Effectiveness of small group cognitive behavioural therapy for anxiety and depression in Ebola treatment centre staff in Sierra Leone

Abstract

Background: Following the 2014 Ebola outbreak, South London and Maudsley NHS Foundation Trust (SLAM) were commissioned to provide a "culturally appropriate, effective and sustainable" intervention to address the psychological needs of the Sierra Leonean Ebola Treatment Centre (ETC) staff. Aims:The study evaluated the effectiveness of group Cognitive Behavioural Therapy (CBT) developed to treat anxiety, depression and functional impairment amongst a sample of former ETC staff in Sierra Leone. Group comparisons explored whether the effect of the intervention differed dependent on the facilitators that delivered it, as well as whether it differed between former staff of high-and low-risk ETC roles.Methods: A sample of 253 former ETC staff attended the group CBT intervention comprised of eight sessions over six weeks. Outcome measures were administered upon entry and within two weeks after the intervention.Results: At post-intervention, anxiety, depression and functional impairment significantly reduced.Reading ability (RA) was introduced as a covariate having impacted the outcomes. The intervention effect differed by facilitators delivering the sessions but not by ETC role risk. The implications of these results are discussed.Conclusions: Group CBT is a promising psychological intervention for treating the anxiety, depression and functional impairment of former ETC staff in Sierra Leone. Furthermore, as part of a stepped-care approach, it may provide a model for psychological support for staff that have worked on the frontline during future epidemics.

Mental health interventions and supports during COVID- 19 and other medical pandemics: A rapid systematic review of the evidence

“…Implementation of existing or new training programs/guidelines/system-level protocols? Study Pandemic Country Design & type of sample Assessment methods Participants Intervention/support (components/details) Psychosocial/mental health measures (outcomes) Findings Quality rating Chen et al [ 22 ] SARS Taiwan Longitudinal (4 time points) Convenience sample: Volunteers from nursing staff of largest obligatory SARS hospital Self-reported questionnaires completed pre-care delivery, 2 weeks and 1 months after start of care, 1 month after, and 1 month post-return to normal hospital functioning 116 nurses from designated SARS treatment hospital SARS prevention program (program content based on WHO and CDC epidemic prevention information to develop hospital protocols and standards for space, staff, and environment) SAS, SDS, PSQI Improvement in anxiety and depressive symptoms from baseline to time 4; no improvement in sleep quality 74 Cole et al [ 25 ] Ebola Sierra Leone Pre-post Convenience sample: Phase 3 participants (see Waterman et al [ 20 ]) Self-completed outcome measures (with facilitator assistance available) at 1-week pre-intervention and within 2 weeks post-intervention 253 Ebola treatment clinic staff enrolled in Phase 3 8 CBT group sessions over 6 weeks focusing on depression and anxiety GAD-7, PHQ9, WSAS Improvements in anxiety, depression, and functional impairment scores; results tempered by respondents' reading ability, geographic location, and facilitator characteristics 77 Geoffroy et al [ 31 ] COVID-19 France Cross sectional Convenience sample; all hospital workers in regional group of 39 hospitals eligible Data collected at time of call to hotline (over 26 days) 149 hotline calls Hotline volunteers providing rapid assessment, crisis resolution, referrals to other services as needed Date/time of call; sociodemographic, professional, and hospital department characteristic; psychiatric history and reason for call Rapidly developed (3-day) hotline-based support program demonstrated accessibility, spread (many professions, many hospital departments); numbers of referrals reported 89 Horn et al [ 29 ] Ebola Sierra Leone, Liberia ...…”

“…All of the studies described the emotional stress that health professionals [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ], non-specialists working in health care [ [29] , [30] , [31] ], patients [ [32] , [33] , [34] , [35] ], children [ 36 ], and members of the general public experience during a medical pandemic [ 37 , 38 , 39 ]. The first cases of a novel disease to emerge spark fear among health professionals and non-specialists working in health care because little or nothing is known about the disease or how it is transmitted [ 19 , [22] , [23] , [24] , 37 ].…”

Adapting IAPT services to support frontline NHS staff during the Covid-19 pandemic: the Homerton Covid Psychological Support (HCPS) pathway

“…Amongst those who took part in all phases of EPSS, improvement was observed on all measures of mental health difficulties included (standardised and bespoke). A group CBT anxiety and depression intervention for staff, resembling a low-intensity IAPT group, was also found to be effective for frontline staff as a standalone (Cole et al, 2020). It is important to note that all EPSS interventions and materials were based on those already delivered in IAPT services, i.e.…”

“…Phase 2 consists of CBT-based interventions, which can be facilitated in a group format by a practitioner through video-conference technologies or at Homerton Hospital following social distancing measures. These sessions would cover the same topics as the EPSS: 'simple coping strategies based on behavioural and cognitive approaches that staff could use as self-help' (Cole et al, 2020;Waterman et al, 2018). Difficulties addressed include stress, anxiety, unhelpful coping, bereavement and grief, low mood and sleep problems.…”

“…• For an example of a CBT-orientated service for frontline disease outbreak staff, see the papers evaluating the Ebola Psychological Support Service (Cole et al, 2020;Waterman et al, 2018;Waterman et al, 2019).…”