PTSD症状（B = 0.10; 95%CI 0.03，0.17; p = 0.008），有朋友被诊断出患有EVD（B = −0.04; 95% CI −0.08，−0.00; p = 0.036）和战争暴露（B = −0.09; 95% CI −0.17，−0.02; p = 0.013）。EVD预防行为与较高的焦虑相关（B = 0.23; 95% CI 0.06，0.40; p = 0.008），有一位朋友被诊断为EVD（B = 0.15; 95% CI 0.04，0.27; p = 0.011）和较高水平的战争暴露（B = 0.45; 95% CI 0.16，0.74; p = 0.003），与心理健康无关。PTSD症状与EVD预防行为水平较低相关（B = −0.24; 95% CI −0.43，−0.06; p = 0.009）。在冲突后环境中，过去的战争创伤和心理健康问题与与抗击EVD相关的健康行为有关。战争创伤与EVD风险行为和EVD预防行为之间的关联可能通过两个关键的心理健康变量介导：抑郁和PTSD症状。考虑心理健康在预防疾病传播中的作用可能有助于对抗冲突后塞拉利昂持续和未来的埃博拉疫情。这一样本仅限于弗里敦和西部地区，可能不能代表塞拉利昂全国。此外，我们的主要结果以及个人EVD暴露，战争暴露和心理健康预测因素依赖于自我报告，因此提高了常见方法偏倚的可能性。然而，这项研究的结果可能与了解西非EVD影响国家其他主要首都城市EVD和心理健康相关的动态有关。Theresa Betancourt及其同事研究了冲突后塞拉利昂心理健康与埃博拉相关健康行为之间的关联。很少有人关注心理健康，创伤，个人暴露于埃博拉病毒病（EVD）与冲突后西非的健康行为之间的关系。这项研究旨在测试心理健康与创伤以及与EVD相关的健康行为之间的联系-增加EVD传播风险的行为和有助于预防EVD传播的行为。在EVD流行高峰期（2015年1月至4月），从塞拉利昂西部农村和西部城市地区的63个人口普查点随机选择了1，008名成年人进行了调查，以检查战争暴露，创伤后应激障碍（PTSD）症状，抑郁，焦虑，EVD个人暴露和EVD相关健康行为之间的关系。报告抑郁症状强度较大和PTSD症状发生率较高的个体也报告了增加EVD传播风险的行为发生率较高，而报告先前暴露于战争或有朋友被诊断患有EVD的个体报告了此类行为的发生率较低。报告焦虑水平较高的人，有一个朋友被诊断患有EVD，以及以前更多地暴露于战争（考虑到他们的心理健康状况），报告有助于防止EVD传播的行为增加，而报告PTSD率较高的人报告此类行为的发生率较低。这些发现表明，在最近有战争或冲突历史的地区，过去的战争创伤和某些心理健康问题与阻止EVD传播的重要健康行为有关。考虑到心理健康，特别是抑郁症和创伤后应激障碍在预防疾病传播中的作用，可能有助于对抗塞拉利昂正在发生和未来的埃博拉疫情。虽然这项研究是针对塞拉利昂西部地区的，但它对受冲突和埃博拉病毒病影响的西非国家具有重要意义。
Little attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors. Using survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January–April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach’s α = 0.84) and EVD prevention behaviors (16 items, Cronbach’s α = 0.88). Main predictors comprised war exposures (8 items, Cronbach’s α = 0.85), anxiety (10 items, Cronbach’s α = 0.93), depression (15 items, Cronbach’s α = 0.91), and PTSD symptoms (16 items, Cronbach’s α = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = −0.04; 95% CI −0.08, −0.00; p = 0.036), and war exposures (b = −0.09; 95% CI −0.17, −0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = −0.24; 95% CI −0.43, −0.06; p = 0.009). In post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa. Theresa Betancourt and colleagues examine the associations between mental health and Ebola-related health behaviors in post-conflict Sierra Leone. Little attention has been paid to how mental health, trauma, personal exposures to Ebola virus disease (EVD) relate to health behaviors in post-conflict West Africa. This study was done to test the links between mental health and trauma and health behaviors related to EVD—behaviors that increase the risk of spreading EVD and behaviors that help to prevent the spread of EVD. At the height of the EVD epidemic (January–April 2015), 1,008 adults selected at random from 63 census enumeration areas in the Western Rural and Western Urban districts of Sierra Leone were surveyed to examine the relationships between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, personal exposure to EVD, and EVD-related health behaviors. Individuals reporting greater intensity of depression symptoms and higher rates of PTSD symptoms also reported higher rates of behaviors that increase the risk of spreading EVD, while individuals reporting previous exposure to war or having a friend diagnosed with EVD reported lower rates of such behaviors. Individuals reporting higher levels of anxiety, having a friend diagnosed with EVD, and greater previous exposure to war (taking into account their mental health status) reported increased rates of behaviors that help to prevent the spread of EVD, while individuals reporting higher rates of PTSD reported lower rates of such behaviors. These findings suggest that in areas with a recent history of war or conflict, past war trauma and certain mental health problems are linked with health behaviors that are important in stopping the spread of EVD. Considering the role of mental health, in particular depression and PTSD, in preventing the spread of disease may help fight ongoing and future Ebola outbreaks in Sierra Leone. While this study is specific to the Western Area of Sierra Leone, its implications are important for countries in West Africa affected by conflict and EVD.