Current Psychiatry Reports

, 18:104 | Cite as

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

  • James M. ShultzEmail author
  • Janice L. Cooper
  • Florence Baingana
  • Maria A. Oquendo
  • Zelde Espinel
  • Benjamin M. Althouse
  • Louis Herns Marcelin
  • Sherry Towers
  • Maria Espinola
  • Clyde B. McCoy
  • Laurie Mazurik
  • Milton L. Wainberg
  • Yuval Neria
  • Andreas Rechkemmer
Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Disaster Psychiatry: Trauma, PTSD, and Related Disorders


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.


Ebola Ebola virus disease (EVD) Fear Fear-related behaviors Pandemic Outbreak 



A special thank you is extended by the authors to Dr. Michelle Riba for taking the time to review the manuscript.

Compliance with Ethical Standards

Conflict of Interest

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.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance and •• Of major importance

  1. 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. Provides an overview of mental health issues in Africa and the United States composed during the peak of the Ebola outbreak.CrossRefPubMedGoogle Scholar
  2. 2.•
    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.
  3. 3.
    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, editors. Oxford handbook of complex disaster risks. New York: Oxford University Press; 2016.Google Scholar
  4. 4.•
    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. A classic paper that models and contrasts the spread of fear and infectious disease and their interplay.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.•
    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. Presents a detailed account of the descriptive epidemiology of the 2013–2016 Ebola outbreak that serves as a key resource for this paper.CrossRefGoogle Scholar
  6. 6.
    Bell BP, Damon IK, Jernigan DB, Kenyon TA, Nichol ST, O’Connor JP, et al. Overview, control strategies, and lessons learned in the CDC response to the 2014-2016 Ebola epidemic. MMWR. 2016;65(3):4–11.CrossRefGoogle Scholar
  7. 7.
    Baize S, Pannetier D, Oestereich L, Rieger T, Koiyogui L, et al. Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med. 2014;371(15):1418–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Briand S, Bertherat E, Cox P, Formenty P, Kieny M-P, Myhre J, et al. The international Ebola emergency. N Engl J Med. 2014;371(13):1180–3. doi: 10.1056/NEJMp1409858.CrossRefPubMedGoogle Scholar
  9. 9.
    WHO Ebola Response Team. Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med. 2014;371:1481–95. doi: 10.1056/NEJMoa1411100.
  10. 10.
    World Health Organization. Ebola situation report—30 March 2016. Accessed 15 Aug 2016.
  11. 11.
    World Health Organization. Statement on the 1st meeting of the IHR Emergency Committee on the Ebola outbreak in West Africa. 2014. 8 August 2014, . Accessed 15 Aug 2016.Google Scholar
  12. 12.
    World Health Organization. Statement on the 9th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa. 29 March, 2016. Accessed 15 Aug 2016.
  13. 13.
    Morens DM, Folkers GK, Fauci AS. Emerging infections: a perpetual challenge. Lancet Infect Dis. 2008;8:710–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.•
    Pappas G, Kiriaze IJ, Giannakis P, Falagas ME. Psychosocial consequences of infectious diseases. Clin Microbiol Infect. 2009;15:743–7. Explicates the propensity of infectious diseases to provoke fear and distress.CrossRefPubMedGoogle Scholar
  15. 15.
    Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J of Aust. 2009;190:S54–60.Google Scholar
  16. 16.
    McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007;87:873–904. doi: 10.1152/physrev.00041.2006.CrossRefPubMedGoogle Scholar
  17. 17.
    Hall RC, Hall RC, Chapman MJ. The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics. Gen Hosp Psychiatry. 2008;30(5):446–52. doi: 10.1016/j.genhosppsych.2008.05.003. PMID: 18774428
  18. 18.
    Kinsman J. “A time of fear”: local, national, and international responses to a large Ebola outbreak in Uganda. Global Health. 2012;8:15.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.•
    Chan M. Ebola virus disease in West Africa—no early end to the outbreak. N Engl J Med. 2014;371(13):1183–4. Important statement by the Director-General of the World Health Organization that liberally highlights the role of fear based behaviors in the epidemic spread of Ebola.CrossRefPubMedGoogle Scholar
  20. 20.
    Mitman G. Ebola in a stew of fear. N Engl J Med. 2014;371:1763–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Cheung EY. An outbreak of fear, rumours and stigma: psychosocial support for the Ebola virus disease outbreak in West Africa. Intervention. 2015;13(1):70–6.CrossRefGoogle Scholar
  22. 22.
    Ogoina D. Behavioural and emotional responses to the 2014 Ebola Outbreak in Nigeria: a narrative review. Int Health. 2016;8(1):5–12. doi: 10.1093/inthealth/ihv065.PubMedGoogle Scholar
  23. 23.•
    Towers S, Afzal S, Bernal G, Bliss N, Brown S, et al. Mass media and the contagion of fear: the case of Ebola in America. PLoS ONE. 2015;10(6):e0129179. doi: 10.1371/journal.pone.0129179. Presents detailed modeling of how news media stories about Ebola set off fear-motivated searches and social media communications in the United States.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.•
    Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma AS, Muana AT, et al. Psychosocial effects of an Ebola Outbreak at individual, community and international levels. Bull World Health Organ. 2016;94:210–4. doi: 10.2471/BLT.15.158543. Presents an important overview of Ebola’s psychosocial consequences over time and at individual and community levels.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Alcabes P. Dread: how fear and fantasy have fueled epidemics from the Black Death to Avian flu. New York: Public Affairs Books; 2009.Google Scholar
  26. 26.
    Feldmann H. Ebola—a growing threat? N Engl J Med. 2014;371(15):1375–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention. Ebola virus disease (EVD) information for clinicians in U.S. healthcare settings. 2016. Accessed 15 Aug 2016.
  28. 28.•
    Hewlett BS, Hewlett BL. Ebola, culture, and politics: the anthropology of an emerging disease. Belmont: Thomson Wadsworth; 2008. The classic medical anthropology text on Ebola virus disease.Google Scholar
  29. 29.••
    Rabelo I, Lee V, Fallah MP, Massaquoi M, Evlampidou I, Crestani R, et al. Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia—a qualitative study. Front Public Health. 2016;4:142. doi: 10.3389/fpubh.2016.00142. A detailed presentation of the psychological and social consequences for Ebola virus disease survivors who were treated and discharged from an ETU.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Komesaroff P, Kerridge I. Ebola, ethics, and the question of culture. J Bioeth Inq. 2014;11(4):413–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Arwady MA, Bawo L, Hunter JC, Massaquoi M, Matanock AM, Dahn B, et al. Evolution of Ebola virus disease from exotic infection to global health priority, Liberia, mid-2014. Emerg Infect Diseases. 2015;21(4):578–84.CrossRefGoogle Scholar
  32. 32.
    Steimer T. The biology of fear and anxiety-related behaviors. Dialogues Clin Neurosci. 2002;4(3):231–49.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Farmer P. Infections and inequalities: the modern plagues. Berkeley: University of California Press; 2001.Google Scholar
  34. 34.
    Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1989.Google Scholar
  35. 35.
    Smith GL, Irving WL, McCauley JW. New challenges to health: the threat of virus infection. Cambridge: Cambridge University Press; 2001.CrossRefGoogle Scholar
  36. 36.
    Bracha HS. Freeze, flight, fight, fright, faint: adaptationist perspectives on the acute stress response spectrum. CNS Spectrums. 2004;9(9):679–85.CrossRefPubMedGoogle Scholar
  37. 37.
    Merler S, Ajelli M, Fumanelli L, Gomes MF, Piontti A, Rossi L, et al. Spatio-temporal spread of the Ebola 2014 outbreak in Liberia and the effectiveness of non-pharmaceutical interventions: a computational modelling analysis. Lancet Infect Dis. 2015;15(2):2014–211. doi: 10.1016/S1473-3099(14)71074-6.CrossRefGoogle Scholar
  38. 38.••
    Bower H, Johnson S, Bangura MS, Kamara AJ, Kamara O, Mansaray SH, et al. Exposure-specific and age-specific attack rates for Ebola virus disease in Ebola-affected households, Sierra Leone. Emerg Infect Diseases. 2016;22(8):1403–11. A definitive epidemiological study that quantifies the behavioral exposures risks—including fear-related behaviors—in relation to Ebola disease rates.CrossRefGoogle Scholar
  39. 39.••
    Roth Allen D, Lacson R. 2015. Understanding why Ebola deaths occur at home in urban Montserrado County, Liberia: report on the findings from a rapid anthropological assessment December 22–31, 2014. Centers for Disease Control and Prevention. 2014. Accessed 15 Aug 2016. A detailed analysis of in-home deaths and risk behaviors, including fear-related behaviors conducted by CDC medical anthropologists.
  40. 40.
    World Health Organization. A fast-moving epidemic full of tragic surprises. Accessed 15 Aug 2016.
  41. 41.
    Gostin LO, Lucey D, Phelan A. The Ebola epidemic: a global health emergency. JAMA. 2014;312(11):1095–6.CrossRefPubMedGoogle Scholar
  42. 42.•
    Cooper J. Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account. Intervention. 2015;13(1):49–57. A powerful and informed personal account from first-hand, front line experience in West Africa during the peak of the outbreak.CrossRefGoogle Scholar
  43. 43.
    Fauci AS. Ebola—underscoring the global disparities in health care resources. N Engl J Med. 2014;371:1084–6. doi: 10.1056/NEJMp1409494.CrossRefPubMedGoogle Scholar
  44. 44.
    Ki M. What do we really fear? The epidemiological characteristics of Ebola and our preparedness. Epidemiol Health. 2014;36:e2014014. doi: 10.4178/epih/e2014014.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Maganga GD, Kapetshi J, Berthet N, Ilunga BK, Kabange F, Kingebeni P, et al. Ebola virus disease in the Democratic Republic of Congo. New Engl J Med. 2014;371(22):2083–91. doi: 10.1056/NEJMoa1411099.CrossRefPubMedGoogle Scholar
  46. 46.
    Mangubo A, Mafuvadze B. The impact of traditional and religious practices on the spread of Ebola in West Africa: time for a strategic shift. Pan Afr Med J. 2015;22 Suppl 1:9.Google Scholar
  47. 47.
    Onoma AK. Rites of mobility and epidemic control: Ebola virus disease in the Mano River Basin. Governance in Africa. 2016;3(1). doi: 10.5334/gia.72
  48. 48.
    Richards P, Amara J, Ferme MC, Kamara P, Mokuwa E, Sheriff AI, et al. Social pathways for Ebola virus disease in rural Sierra Leone, and some implications for containment. PLoS Negl Trop Dis. 2015;9(4), e0003567. doi: 10.1371/journal.pntd.0003567.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Richards P, Mokuwa A. Village funerals and the spread of Ebola virus disease. Cult Anthropol. 2014. Accessed 1 June 2016.
  50. 50.
    Ferme M. The underneath of things: violence, history and the everyday in Sierra Leone. Berkeley: University of California Press; 2001.CrossRefGoogle Scholar
  51. 51.
    Ladner JT, Wiley MR, Mate S, Dudas G, Prieto K, Lovett S, et al. Evolution and spread of Ebola virus in Liberia, 2014–2015. Cell Host Microbe. 2015;18:659–69. doi: 10.1016/j.chom.2015.11.008.
  52. 52.
    Karamouzian M, Hategekimana C. Ebola treatment and prevention are not the only battles: understanding Ebola-related fear and stigma. Int J Health Policy. 2015;4:55–6.CrossRefGoogle Scholar
  53. 53.
    Mobula LM. Courage is not the absence of fear: responding to the Ebola outbreak in Liberia. Glob Health Sci Pract. 2014;2:487–9.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Barnett DJ, Balicer RD, Thompson CB, Storey JD, Omer SB, Semon NL, et al. Assessment of local public health workers’ willingness to respond to pandemic influenza through application of the extended parallel process model. PLoS ONE. 2009;4(7), e6365.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Balicer RD, Barnett DJ, Thompson CB, Hsu EB, Catlett CL, Watson CM, et al. Characterizing hospital workers’ willingness to report to duty in an influenza pandemic through threat- and efficacy-based assessment. BMC Public Health. 2010;10:436.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Barnett DJ, Levine R, Thompson CB, Wijetunge GU, Oliver AL, Bentley MA, et al. Gauging U.S. emergency medical services workers’ willingness to respond to pandemic influenza using a threat- and efficacy-based assessment framework. PLoS ONE. 2010;5(3):e9856.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Hope K, Durrheim DN, Barnett DJ, D’Este C, Kewley C, Dalton CB, et al. Willingness of frontline health care workers to work during a public health emergency. Aust J Emerg Manage. 2010;25(3):39–47.Google Scholar
  58. 58.
    Gulland A. Fear spreads as number of Ebola cases in Guinea rises. Brit Med J. 2014;238:g2644.CrossRefGoogle Scholar
  59. 59.
    Reardon S. Ebola’s mental-health wounds linger in Africa. Nature. 2015;519:13–4.CrossRefPubMedGoogle Scholar
  60. 60.
    Boozary AS, Farmer PE, Jha AK. The Ebola outbreak, fragile health systems, and quality as a cure. JAMA. 2014;312(18):1859–60.CrossRefPubMedGoogle Scholar
  61. 61.
    Mugele J, Priest C. A good death—Ebola and sacrifice. N Engl J Med. 2014;371(13):1185–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Ulrich CM. Ebola is causing moral distress among African healthcare workers. Brit Med J. 2014;349:g6672. doi: 10.1136/bmj.g6672.CrossRefPubMedGoogle Scholar
  63. 63.
    Baden LR, Kanapathipillai R, Campion EW, Morrissey S, Rubin EJ, Drazen JM. Ebola—an ongoing crisis. N Engl J Med. 2014;371(15):1458–9. doi: 10.1056/NEJMe1411378.CrossRefPubMedGoogle Scholar
  64. 64.
    Edmond MB, Diekema DJ, Perencevich EN. Ebola virus disease and the need for new personal protective equipment. JAMA. 2014;312(23):2495–6. doi: 10.1001/jama.2014.15497.CrossRefPubMedGoogle Scholar
  65. 65.
    Wolz A. Face to face with Ebola—an emergency care center in Sierra Leone. N Engl J Med. 2014;371(12):1081–3. doi: 10.1056/NEJMp1410179.CrossRefPubMedGoogle Scholar
  66. 66.
    Centers for Disease Control and Prevention (CDC). Cost of the Ebola epidemic. 2016. Accessed 1 June 2016.
  67. 67.•
    Parpia A, Ndeffo-Mbah ML, Wenzel NS, Galvani AP. Effects of response to 2014-2015 Ebola Outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerg Infect Dis. 2016;22(3):433–41. doi: 10.3201/eid2203.150977. Important documentation of the magnitude of preventable non-Ebola deaths due to failure to treat endemic diseases.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Iyengar P, Kerber K, Howe CJ, Dahn B. Services for mothers and newborns during the Ebola outbreak in Liberia: the need for improvement in emergencies. PLoS Current Outbreaks Edition 1. 2015, doi: 10.1371/currents.outbreaks.4ba318308719ac86fbef91f8e56cb66f
  69. 69.
    Hill WC. Ebola virus disease: understanding the facts, putting fears in perspective, and being prepared. Obstet Gynecol. 2015;125:13–5.CrossRefPubMedGoogle Scholar
  70. 70.
    Shears P, O’Dempsey TJD. Ebola virus disease in Africa: epidemiology and nosocomial transmission. J Hosp Infect. 2015;90:1–9. doi: 10.1016/j.jhin.2015.01.002
  71. 71.
    Matanock A, Arwady MA, Ayscue P, Forrester JD, Gaddis B, Hunter JC, et al. Ebola virus disease cases among health care workers not working in Ebola treatment units—Liberia, June-August, 2014. MMWR. 2014;63(46):1077–81.PubMedGoogle Scholar
  72. 72.
    Levin A. Response to Ebola crisis will require attention to MH needs. Psychiatric News. 2014;49(20):1,26. Accessed 15 Aug 2016.Google Scholar
  73. 73.
    Evansa DK, Goldstein M, Popova A. Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health. 2015;3(8):e439–40. doi: 10.1016/S2214-109X(15)00065-0.CrossRefGoogle Scholar
  74. 74.
    Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J. Ebola and indirect effects on health service function in Sierra Leone. PLOS Currents Outbreaks. 2014 Dec 19. Edition 1. doi: 10.1371/currents.outbreaks.0307d588df619f9c9447f8ead5b72b2d
  75. 75.••
    Betancourt TS, Brennan RT, Vinck P, VanderWeele TJ, Spencer-Walters D, Jeong J, et al. Associations between mental health and Ebola-related health behaviors: a regionally representative cross-sectional survey in post-conflict Sierra Leone. PLoS Med. 2016;13(8):e1002073. doi: 10.1371/journal.pmed.1002073. A well-conducted research study of Ebola risk behaviors, depression, PTSD, war trauma, and related psychological factors among a representative sample of Sierra Leone rural and urban residents.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Scott JT, Sesay FR, Massaquoi TA, Idriss BR, Sahr F, Semple MG. Post-Ebola syndrome, Sierra Leone. Emerg Infect Dis. 2016;22(4).  10.32032/eid2204.151302
  77. 77.
    Banerjee A, Mor S, Kok J, Sorrell TC, Hill-Cawthorne GA. Vulnerability, hysteria and fear—conquering Ebola virus. Med J Aust. 2014;6:320–1.CrossRefGoogle Scholar
  78. 78.
    De Roo A, Ado B, Rose B, Guimard Y, Fonck K, Colebunders R. Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: their feelings and experiences. Trop Med Int Health. 1998;3:883–5.CrossRefPubMedGoogle Scholar
  79. 79.
    Hugo M, Declerck H, Fitzpatrick G, Severy N, Osman BG, Decroo T, et al. Post-traumatic stress reactions in Ebola virus disease survivors in Sierra Leone. Emerg Med. 2015;5:285. doi: 10.4172/2165-7548.1000285.CrossRefGoogle Scholar
  80. 80.
    Arwady MA, Garcia EL, Wollor B, Mabande LG, Reaves EJ, Montgomery JM. Reintegration of Ebola survivors into their communities—Firestone District, Liberia, 2014. MMWR. 2014;63(50):1207–9.PubMedGoogle Scholar
  81. 81.
    Lee-Kwan SH, DeLuca N, Adams M, Dalling M, Drevlow E, Gassama G, et al. Support services for survivors of Ebola virus disease—Sierra Leone, 2014. MMWR. 2014;63(50):1205–6.PubMedGoogle Scholar
  82. 82.
    UNICEF Press Centre. Thousands of children still need care and support in wake of Ebola epidemic. Accessed 15 Aug 2016.
  83. 83.
    News BBC. Ebola outbreak: Guinea health team killed. 19 Sept. 2014. Accessed 20 March 2015.
  84. 84.
    Sharfstein J. On fear, distrust, and Ebola. JAMA. 2015;313(8):784. doi: 10.1001/jama.2015.346.CrossRefPubMedGoogle Scholar
  85. 85.
    Drazen JM, Kanapathipillai R, Campion EW, Rubin EJ, Hammer SM, Morrissey S, et al. Ebola and quarantine. N Engl J Med. 2014;371(21):2029–30. doi: 10.1056/NEJMe1413139.CrossRefPubMedGoogle Scholar
  86. 86.
    Gonsalves G, Staley P. Panic, paranoia, and public health—the AIDS epidemic’s lessons for Ebola. N Engl J Med. 2014;371(25):2348–9. doi: 10.1056/NEJMm1413425.CrossRefPubMedGoogle Scholar
  87. 87.
    Downes E. Nursing and complex humanitarian emergencies: Ebola is more than a disease. Nurs Outlook. 2015;63:12–5.CrossRefPubMedGoogle Scholar
  88. 88.
    Tambo E. Non-conventional humanitarian interventions on Ebola outbreak crisis in West Africa: health, ethics and legal implications. Infect Dis Poverty. 2014;3(1):42. doi: 10.1186/2049-9957-3-42.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    United Nations Development Group—Western and Central Africa. Socio-economic impact of Ebola virus disease in West African countries: a call for national and regional containment, recovery and prevention. 2015. Accessed 23 Aug 2016.
  90. 90.
    Sy A, Copley A. Understanding the economic effects of the 2014 Ebola outbreak in West Africa. Brookings: Africa in Focus. 1 October, 2014. Accessed 23 Aug 2016.
  91. 91.
    Osterholm MT, Moore KA, Gostin LO. Public health in the age of Ebola in West Africa. JAMA Intern Med. 2014. doi: 10.1001/jamainternmed.2014.6235.Google Scholar
  92. 92.
    The World Bank. Summary on the Ebola recovery plan: Sierra Leone. April 15, 2015. Accessed 20 Jan 2016.
  93. 93.
    The World Bank. Summary on the Ebola recovery plan: Guinea. April 16, 2015. Accessed 20 Jan 2016.
  94. 94.
    The World Bank. Summary on the Ebola recovery plan: Liberia—economic stabilization and recovery plan (ESRP). April 15, 2015. Accessed 20 Jan 2016.
  95. 95.
    Fung I, Ho Tse Z, Cheung CN, Miu AS, Fu K. Ebola and the social media. Lancet. 2014;384(9961):2207.CrossRefPubMedGoogle Scholar
  96. 96.
    Lancet. The medium and the message of Ebola. Lancet. 2014; 384(9955):1641. doi: 10.1016/S0140-6736(14)62016-X
  97. 97.
    McCarthy M. Four in 10 US people fear large outbreak of Ebola. Brit Med J. 2014;349:g5321.CrossRefPubMedGoogle Scholar
  98. 98.
    Merino JG. Response to Ebola in the US: misinformation, fear, and new opportunities. Brit Med J. 2014;349:g6712.CrossRefPubMedGoogle Scholar
  99. 99.
    Rodriguez-Morales A, Catañeda-Hernández DM, McGregor A. What makes people talk about Ebola on social media? A retrospective analysis. Travel Med Infect Dis. 2015;13(1):100–1. doi: 10.1016/j.tmaid.2014.11.004.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • James M. Shultz
    • 1
    Email author
  • Janice L. Cooper
    • 2
  • Florence Baingana
    • 3
  • Maria A. Oquendo
    • 4
  • Zelde Espinel
    • 5
  • Benjamin M. Althouse
    • 6
    • 7
    • 8
    • 9
  • Louis Herns Marcelin
    • 10
    • 11
  • Sherry Towers
    • 12
  • Maria Espinola
    • 13
  • Clyde B. McCoy
    • 14
  • Laurie Mazurik
    • 15
  • Milton L. Wainberg
    • 16
  • Yuval Neria
    • 4
  • Andreas Rechkemmer
    • 17
  1. 1.Center for Disaster and Extreme Event Preparedness (DEEP Center)University of Miami Miller School of MedicineMiamiUSA
  2. 2.The Carter Center, Mental Health Program LiberiaMonroviaLiberia
  3. 3.Makerere University School of Public HealthKampalaUganda
  4. 4.Department of PsychiatryColumbia University and New York State Psychiatric InstituteNew YorkUSA
  5. 5.Department of Psychiatry and Behavioral HealthUniversity of Miami Miller School of Medicine and Jackson Memorial HospitalMiamiUSA
  6. 6.Institute for Disease ModelingBellevueUSA
  7. 7.University of WashingtonSeattleUSA
  8. 8.New Mexico State UniversityLas CrucesUSA
  9. 9.Santa Fe InstituteSanta FeUSA
  10. 10.Interuniversity Institute for Research and Development (INURED)Port-au-PrinceHaiti
  11. 11.Department of AnthropologyUniversity of MiamiCoral GablesUSA
  12. 12.Simon A. Levin Mathematical, Computational and Modeling Sciences CenterArizona State UniversityTempeUSA
  13. 13.Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiUSA
  14. 14.Department of Public Health Sciences and Comprehensive Drug Research CenterUniversity of Miami Miller School of MedicineMiamiUSA
  15. 15.Department of Emergency MedicineSunnybrook Health Sciences CentreTorontoCanada
  16. 16.Department of PsychiatryColumbia University and the New York State Psychiatric InstituteNew YorkUSA
  17. 17.Graduate School of Social Work (GSSW)University of DenverDenverUSA

Personalised recommendations