Psychological Distress among Ebola Survivors Discharged from an Ebola Treatment Unit in Monrovia, Liberia - A Qualitative Study.
Psychological Distress among Ebola Survivors Discharged from an Ebola Treatment Unit in Monrovia, Liberia - A Qualitative Study.
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DOI：
10.3389/fpubh.2016.00142
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发表时间：
2016
影响因子：
5.2
通讯作者：
Severy N
中科院分区：
文献类型：
--
作者：
Rabelo I;Lee V;Fallah MP;Massaquoi M;Evlampidou I;Crestani R;Decroo T;Van den Bergh R;Severy N
2014-2015年西非埃博拉疫情爆发的一个后果是，从埃博拉治疗单位出院的埃博拉幸存者人数达到了前所未有的水平。仅利比里亚一国就有5000多名幸存者。我们在蒙罗维亚进行了一项定性研究，以更好地了解幸存者在住院和重新融入社区期间所经历的精神痛苦。来自利比里亚最大的ETU ELWA3的特意挑选的埃博拉幸存者被邀请参加焦点小组讨论。寻求口头知情同意。在2015年2月至4月期间进行了三个重点小组，共有17人参加。采用主题分析的方法对数据进行分析。ETU内部的主要压力来源是每天接触身体，通常在活人中停留数小时；患者与家人隔离和对他们的福祉的担忧；有时是ETU工作人员对他们不尊重的感觉。然而，大多数幸存者报告了工作人员如何激励患者喝水、吃饭、洗澡和走路。此外，雇用幸存者作为工作人员培养了希望，叫病人的名字增加了信心和熟悉度，组织祈祷和唱歌活动带来了安慰。当埃博拉病毒幸存者回国时，活着的经历既是一份礼物，也是一种负担。倒叙在幸存者中很常见。许多人被认为具有传染性，被排除在家庭、职业和社交生活之外。一些幸存者面临离婚，被赶出家门，或失去工作。随后的隔离使幸存者无法恢复日常生活，多重损失影响了他们的应对机制。然而，如果可以，家人、朋友和祈祷的支持使幸存者能够应对他们的精神痛苦。对于那些被排除在社会之外的人来说，心理社会咨询和幸存者网络是赋予后埃博拉时代生活意义的方式。暴露在ETU的死亡和社区的耻辱导致了埃博拉幸存者的创伤后应激反应和抑郁症状。通过及时处理身体，可以减少ETU的痛苦。可以通过信任关系、宗教、同伴/社区支持和基于社区的心理社会护理来加强应对机制。精神健康障碍需要通过适当的专门护理和后续行动加以解决。
A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community. Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data. The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients’ isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor’s network were ways to give a meaning to life post-Ebola. Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.