Protecting mental health during infectious disease outbreaks

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OPINION 

By Dr Emmanuel Mfitundinda

Infectious disease outbreaks and the public health measures required to control them lead to increased psychological distress and mental illness for the patients, their caretakers, families, and health workers in the affected communities. Mental and psychological illnesses associated with infectious disease outbreaks include, but are not limited to, stigma, anxiety disorders, grief and bereavement, burnout among health workers, depression and suicidal ideations, among others.

The COVID-19 pandemic unmasked the relationship between outbreaks and mental and psychological illnesses. The effects of these outbreaks also impact the continuation of routine health services that include mental health services. Protecting the mental health of the health workers and the public, and especially those affected, is critical to improve compliance with public health measures, which facilitates fact outbreak control.

Uganda is currently faced with two infectious disease outbreaks: mpox since July 2024 and, recently, from January 30, 2025, with Sudan Ebola Virus Disease (SUDV). The country has registered over 3,800 mpox case-patients with 30 deaths and has spread to over 99 districts as of the end of February 2025. Mpox is a viral disease caused by the monkeypox virus (MPXV) and primarily affects the skin. Since its declaration by the Ministry of Health, the deadly SUDV outbreak has affected several districts.

The disease is highly infectious and fatal, also requiring strict isolation of case-patients and quarantine of their contacts to limit its spread. This causes psychological distress to the health workers, to the patients, their families, and contacts. These outbreaks not only strain the healthcare system but also exacerbate existing mental health challenges, making it imperative for healthcare providers to address both physical and psychological needs in their response strategies.

The two outbreaks have been associated with stigma. Stigma due to mpox stems from its presentation and the perception of its transmission. It has been associated with sexual transmission, and this has further worsened the stigma associated with it, with people labelling it as a disease associated with promiscuity. However, this perception overlooks the reality that anyone can contract the virus, regardless of their sexual behaviour.

The SUDV outbreak stigma has been related to fear and discrimination against survivors of the disease, their families, and contacts due to fear in the communities of contracting the disease from them. This is untrue, as the survivors and contacts are only discharged when they have been fully healed and cannot transmit the disease and the contacts have been followed up adequately and can no longer develop the disease.

Various strategies are being implemented to combat the stigma, including health education using various modalities, psychosocial counselling to the survivors and contacts, avoiding use of stigmatizing language such as the change of the naming of monkeypox to mpox, and engaging community leaders.

Anxiety disorders have also been associated with the outbreaks. It may arise due to fear of contracting the infectious disease or the possibility of complications and death among the case-patients. It presents with extremes of fear, racing heartbeats or palpitations, feelings of impending doom, difficulty concentrating, and episodes of mutism in some individuals. The disorder can be minimized through breathing exercises, relaxation, peer support, and sharing experiences.

Grief and bereavement are common during infectious disease outbreaks due to the high rate of fatalities that are commonly associated with them. The grief is worsened by the sudden and unexpected loss of a loved one, interruptions to cultural ways of mourning and send-off, especially during safe and dignified burials for Ebola confirmed-patients. The close relatives of such patients are likely to suffer prolonged or complicated grief disorder that presents with an inability to speak, intense longing for the deceased, difficulty concentrating on daily activities, and an inability to accept the loss and move on. Prolonged grief might last for a longer time compared to usual grief and bereavement.

Health workers who are involved in responding to infectious disease outbreaks are likely to suffer burnout as a result of increased work demands and caring for very sick patients or those with unusual presentations that are common with infectious disease outbreaks. Similarly, there is an increased risk of contracting the disease due to workplace contamination.

They also require isolation and heightened personal protective equipment to be worn, and yet these are sometimes inadequate. Health workers with burnout present with excessive exhaustion from work, reduced output, and loss of interest in the work. This can be mitigated through rotational shifts, mental and psychosocial counselling and support, regular relaxation exercises, support from the public and community members, adequate supplies, and providing funding for risk allowance.

Depression and suicide are likely to increase during infectious disease outbreaks due to public health measures that are instituted, such as isolation and quarantine, and in some cases, lockdowns. Economic hardships are also common during infectious disease outbreaks and are likely to increase the risk of depression and suicide. Providing community-based psychosocial and mental health services, using telemedicine, and using media such as messages on radio, newspapers, and short text messages (SMS) can mitigate these effects.

To mitigate the mental health effects of these outbreaks, the Ministry of Health is implementing the integration of a mental health and psychosocial support (MHPSS) package in infectious disease outbreaks. The activities span from training and orienting the community leaders and village health team (VHT) members on how to support affected communities, give first aid to protect mental health, and prevent mental illnesses associated with infectious disease outbreaks.

It also entails training health workers on mental health and preventing mental illnesses. Psychological counselling and support have been offered to patients, their families, contacts, and health workers since the beginning of these outbreaks. During the current outbreaks, psychosocial teams have been deployed in communities, quarantine centres, and isolation and treatment units to offer mental and psychotherapy services to the affected people and communities.

To further protect mental health during the uncertain times of outbreaks, encouraging community members to practice self-care that includes regular exercises, meditation, and eating a balanced diet; gathering relevant and reliable information; leveraging technology to maintain social networks, especially during quarantine and lockdowns; and speaking out against misinformation and discrimination can contribute to protecting mental health during outbreaks.

In conclusion, as we fight to end the various infectious disease outbreaks that the country is currently facing, protecting the mental health of the public and especially those affected can improve compliance to public health measures and contribute to the overall control of the outbreaks with limited resistance from the population.

The writer is a field epidemiology fellow with the Uganda Public Health Fellowship Program, Ministry of Health