ANXIETY, DEPRESSION, AND POSTTRAUMATIC STRESS DISORDER IN ADOLESCENTS RESIDING ALONG THE WHARF COMMUNITY IN FREETOWN IN THE POST-EBOLA PERIOD

Abstract

The period of adolescence is characterized by rapid change physically, mentally, emotionally and socially. Consequently, adolescents need enabling and supportive environments to develop into healthy adults that can function successfully in the thought, mood and behavioural realms, and engage in productive activities and fulfilling relationships. Studies have established that adolescents living in less privileged environments and those exposed to traumatic events are more likely to experience significant impairment in their cognitive, affective or relational abilities than their counterparts. Sierra Leone has been through a number of traumatic events including war, flooding and the most recent Ebola Virus Disease (EVD) epidemic, thus subjecting its people to a continuous series of trauma, with the younger population been the most affected. However, there is little data on the mental health status of adolescents and a dearth of child and adolescent mental healthcare available to survivors of these traumatic events. This study therefore aimed to assess the prevalence and correlates of anxiety disorder, depression, and post-traumatic stress disorder among adolescents living in the Wharf communities in Freetown, Sierra Leone in the post-Ebola period. METHODOLOGY This was a descriptive cross sectional study conducted in a Wharf community in Freetown, Sierra Leone. A cluster sampling technique was used to select study participants, and a total of 429 adolescents 13-19 years were recruited into the study. Instruments used were a socio-demographic questionnaire, Child PTSD checklist, and Beck’s depression and anxiety inventory. Frequency tables were used to represent socio-demographic characteristics, reported experiences of the EVD epidemic and coping strategies used by adolescents to deal with stressful events. Correlates of anxiety, depression and probable diagnosis of PTSD were determined using the Chi-square and logistic regression analysis. Selection criteria of 20% was used to input variables into the logistic regression and Statistical significance was set at P<0.05. RESULTS The mean age of the participants was 15.3 (±1.8) years, with over half (57%) of the participants within the 13 to 15 years old category. The male to female ratio was 2:3 and majority (86.9%) of the adolescents were in school. Almost half (45.8%) worked to earn money before or after school. About one in every 4 respondents had a probable diagnosis of PTSD (24.0%) and anxiety (24.7%) respectively, while about 1in every 5 (21.2%) had depression. A higher proportion of the older adolescents (15-19years old) had depression (27.7% Vs 16.3%; p=0.004), while younger adolescents (13 - 15 years old) were more likely to have anxiety (79.6% Vs. 69.6%; p=0.06). Adolescents who were single or double orphans and those who were living with persons other than their parents were significantly more likely to have depression (p=<0.01) and PTSD (p=0.013). Adolescents, whose parents were separated, divorced or dead were significantly more likely to have depression (p=<0.001) compared to adolescents whose parents were married (p=<0.01). Among in-school adolescents, those who had to work to earn money before or after school were significantly more likely to have anxiety compared to their counterparts (p=0.003). Adolescents who were infected with the EVD and those who lost a loved one during the EVD epidemic were significantly more likely to have PTSD (p=0.016) and anxiety disorder (<0.01), while adolescents whose family members were infected with the EVD were significantly more likely to have PTSD (p<0.01) and depression (p=0.017) compared to their counterparts. Over two-thirds of the participants reported they used emotion-focused methods of coping with stressful events, and ‘Religion’ was the most utilized sub-theme among these participants. About 25% of participants made use of distraction (avoidant coping) and 13.1% sought out (problem-focused coping) ways to combat stressful events. CONCLUSION Adolescents in the Wharf Communities had high prevalence rates of PTSD, depression and anxiety in the Post EVD period. Factors such as being infected with the EVD, having family members who was infected with the EVD, losing a loved one to the EVD epidemic, being out of school, living with persons other than parents, working to earn money and having parents who were separated, divorced or dead, were associated with adolescents’ having a mental disorder. The most common coping strategy among adolescents was the Emotion-focused strategy. Providing mental health services for adolescents in this community would be beneficial both to the adolescents and to the community at large