Reflections on the Ebola Public Health Emergency of International Concern, Part 2: The Unseen Epidemic of Posttraumatic Stress among Health-care Personnel and Survivors of the 2014-2016 Ebola Outbreak

Introduction Neither dramatic footage nor horrifying statistics from the most recent Ebola virus (EBOV) outbreak come close to reflecting the true impact of the EBOV disease (EVD) on affected countries, communities, patients, health-care workers, or their friends and families. [3],[4] Posttraumatic stress disorder (PTSD) is defined by Diagnostic and Statistical Manual of Mental Disorders, 5th edition as a specified constellation of emotional and behavioral responses to traumatic events. Within this context, one or more of the following are required to meet the diagnosis of PTSD: (a) direct exposure to trauma; (b) witnessing the traumatic act or event in person; (c) indirect involvement, by learning that a close relative or close friend was exposed to trauma; (d) if the event involved actual or threatened death, it must have been violent or accidental; and (e) repeated or extreme indirect exposure to aversive details of the event(s) has occurred, usually in the course of professional duties (e.g., first responders, collecting body parts, social workers repeatedly exposed to details of child abuse). Postoutbreak Effects of Ebola on Health-care Staff The tremendous need for health-care services during the Ebola outbreak was associated with substantial risks and stressors (both physical and psychological) to health-care workers. [14] Likely reflective of "collective PTSD" manifestations within the community, the fear, anxiety, distrust, and emotional stress experienced by volunteer workers were further compounded by physical exhaustion, frustration at the scarcity of available health-care resources, poor management of mission goals, problems with assignment of roles and responsibilities, as well as the...