The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak

James M Shultz¹, Janice L Cooper², Florence Baingana³, Maria A Oquendo⁴, Zelde Espinel⁵, Benjamin M Althouse^{6

7

8

9}, Louis Herns Marcelin^{10

11}, Sherry Towers¹², Maria Espinola¹³, Clyde B McCoy¹⁴, Laurie Mazurik¹⁵, Milton L Wainberg¹⁶, Yuval Neria⁴, Andreas Rechkemmer¹⁷

Affiliations

¹ Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, 251 174 St. #2319, Sunny Isles Beach, Miami, FL, USA. jamesmichaelshultz@gmail.com.
² The Carter Center, Mental Health Program Liberia, Monrovia, Liberia.
³ Makerere University School of Public Health, Kampala, Uganda.
⁴ Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
⁵ Department of Psychiatry and Behavioral Health, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA.
⁶ Institute for Disease Modeling, Bellevue, WA, USA.
⁷ University of Washington, Seattle, WA, USA.
⁸ New Mexico State University, Las Cruces, NM, USA.
⁹ Santa Fe Institute, Santa Fe, NM, USA.
¹⁰ Interuniversity Institute for Research and Development (INURED), Port-au-Prince, Haiti.
¹¹ Department of Anthropology, University of Miami, Coral Gables, FL, USA.
¹² Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, USA.
¹³ Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁴ Department of Public Health Sciences and Comprehensive Drug Research Center, University of Miami Miller School of Medicine, Miami, FL, USA.
¹⁵ Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁶ Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
¹⁷ Graduate School of Social Work (GSSW), University of Denver, Denver, CO, USA.

PMID: 27739026
PMCID: PMC5241909
DOI: 10.1007/s11920-016-0741-y

Review

The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak

James M Shultz et al. Curr Psychiatry Rep. 2016 Nov.

. 2016 Nov;18(11):104.

doi: 10.1007/s11920-016-0741-y.

Authors

Affiliations

¹ Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, 251 174 St. #2319, Sunny Isles Beach, Miami, FL, USA. jamesmichaelshultz@gmail.com.
² The Carter Center, Mental Health Program Liberia, Monrovia, Liberia.
³ Makerere University School of Public Health, Kampala, Uganda.
⁴ Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
⁵ Department of Psychiatry and Behavioral Health, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA.
⁶ Institute for Disease Modeling, Bellevue, WA, USA.
⁷ University of Washington, Seattle, WA, USA.
⁸ New Mexico State University, Las Cruces, NM, USA.
⁹ Santa Fe Institute, Santa Fe, NM, USA.
¹⁰ Interuniversity Institute for Research and Development (INURED), Port-au-Prince, Haiti.
¹¹ Department of Anthropology, University of Miami, Coral Gables, FL, USA.
¹² Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, USA.
¹³ Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁴ Department of Public Health Sciences and Comprehensive Drug Research Center, University of Miami Miller School of Medicine, Miami, FL, USA.
¹⁵ Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁶ Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
¹⁷ Graduate School of Social Work (GSSW), University of Denver, Denver, CO, USA.

PMID: 27739026
PMCID: PMC5241909
DOI: 10.1007/s11920-016-0741-y

Abstract

The 2013-2016 West Africa Ebola virus disease pandemic was the largest, longest, deadliest, and most geographically expansive outbreak in the 40-year interval since Ebola was first identified. Fear-related behaviors played an important role in shaping the outbreak. Fear-related behaviors are defined as "individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. FRBs modify the future risk of harm." This review examines how fear-related behaviors were implicated in (1) accelerating the spread of Ebola, (2) impeding the utilization of life-saving Ebola treatment, (3) curtailing the availability of medical services for treatable conditions, (4) increasing the risks for new-onset psychological distress and psychiatric disorders, and (5) amplifying the downstream cascades of social problems. Fear-related behaviors are identified for each of these outcomes. Particularly notable are behaviors such as treating Ebola patients in home or private clinic settings, the "laying of hands" on Ebola-infected individuals to perform faith-based healing, observing hands-on funeral and burial customs, foregoing available life-saving treatment, and stigmatizing Ebola survivors and health professionals. Future directions include modeling the onset, operation, and perpetuation of fear-related behaviors and devising strategies to redirect behavioral responses to mass threats in a manner that reduces risks and promotes resilience.

Keywords: Ebola; Ebola virus disease (EVD); Fear; Fear-related behaviors; Outbreak; Pandemic.

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Conflict of interest statement

James M. Shultz, Janice L. Cooper, Florence Baingana, Zelde Espinel, Benjamin M. Althouse, Louis Herns Marcelin, Sherry Towers, Maria Espinola, Clyde B. McCoy, Laurie Mazurik, Milton L. Wainberg, Yuval Neria, and Andreas Rechkemmer declare that they have no conflict of interest.

Maria A. Oquendo receives royalties for the use of the Columbia Suicide Severity Rating Scale. Her family owns stock in Bristol Myers Squibb. Dr. Oquendo receives a stipend from the APA for her service as president.

References

1. Shultz JM, Baingana F, Neria Y. The 2014 Ebola outbreak and mental health: current status and recommended response. JAMA. 2015;313(6):567–8. doi: 10.1001/jama.2014.17934. - DOI - PubMed
1. Shultz JM, Althouse BM, Baingana F, Cooper JL, Espinola M, Greene MC, et al. Fear factor: the unseen perils of the Ebola outbreak. Bul At Sci. 2016;72(5):1–7. doi:10.1080/00963402.2016.1216515. An invited paper that lays out the precepts of fear-related behaviors during the 2013–2016 Ebola outbreak for a general readership. - PMC - PubMed
1. Shultz JM, Cooper JL, Baingana F, Espinel Z, Althouse B, Espinola M, et al. The 2013–2016 West Africa Ebola virus disease (EVD) outbreak. In: Shultz JM, Rechkemmer A, Johnson NF, et al., editors. Oxford handbook of complex disaster risks. New York: Oxford University Press; 2016.
1. Epstein JM, Parker J, Cummings D, Hammond RA. Coupled contagion dynamics of fear and disease: mathematical and computational explorations. PLoS ONE. 2008;3(12):e3955. doi: 10.1371/journal.pone.0003955. - DOI - PMC - PubMed
1. Shultz JM, Espinel Z, Espinola M, Rechkemmer A. Distinguishing epidemiological features of the 2013-2016 West Africa Ebola virus disease outbreak. Disaster Health. 2016;3(3):1–10. doi: 10.1080/21665044.2016.1228326. - DOI - PMC - PubMed

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The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak

Affiliations

The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical