Prevalence and risk factors of post-traumatic stress disorder and psychological distress symptoms in populations affected by Ebola in DR Congo before and during the COVID-19 pandemic.

Background: Ebola virus disease (May 19-September 16, 2020) and COVID-19 simultaneously affected the province of Equateur in DR Congo (DRC). To date, no longitudinal studies have explored symptoms of post-traumatic stress disorder (PTSD) and psychological distress (PD) related to COVID-19 or Ebola in DRC.

Methods: A representative sample of 1669 participants aged ≥18 was recruited in March-April 2019 (Time 1) and August-September 2020 (Time 2). Questionnaires assessed PTSD (PCL-5) and PD (K-10) symptoms, social support, Ebola and COVID-19 exposure and related stigmatization.

Results: Prevalence of PTSD (58.24 % in T1 to 43.74% at T2, x(1) = 5.83, p < .001) and PD symptoms (49.44 % in T1 to 28.94 % at T2, x (1) = 5.83, p < .001) decreased from the Ebola outbreak to the COVID-19 pandemic. Populations living in rural areas consistently reported higher prevalence of PTSD and PD symptoms. Generalized estimating equation (GEE) models showed that stigmatization related to Ebola is the most important predictor of both PTSD (B = 0.90, p < .0001) and PD (B = 1.22, p < .001) symptoms, followed by exposure to Ebola (B = 0.41, p < .001 and B = 0.56, p < .001). COVID-19 related stigmatization only predicted PTSD symptoms (B = 0.21, p = .009). GEE models also confirmed that PTSD (B = -0.78, p < .001) and PD (B = -1.25, p < .001) decreased from Ebola outbreak to the COVID-19 pandemic. A significant interaction was found between Ebola stigmatization and time (B = -0.40, p = .021) for PTSD, and between exposure to Ebola and time (B = -0.36, p = .026) for PD.

Conclusions: This study confirms that Ebola related stigmatization is the most important predictor of mental health problems. Community-based strategies can address, reduce, and eliminate this issue.