Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 21, Number 5—May 2015

Ebola and Psychological Stress of Health Care Professionals

Cite This Article

To the Editor: Providing medical care for Ebola virus–infected patients entails physical and psychological stress, extended shift times, and risk for infection. In addition, the wearing of personal protective equipment impairs communication and performance of diagnostic and therapeutic procedures. Lessons learned from outbreaks of other infectious diseases indicate that such challenging treatment environments require the monitoring of health care professionals for psychological distress (e.g., anxiety, depression, fatigue, and social isolation) to prevent personal exhaustion and reduced job performance (1).

In August 2014, the first patient in Germany known to have Ebola virus disease was admitted to the University Medical Center Hamburg-Eppendorf (2) and received treatment in the isolation facility for 18 days. We hypothesized that health care professionals working in the isolation unit who had direct contact with the Ebola patient would show more signs of psychological distress than those not working in the isolation unit.

To test our hypothesis, we conducted a cross-sectional controlled study by using validated self-report scales (1,35) and open-response questions. Seven days after the Ebola patient was admitted, we distributed questionnaires to the 46 health care professionals (17 physicians, 29 nurses) who had direct contact with the patient (Table).

Of the 46 health care professionals, 30 participated in the study. During patient contact, these staff members wore Astro-Protect pressurized suits (Asatex, Bergheim, Germany). As a control group, 40 health care professionals from other wards in the same department were recruited and participated in the study. Providers in the control group cared for terminally ill patients and for patients with reduced consciousness, but they had no direct contact with the Ebola patient. The control participants were not recruited from intensive care units because, at the time of the study, the patient was not receiving intensive care treatment. The 2 groups were balanced with respect to age and occupational characteristics (Table). There was no special psychological support service for health care workers in this hospital. Staff members had received mandatory biweekly training, which included decontamination procedures, technical aspects of diagnostic procedures, and emergency care.

In contrast to our hypothesis, no significant differences emerged between the 2 groups with respect to the severity of somatic symptoms, anxiety, depression, and fatigue (Table). Moreover, mean total scores for both groups were at a comparable level to mean scores for the general population (35). However, health care professionals who had direct contact with the Ebola patient reported significantly greater social isolation and felt significantly more need for shorter shift hours. The open responses of participants who experienced social isolation suggested that their spouses, children, and other relatives had infection-related concerns. Additionally, half of the participants who did not have direct patient contact reported feeling a need for psychological preparation (Table). Nevertheless, almost all health care professionals (97% of those with direct patient contact, 93% of those without direct patient contact) believed that the health care facilities of the hospital were safe.

Our investigation of the psychological stress of health care professionals in a Western tertiary care center showed that a well-trained and dedicated team can cope well with the stress of caring for a severely ill Ebola patient. Of note, the direct patient contact group tended to comprise more male participants and more participants living with partners, which may have influenced the experience of psychological stress. No staff member refused to participate in the treatment of the Ebola patient, which underlines the high level of motivation within the team and may render direct comparison to other centers difficult.

While the patient was in the isolation unit, working shifts lasted up to 12 hours, consisting of 2 periods with 3–4 hours of work while wearing personal protective equipment in addition to time spent disinfecting. Most respondents felt that these shifts were too long. We therefore suggest that shift durations should be decreased to 8 hours comprising 2 blocks of 2 hours each for direct patient contact. Shorter shifts should improve staff satisfaction with the working conditions and potentially increase the personal safety of all health care personnel involved in direct patient contact.


Marco Lehmann1Comments to Author , Christian A. Bruenahl1, Bernd Löwe, Marylyn M. Addo, Stefan Schmiedel, Ansgar W. Lohse, and Christoph Schramm
Author affiliations: University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M. Lehmann, C.A. Bruenahl, B. Löwe, M.M. Addo, S. Schmiedel, A.W. Lohse, C. Schramm); Schön Klinik Hamburg-Eilbek, Hamburg (M. Lehmann, C.A. Bruenahl, B. Löwe); German Center for Infection Research, Hamburg-Lübeck-Borstel, Germany (M.M. Addo)



  1. Imai  H, Matsuishi  K, Ito  A, Mouri  K, Kitamura  N, Akimoto  K, Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross-sectional study of hospital workers in Japan during the pandemic (H1N1) 2009. BMC Public Health. 2010;10:672 . DOIPubMedGoogle Scholar
  2. Kreuels  B, Wichmann  D, Emmerich  P, Schmidt-Chanasit  J, de Heer  G, Kluge  S, A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014;371:2394401 .DOIPubMedGoogle Scholar
  3. Gierk  B, Kohlmann  S, Kroenke  K, Spangenberg  L, Zenger  M, Brähler  E, The Somatic Symptom Scale-8 (SSS-8): a brief measure of somatic symptom burden. JAMA Intern Med. 2014;174:399407. DOIPubMedGoogle Scholar
  4. Löwe  B, Decker  O, Müller  S, Brähler  E, Schellberg  D, Herzog  W, Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46:26674. DOIPubMedGoogle Scholar
  5. Rief  W, Nanke  A, Klaiberg  A, Braehler  E. Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord. 2004;82:2716 . DOIPubMedGoogle Scholar




Cite This Article

DOI: 10.3201/eid2105.141988

1These authors contributed equally to this article.

Related Links


Table of Contents – Volume 21, Number 5—May 2015

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.



Please use the form below to submit correspondence to the authors or contact them at the following address:

Marco Lehmann, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Martinistraße 52, 20246 Hamburg, Germany

Send To

10000 character(s) remaining.


Page created: April 18, 2015
Page updated: April 18, 2015
Page reviewed: April 18, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.