Health-related quality of life among Ebola survivors in Sierra Leone: the role of socio-demographic, health-related and psycho-social factors

Abstract

Background Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone. Methods We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression. Results When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (β = − 3.90, 95% CI − 6.47 to − 1.32, p = 0.003), had no formal education (β = − 2.80, 95% CI − 5.16 to − 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (β = − 1.08, 95% CI − 1.74 to − 0.43, p < 0.001) and experienced a unit increase in enacted stigma (β = − 2.61, 95% CI − 4.02 to − 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (β = − 0.60, 95% CI − 0.103 to − 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (β = − 1.50, 95% CI − 2.67 to − 0.33, p = 0.012). Conclusion Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs.

The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone

“…Furthermore, EVD survivors with a unit increase in the time spent in the ETC were likely to report a decrease in mental health. 30 Our results agreed with these findings demonstrating that a prolonged duration of acute EVD increased the likelihood of experiencing PTSD. Other risk factors for anxiety depression and PTSD include experience of perceptions of others, mortality, socioeconomic insecurities, stigma and discrimination, all may have been experienced in Sierra Leone by EVD survivors.…”

“…11 EVD survivors who experienced a unit increase in Enacted Stigma were more likely to report a decreased level of mental health. 30 We demonstrated in our results that stigma is significantly associated with experiencing PTSD, with a more detailed analysis on this topic available in Schindell et al 14 EVD survivors continue to suffer from psychological distress due to grief resulting from losing loved ones, social exclusion and community stigmatisation. 31 32 Limitations have led to survivors being unemployed, leading to dependence on others and a loss of self-worth particularly among those with advanced age.…”

Health-related quality of life in persons post-COVID-19 infection in comparison to normative controls and chronic pain patients

“…Health-related quality of life (HRQoL) is a patient-centered outcome to evaluate a person's overall physical, emotional and social wellbeing in one outcome measure ( 10 , 11 ). In populations with persisting problems, among which survivors of infectious diseases, a decreased HRQoL is often reported ( 12 – 14 ). Persons with persisting pain for several months [i.e., the presence of chronic pain ( 15 )], such as patients with chronic low back and leg pain or patients with fibromyalgia, also suffer from a poor HRQoL ( 16 , 17 ).…”

Social distancing, community stigma, and implications for psychological distress in the aftermath of Ebola virus disease

“…EVD survivors also experience stigma when returning to their communities, manifesting as social avoidance, lost jobs and housing, destruction of personal belongings, and interpersonal violence [ 21 ], verbal abuse and healthcare neglect [ 22 ]. Stigma from having survived EVD has been associated with decreased mental and physical quality of life [ 23 ].…”