Psychosocial impact of Marburg virus disease on recovered individuals and frontline health workers in Rwanda: a cross-sectional survey
Ruth Tsigebrhan, Darius Gishoma, Asmeret Andebirhan, Shadrack Ntirenganya, Kara Neil, Egide Munyaneza, Eugene Harerimana, Athanase Nsengiyumva, Anita Kamikazi, Amanda Rurangwa, Claude Nsabimana, Menelas Nkeshimana, Edison Rwagasore, Yvonne Kayiteshonga, Theogene Twagirumugabe, Eric Seruyange, Claire N Misago, Jeanne D’arc Dusabeyezu, Espoir Hakizimana, Janvier Ndayambaje, Christiane Niyibigira, Ryan P Westergaard, Tsion FirewObjectives
To examine the psychosocial impact of this disease on recovered individuals and frontline health workers (FHWs) following the 2024 MVD outbreak in Rwanda.
Design
a cross-sectional survey.
Setting
Kigali, the capital city of Rwanda, had two treatment centres during the outbreak of the MVD disease from 24 September to 24 October 2024.
Participants
All 51 recovered individuals from MVD and 98 FHWs who met the eligibility criteria were involved in the study.
Depression was measured using the Patient Health Questionnaire (PHQ-9), anxiety with the Generalised Anxiety Disorder (GAD-7) scale and post-traumatic stress disorder using the PTSD Checklist for DSM-5 (PCL-5). Perceived stigma was measured using the adapted Ebola stigma and discrimination questionnaire and the Multidimensional Scale of Perceived Social Support Scale (MPSS) to assess social support. Wilcoxon rank-sum and Kruskal–Wallis tests examined differences in depression, anxiety and PTSD by sex and profession. Spearman correlation assessed relationships between variables.
Results
115 participants, including 29 recovered people and 86 FHWs. 11.8% of FHWs had moderate to severe depression and 20.7% of recovered people had mild to moderate depression. Moderate to severe anxiety was exhibited by 9.4% of FHWs, and mild anxiety was reported by 17.2% of recovered people. 9.3% of FHWs and one recovered individual had a total PCL score above 33 (PTSD). Among recovered people, there was a significant negative correlation between anxiety and social support (r=−0.36, p value=0.05) and a significant difference in PTSD symptom levels between sexes (p value=0.01). Among FHWs, MVD-related stigma was positively correlated with PTSD symptoms (r=+0.23, p value=0.05). Symptoms of depression (β coef.=−0.19, 95% CI −0.32, −0.05) and anxiety (β coef.=−0.16, 95% CI −0.26, −0.06) decreased with age. Married FHWs had lower levels of depression (β coef.=−2.72, 95% CI −4.96, −0.49) and anxiety (β coef.=−2.35, 95% CI −4.07, −0.62) compared with single individuals.
Conclusion
Six months post-containment of the MVD outbreak in Rwanda, many FHWs were still experiencing depression, anxiety and PTSD. Contextualised and culturally adapted mental health and psychosocial support interventions are highly recommended for integration into infectious disease response plans.