title: The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak.
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.
authors.affiliation: 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.
authors.forename: James M
authors.initials: JM
authors.lastname: Shultz
authors.affiliation: The Carter Center, Mental Health Program Liberia, Monrovia, Liberia.
authors.forename: Janice L
authors.initials: JL
authors.lastname: Cooper
authors.affiliation: Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Florence
authors.initials: F
authors.lastname: Baingana
authors.affiliation: Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.affiliation: Department of Psychiatry and Behavioral Health, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: Zelde
authors.initials: Z
authors.lastname: Espinel
authors.affiliation: Institute for Disease Modeling, Bellevue, WA, USA.|University of Washington, Seattle, WA, USA.|New Mexico State University, Las Cruces, NM, USA.|Santa Fe Institute, Santa Fe, NM, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Althouse
authors.affiliation: Interuniversity Institute for Research and Development (INURED), Port-au-Prince, Haiti.|Department of Anthropology, University of Miami, Coral Gables, FL, USA.
authors.forename: Louis Herns
authors.initials: LH
authors.lastname: Marcelin
authors.affiliation: Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, USA.
authors.forename: Sherry
authors.initials: S
authors.lastname: Towers
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Espinola
authors.affiliation: Department of Public Health Sciences and Comprehensive Drug Research Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: McCoy
authors.affiliation: Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Mazurik
authors.affiliation: Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Milton L
authors.initials: ML
authors.lastname: Wainberg
authors.affiliation: Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Neria
authors.affiliation: Graduate School of Social Work (GSSW), University of Denver, Denver, CO, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rechkemmer
mesh_terms: D000354:Africa, Western; D001294:Attitude to Health; D004196:Disease Outbreaks; D005239:Fear / Q000523:psychology*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000523:psychology*; D006801:Humans
keywords: Ebola; Ebola virus disease (EVD); Fear; Fear-related behaviors; Outbreak; Pandemic