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

Abstract

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. 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. 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. 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. 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.

Keywords:

• Ebola virus disease
• CBT
• Sierra Leone
• disaster response
• anxiety and depression

Acknowledgements

Idit Albert, Violet Asgill, Holly Bagnall, Cecelia Barnett, Annis Cohen, Sarah Coleman, Fanny Conteh, Osman Conteh, Jennifer Foster, Ishmael George, Jennifer House, Mary Ion, Aminata Jalloh, Alison Jones, Kadie-Yatta Kallon, Ukwuori-Gisela Kalu, John Kanu, Franklin Koroma, Theo Lloyd, Kevin Long, Hawanatu Mansaray, Kathy Nairne, Clare Reeder, Brima Sahr, Jassie Samah, Bockarie Swaray, Andy Sweeting, Klya Vailancourt, Christopher Whiteley, Janet Wingrove, Adama Yambasu.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Financial support was received from the UK Public Health Rapid Support Team, funded by the UK Government, the UK Department for International Development and the Maudsley Charity. This report is independent research by the UK Public Health Rapid Support Team. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health.