Ebola virus disease (EVD) (previously known as Ebola haemorrhagic fever) causes a serious, acute illness which is often fatal if untreated.

1. 1
Emergency settings and the need to provide accompaniment for Ebola
survivors: the psychological care of patients following Ebola virus disease
infection and patients affected psychologically by the epidemic in Conakry
Keita MM1, Doukouré M1,Chantereau I2, and al
1-Service de psychiatrie de l’hôpital national Donka (Conakry – Guinée)
2-Centre Hospitalier de Saint-Cyr-au-Mont-d’Or (Rhône – France)
Abstract
The aim of this study was to report the psycho-social experience of patients having recovered
from Ebola virus infection and other persons affected by it psychologically in Conakry (Guinea),
and to describe the psychological methods implemented for their care.
Materials and methods
The study was prospective, cross-sectional and descriptive, and lasted three months in the
epidemic crisis period. It concerned patients who had been infected and had recovered, and
patients affected psychologically by Ebola, seen in the psychiatric department of Donka national
hospital for psychological support on request from the NGO Save the Children. The patients were
seen between May and August 2014 and divided into different groups. The interviews were
confidential, and under the responsibility of two psychiatrists and psychotherapists.
All patients gave their informed consent to take part in the study. For children, parental or legal
representative consent was sought.
Results
Between May 30th
and 9th
August 2014, sixty-eight (68) patents were seen in the psychiatric
department of Donka national hospital for psychological support. Among them, there were 37
Ebola virus-infected subjects reported cured, 17 contact subjects, and 14 non-contact subjects but
presenting psychological trauma. The fear of falling ill and dying, anxiety, insomnia, mistrust or
avoidance, feelings of rejection, withdrawal, hospitalism for the orphans, and loss of interest in
usual activities (anhedonia) were the main psychological problems presented by these patients as
a whole. Three of the patients in the overall cohort, or 4.41%, presented a state of post-traumatic
stress, and seven (10.9%) presented moderate depression without psychotic symptoms.
In the social sphere, 37 patients (54%) experienced rejection and stigmatisation by their
community and/or professional entourage.
Psychological debriefing, followed by supportive psychotherapy and cognitive-behavioural
therapy, with use of antidepressants in some cases, were the therapeutic means deployed. Advice
on individual and collective hygiene was provided for all subjects in a prevention drive.
Once the patients had regained confidence, they joined a NGO to back up monitoring and
awareness-raising teams in the districts of Conakry and across the country.
Conclusion
Patients who have had Ebola virus infection and have recovered, like those affected in other ways
by the epidemic, undergo genuine psychological trauma. The provision of psychological support
efficiently alleviated the psychological suffering of these individuals and contributed to their social
and professional rehabilitation. A further, wider study on victims of Ebola could enable a clearer
understanding of the psychological disruption occasioned, so as to improve psychotherapeutic
care.
The psychological accompaniment of survivors should be a healthcare priority.
Keywords: psychological support, persons infected/cured, persons affected, Ebola, Guinea-
Conakry, outbreak, trauma care, mental health, viral diseases

2. 2
INTRODUCTION
Ebola virus disease (EVD) (previously known as Ebola haemorrhagic fever) causes a serious, acute
illness which is often fatal if untreated. Infected subjects remain contagious so long as the virus is
present in their blood and other biological fluids, including sperm and maternal milk. Sperm can
continue to transmit the virus for as long as seven weeks after clinical recovery. The mean fatality
rate is around 50%. In earlier outbreaks of the disease it ranged from 25% to 90% [1,2].
The EVD epidemic in West Africa started in Guinea in December 2013, but was only notified on
March 21st
2014, before extending to neighbouring countries (Liberia, Sierra Leone). The epidemic,
caused by the Zaire strain of the virus, is thought to have caused the largest number of deaths
since the discovery of the first cases in 1976 in the Congo. The Ebola river, located near the
Congolese village of Yambuku where the virus was discovered, gave it its name [3].
The most seriously affected countries (Guinea, Sierra Leone and Liberia) have very vulnerable
health systems, they lack human resources and infrastructures, and have only just emerged from
long periods of conflict and socio-political unrest.
On August 8th
2014 the general director of WHO declared that the epidemic was a public health
emergency on international scale, and that there was currently no recognised vaccine or
treatment against Ebola. Since then, pharmaceutical laboratories in the ISA, such as Mapp
Biophamaceutical, have developed ZMAPP, a vaccine that proved successful in the treatment of
two American aid workers, Kent Bradley and Nancy Writebol, who contracted the virus in Liberia
[4].
This first announcement by WHO, relayed on national radio, television, in the press and by the
health authorities, caused panic in the Guinean population, for whom Ebola was synonymous with
death, despite the fact that the Guinean government and WHO had already launched a first round
of clinical trials on the vaccine VSV-EBOV, developed by the public health Agency in Canada.
Around 10 000 volunteers were included in these trials extending over a period of six to eight
weeks, with a planned follow-up of three months. Preliminary results were expected for July 2015
[4].
These initial announcements fed nightmare rumours creating almost permanent general anxiety in
the population, amounting to mass panic. People who were considered cured were heroes for
some, or walking dead for others, already mourned by their families and friends. This generated
mistrust, rejection and stigmatisation of convalescent patients by their families and sometimes
their professional environments.
In 2007, the Republic of Uganda saw an Ebola epidemic of the Bundibugyo type, with 187 cases of
infection and 25% fatalities.
In the same year, the Congo Democratic Republic saw an outbreak of the Zaire strain infecting 264
people with 71% fatalities.
In 2012, an Ebola epidemic of the Bundibugyo type broke out in the Congo Democratic Republic
with 57 cases and 27 deaths, amounting to 29% fatalities.

3. 3
In Guinea, the absence of earlier studies on the psychological care of survivors of Ebola
haemorrhagic fever motivated the choice of the present study theme: the psychological care of
patients following Ebola virus disease infection and patients affected psychologically by the
epidemic in Conakry.
The aims of this work were as follows :
1- to report on the psychological experiences of individuals infected and subsequently cured,
and of other individuals affected psychologically by the epidemic in Conakry
2- to anticipate the appearance (several weeks or months later) of post-traumatic stress
syndrome
3- to facilitate social and professional rehabilitation
4- to describe the psychological techniques implemented, enabling patients to put their distress
into words.
I. BACKGROUND
Setting :
Guinea is on the western coastline of Africa. The population in 2012 numbered 11 663 627
inhabitants, amounting to a density of 47 individuals per square kilometre.
The EVD outbreak in Guinea occurred in the setting of a weak health system, characterised by the
inadequacy of infrastructures and health facilities.
This latest outbreak in West Africa, where the first cases were notified in March 2014 in Guinea, is
the largest and most complex since the virus was discovered in 1976. It has caused more deaths
that all the other outbreaks combined.
The EVD epidemic overturned the cultural and social codes of these West African countries, where
families could no longer bury their dead according to traditional rites, since the bodies were highly
contagious. This generated considerable hostility in the population towards expatriate or local aid
workers in the treatment centres. Generally speaking, relations with the local communities were
more complicated in the setting of Ebola than in other intervention fields.
The psycho-traumatic impact of EVD :
A traumatic event can involve a single situation, or several prolonged, repeated events, and it can
completely overwhelm an individual's ability to integrate the ideas and emotions generated by
that experience. Mental trauma can have serious negative consequences in the long term [7].
The EVD epidemic had considerable impact on the well-being of the individuals concerned, on
that of their families, and that of the healthcare staff in charge of treating Ebola patients. The
disease generates specific problems for people involved (for instance stigmatisation, isolation, fear
and possible abandonment by family) and for healthcare staff and other professionals (for
instance personal safety and access to updated information) [8].

4. 4
It can also be recalled that Ebola has an effect on ways in which people provide support for one
anther (for instance they cannot touch each other), and on the way in which the death of persons
close is met (for instance, they can no longer attend traditional burials), all of which can seriously
aggravate the psychological distress of some individuals.
In our care system, different professionals intervene with a patient to help him or her to overcome
the different aspects of the trauma (medical, psychological, legal etc): medical specialists (most
often psychiatrists) psychologists, legal advisers, social workers. Patient management can be
coordinated with support groups.
The EVD epidemic is an event that generates stress, and has specific features and specific care
requirements. Event-related stress constitutes a single trauma that is limited in time. It is unlikely
to occur again. Yet it is the fear of relapse that dominates, the fear of a recurrence, in particular
because the event originally occurred in accidental manner. Specific care for this type of stress is
clearly codified, involving in particular well-tested psychological support frameworks.
The psychological intervention
There are three types of intervention :
• Intervention of a preventive type following a potentially traumatic incident. It is sometimes
necessary to intervene promptly to avoid the development of traumatic neurosis (Post-Traumatic
Stress Disorder, PTSD in the DSM), characterised by symptoms linked to the psychological shock,
which may become chronic. Here the technique used is known as "debriefing", which mainly aims
to alleviate anxiety and stress, and to enable an individual subjected to a potentially stressful
event, liable to exhibit delayed psychopathological reactions, to find his or her identity and place
in reality. To be represented, emotion needs to carry meaning, which is deployed in a narrative
delivered to or by another person. The use of debriefing sometimes runs alongside subsequent,
more in-depth curative treatment. Debriefing is a therapeutic interview technique implemented
within a certain time-lapse after the traumatic event – 24 to 72 hours or more for type 1 trauma
(single event) and up to several years after type 2 trauma (numerous or repeated events, as is the
case in ill-treatment) [17]. Psychological debriefing is used for willing subjects, in groups or
individually, following a traumatic event.
• Intervention intended to manage stress. There are different therapeutic stress-management
techniques that enable the subject to achieve better control. This type of debriefing is sometimes
accompanied by controlled breathing aiming to have an effect on the sympathetic and
parasympathetic system, relaxation techniques, meditation, etc.
• Intervention of the curative type. Here mainly behavioural-cognitive therapies (CBT) are
implemented. We can also recall the use of hypnosis, which is unfortunately often not easy to use.
Pain control and the treatment of anxiety are particularly important, and all patients should
receive careful follow-up and psychological support [8].
II. METHODS
This study was prospective, cross-sectional and descriptive, and lasted three months. It involved
patients who had been infected and subsequently cured in the Ebola treatment centre, and

5. 5
patients psychologically affected by EVD, seen in the Donka national hospital psychiatry
department for psychological support on request from the NGO Save the Children. All gave their
informed consent to participate, and for children consent was obtained from the parents or legal
representatives.
Patients were seen in successive periods and divided into groups. The premises provided several
interview rooms. Interviews were confidential and under the responsibility of two
psychiatrists/psychotherapists. Children of 2 to 11 years were catered for by the department's
paediatric psychiatrist, and were able to express themselves by way of drawings and other
techniques suited to the age group.
Preventive psychological debriefing coupled with supportive psychotherapy and cognitive-
behavioural therapy for some, and/or curative therapy, were the methods deployed. Individual
and collective hygiene advice (chlorine, soap) was also given to all patients.
III. RESULTS
Cf. Appendix Tables
IV. DISCUSSION
In Guinea, from the moment when the EVD epidemic was reported in March 2014 and June 2nd
2014, the national crisis committee registered 199 confirmed cases and 118 deaths amounting to
59% fatalities, leaving 81 Ebola survivors or cured patients.
This situation calls for awareness-raising backed up by clear scientific information to efficiently
combat rumours on the subject of EVD. And above all, the direct and indirect victims of EVD alike
need psychological support. The illness has been a genuine psychological trauma, with its
aftermath of psychological distress and stigmatisation.
In Conakry, and even more in rural areas, people mistrust everything and everyone. Official
announcements are ignored. The wildest rumours spread, even faster than the virus – on the
origins of the disease, how it is transmitted, treatments, the way funds are used - everything is
suspect. The idea that Ebola is a disease created and propagated by white people is widespread
and resilient. Even in the city, there is talk of the "Ebola business" supposedly run by whites.
Communities have of course hidden their patients, because of the general mistrust, and because
people do not want to be quarantined and thus to lose their meagre livelihoods. And there is also
the conviction that, in all events, medicine is powerless [9].
In Africa, heads of families often have 5 to 15 mouths to feed, with a large proportion of cousins
and nephews enlisted in schools. In addition, corpses are venerated, and should receive all the
rites of the community to avoid punishment by the spirits of the ancestors for animists, or by God
for believers. Ebola corpses are not allowed these rites.
Orphans and widows are particularly vulnerable, and are generally a focus of attention in
traditional African communities in terms of psychological and material support. Previously, a
motherless orphan was entrusted to a maternal female figure, either the grandmother, or another
woman in the community recognised as being attentive to the child's care. A widow was remarried
in her dead husband's family to one of her brothers-in-law, or another man of her choice in the

6. 6
community, who then took charge of her with her children after a traditional period of
widowhood of four months and ten days among Moslems (to allow for a pregnancy, in which case
she would wait for the child to be born to remarry). Widowers were rapidly provided with a wife
of their choice "to dry his tears and care for the orphans". But Ebola, known for its virulence and
high fatality rate, disrupted all these social traditions, complicating the maternal care of orphans
and remarriage among widows and widowers.
The NGO Save the Children was only able to access 68 of the 81 survivors for psychological
assistance, i.e. 45.67%.
Our work concerned the 54% who agreed to meet a psychologist. Their first common reaction was
to thank God/Allah for having escaped death, after having been close to dying and then being
cured, and also to thank all the staff.
The fact that other survivors did not respond to the offer can be explained by the fact that certain
cured patients, labouring under the psychological distress caused by the illness and rumours,
continued to seek care from traditional medicine and/or marabouts, since the first messages
circulated by the health authorities stated that there was no cure for Ebola ("no treatment or
vaccine available to date"). This information did not encourage patients to resort to modern
medicine. If there is no cure, why should the illness be reported? Better to trust traditional
medicine and practitioners – salt water, coconut oil or lemons were thought to provide a cure.
Thus certain patients escaped from the confinement centres to consult traditional practitioners. It
is particularly important in this country to die near one's family, and also to abide by funeral rites
[8].
Contact patients (25%) and non-contact patients, i.e. including widow(er)s and orphans (21%)
were affected in different manners. However one point in common was the stigmatisation by their
entourage for fear of contamination, as well as insomnia, grief for the death of someone close,
and fear of divine punishment for failure to follow traditional mourning rituals.
Male gender. Males were more frequently affected in our cohort as a whole – 60.29% vs 39.7%
females, a gender-ration of 1.51.
In African tradition, men are on the front line in difficult situations, such as the care of an Ebola
patient because they are thought to stand up to adverse events better than women. This could
explain the difference.
The age group most frequently affected in the cohort was the 22-32 age group (young working
adults) with 38.23%. This figure is in line with WHO data.
The 17 Ebola contacts affected by the death of family members (25% of the overall sample) had
not contracted the disease but were afflicted by the sudden loss of loved ones, most often the
mother or the father or another resource person in the family. These families experienced
between 2 and 7 deaths among their members. It is easy to see that premature death amounts to
a family tragedy.

7. 7
The 14 patients who were not contacts also sustained psychological trauma. They were not with
their families at the time of their illness, and only returned after their deaths and the 21 days
quarantine imposed by the Red Cross.
Among these contact and non-contact patients there were 14 orphans (45.16%), 8 widows (25.8%)
and 9 widowers (29.03%).
When age groups are crossed with the psychological symptoms observed, orphans between 2 and
12 years of age were the most affected, at 28.57% of the 14 cases for whom the symptoms were
the most pronounced (wanting to see their mother, despair, crying, isolation and rejection,
irritability, disobedience, fear of contracting the disease, anxiety, insomnia, nightmares, difficulty
concentrating, feelings of abandonment, loss of interest in play, anorexia, lack of implication in
school).
Only one orphan aged five with good family support (grandmother providing maternal care)
presented no particular symptom.
The distribution of patients according to the psychopathological problems encountered showed a
clear predominance of acute stress (54%). This clinical characteristic features the fear of falling ill,
virtually permanent anxiety, insomnia alternating with nightmares, stigmatisation by the
entourage, feelings of rejection and shame.
In popular culture, Ebola is synonymous with death because of its virulence, the fatality rate and
its "spectacular" symptoms. The Ebola virus has become one of the most dreaded incarnations of
biological threat [4].
In our study, the Ebola victims were seen 3 to 5 months after being cured, but they were also
psychologically traumatised by deaths in their families. The psychological debriefing was essential
to enable them to put words on their suffering.
The patients were first subjected to debriefing and then received support psychotherapy. These
techniques enabled them to overcome the huge emotion and the rumours, and to reposition
themselves with respect to the future.
However 30.88% of our patients had good family support, and normal sleep and appetite, despite
mild anxiety. After debriefing and group therapy, the pursuit of personal and collective hygiene
was recommended.
Moderate depressive syndromes without psychotic symptoms were diagnosed for 10.29% of our
patients. This group also received debriefing followed by support psychotherapy, along with clear,
updated scientific information on the disease, restoring their confidence in themselves and their
environment. Appointments were made for subsequent encounters.
Post-Traumatic Stress (PTSD in DSM-IV-TR) was diagnosed for 4.46% of our patients. These
patients, seen 5 months after the event, presented a characteristic clinical profile with specific
symptoms such as reliving (flash-back) – the repetition of hallucinatory images of dying parents,
groaning in their blood and uttering their last words (my son, my dear wife... it's over, I cannot go
on, take care of your brothers, our family..." etc. Here the visions occurred several times a day.

8. 8
Avoidance of hospital and fear of white coats (recalling the protective clothing of healthcare staff)
were reported by our patients. This was accompanied by other major symptoms such as
nightmares, insomnia, fear of (re)contracting Ebola, anxiety, starts at the slightest sound of
ambulance sirens and mistrust of the entourage for fear of rejection. Subjects declared cured were
heroes for some, but living dead for others already mourning for them. This also engenders
mistrust, rejection and stigmatisation of convalescent subjects by their entourage or community.
This last group of patients (PTSD) particularly drew our attention on account of the severity of
their symptoms. They underwent collective debriefing to de-dramatise the situation. Each person,
hearing other people's narrative, understands that he or she is not the only one undergoing the
consequences of the trauma. Support psychotherapy and cognitive behavioural therapy sessions
were organised. Two patients in this group were prescribed antidepressants of the SSRI type
(Paroxetine) which proved efficacious after three weeks, and follow-up was to be pursued for six
months. Child orphans were followed by the department paediatric psychiatrist.
Results of psychological follow-up among recovered Ebola-infected subjects and subjects
otherwise affected by the epidemic
Psychological debriefing coupled with supportive psychotherapy and cognitive behavioural
therapy formed the therapeutic approach implemented. Individual and collective hygiene advice
was provided for all subjects for the prevention of spread, especially for convalescent patients.
Patients previously infected and cured regained confidence, because they knew they were
immunised against the Ebola virus, and they formed a NGO to back up the awareness-raising and
surveillance teams in combating rumour, and in reaching the families of concealed cases in
Conakry and outside.
By organising focus groups in urban districts and public venues, these recovered patients have
taken an active part in combating stigmatisation and mistrust (workshops on the subject of Ebola,
such as those organised by Axiome-Génie Conseil with the World Bank, and also public and private
press media). This NGO of formerly infected Ebola patients has taken active part in combating
stigmatisation and mistrust.
Conclusion
People who were infected by Ebola and then recovered, and likewise those affected
psychologically by the epidemic in Conakry, underwent genuine psychological trauma.
Psychological debriefing, supportive psychotherapy and cognitive-behavioural therapy, along with
medication in some cases, were the successful means implemented by our team to relieve the
mental suffering of the victims and facilitate their social and professional rehabilitation. For the
children, a fairly large proportion of our sample, expression techniques suited to age were
implemented.
This all shows the importance of psychiatrists, social workers and psychologists integrated into a
multidisciplinary team in charge of managing recovered Ebola patients. The psychological
accompaniment of survivors, despite the fact that it could be thought that a cure solves the
problem, should be a health priority.

9. 9
This work was conducted over a limited period in a time of crisis. A study based on an evaluation
methodology extended to other recovered Ebola patients and other people affected
psychologically by Ebola-related events could enable the scale of the psychological damage to be
assessed, and prevention of psychological complications in the aftermath of Ebola, providing
appropriate psychotherapeutic care at the right time.

10. 10
APPENDIX TABLES
Table I : Distribution of patients according to their situation
Situation Numbers Percentage (%)
Patients infected and cured 37 54
Patients affected
psychologically - contacts
17 25
Patients affected
psychologically - non
contacts
14 21
Total 68 100
Table II : Distribution of patients according to gender
Gender Total Percentage (%)
Male 41 60,29
Female 27 39,70
Total 68 100
Sex-ratio : M/F= 1,51
Table III: Distribution of patients according to age
Age group Number of cases Percentage (%)
2- 11 21 30,88
12-21 21 30,88
22-32 26 38,23
Total 68 100
Mean age: 21.5 yrs

11. 11
Table IV: Distribution of patients according to symptoms encountered
Problems encountered Syndrome diagnosis Numbers Percentage %
- Fear of falling ill again, anxiety,
insomnia and nightmares,
stigmatisation, feelings of rejection
and shame
State of acute stress 37 54%
- Difficulty concentrating, despair,
self-devaluation
- Relational difficulties
- Depressive mood, anhedonia,
insomnia, anorexia
Moderate depressive
syndrome without
psychotic symptoms
07 10,29%
- Nightmares, insomnia, fear of
falling ill again, anxiety, starts,
mistrustfulness, reliving (flash-
back), avoidance. Fear of white
coats (recalling protective clothing
of staff)
Post-traumatic stress
disorder (PTSD) 03 4,46%
-Good-quality family support,
-Mild anxiety
-Good appetite and sleep None 21 30,88%
TOTAL - 68 100%
Supplementary tables (partial cohort results)
Table V-1 : Distribution numbers of deaths in the family for the 17 contacts
Contacts affected
psychologically
Number of Ebola deaths in the family
1 3
2 6
3 4
5 7
6 2

12. 12
Table V-2 : Distribution of patients between contacts and non-contacts psychologically affected
by the death of family members.
Situation
N° contacts affected
psychologically
N° non-contacts
affected
psychologically
Total %
Orphans 8 6 14 45,16
Widows 5 3 8 25,80
Widowers 4 5 9 29,03
Total 17 14 31 100
Table V-3 Distribution according to symptoms of the 14 non-contacts affected psychologically by
the death of family members
Age group
Symptoms
2 - 11 yrs 12 – 21 yrs 22 yrs and
over
- Despair, crying, wanting to see mother,
isolation with feelings of rejection,
irritability, disobedience, fear of getting the
disease, anxiety, insomnia, nightmares,
difficulty concentrating, stigmatisation and
feelings of abandonment, lack of interest in
play, anorexia
- Lack of involvement in school
3 1 -
- Difficulty concentrating, despair, feeling
devalued, guilt, relational difficulties
- Depressive mood with anhedonia,
insomnia and anorexia
- - 3
- Nightmares, insomnia, fear of contracting
Ebola, anxiety, starts, mistrust, reliving
(flash-back), avoidance, fear of white coats
(recalling staff protective equipment)
- 1 2
- Good-quality family support
- Mild anxiety
- Normal sleep and appetite
1 - 3
TOTAL 4 2 8

13. 13
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16. DSM V – Criteria for PTSD - National center for PTSD
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Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

14. 14
Hospital National Donka – Conakry-Guinea
Psychologists intervene with medical teams in West Africa,
but also when they return to Europe.
Needed support because of accumulated stress faced by caregivers in the disease.

15. 15
APPENDIX
Table I : Distribution of patients according to their situation
Situation Numbers Percentage (%)
Patients infected and cured 37 54
Patients affected
psychologically - contacts
17 25
Patients affected
psychologically - non
contacts
14 21
Total 68 100
Table II : Distribution of patients according to gender
Gender Total Percentage (%)
Male 41 60,29
Female 27 39,70
Total 68 100
Sex-ratio : M/F= 1,51
Table III: Distribution of patients according to age
Age group Number of cases Percentage (%)
2- 11 21 30,88
12-21 21 30,88
22-32 26 38,23
Total 68 100
Mean age: 21.5 yrs

16. 16
Table IV: Distribution of patients according to symptoms encountered
Problems encountered Syndrome diagnosis Numbers Percentage %
- Fear of falling ill again, anxiety,
insomnia and nightmares,
stigmatisation, feelings of rejection
and shame
State of acute stress 37 54%
- Difficulty concentrating, despair,
self-devaluation
- Relational difficulties
- Depressive mood, anhedonia,
insomnia, anorexia
Moderate depressive
syndrome without
psychotic symptoms
07 10,29%
- Nightmares, insomnia, fear of
falling ill again, anxiety, starts,
mistrustfulness, reliving (flash-
back), avoidance. Fear of white
coats (recalling protective clothing
of staff)
Post-traumatic stress
disorder (PTSD) 03 4,46%
-Good-quality family support,
-Mild anxiety
-Good appetite and sleep None 21 30,88%
TOTAL - 68 100%
Supplementary tables (partial cohort results)
Table V-1: Distribution numbers of deaths in the family for the 17 contacts
Contacts affected
psychologically
Number of Ebola deaths in the family
1 3
2 6
3 4
5 7
6 2

17. 17
Table V-2: Distribution of patients between contacts and non-contacts psychologically affected
by the death of family members.
Situation
N° contacts affected
psychologically
N° non-contacts
affected
psychologically
Total %
Orphans 8 6 14 45,16
Widows 5 3 8 25,80
Widowers 4 5 9 29,03
Total 17 14 31 100
Table V-3 Distribution according to symptoms of the 14 non-contacts affected psychologically by
the death of family members
Age group
Symptoms
2 - 11 yrs 12 – 21 yrs 22 yrs and
over
- Despair, crying, wanting to see mother,
isolation with feelings of rejection,
irritability, disobedience, fear of getting the
disease, anxiety, insomnia, nightmares,
difficulty concentrating, stigmatisation and
feelings of abandonment, lack of interest in
play, anorexia
- Lack of involvement in school
3 1 -
- Difficulty concentrating, despair, feeling
devalued, guilt, relational difficulties
- Depressive mood with anhedonia,
insomnia and anorexia
- - 3
- Nightmares, insomnia, fear of contracting
Ebola, anxiety, starts, mistrust, reliving
(flash-back), avoidance, fear of white coats
(recalling staff protective equipment)
- 1 2
- Good-quality family support
- Mild anxiety
- Normal sleep and appetite
1 - 3
TOTAL 4 2 8