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

James M. Shultz, 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

Research output: Contribution to journalReview articlepeer-review

127 Scopus citations


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.

Original languageEnglish (US)
Article number104
JournalCurrent psychiatry reports
Issue number11
StatePublished - Nov 1 2016


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

ASJC Scopus subject areas

  • Psychiatry and Mental health


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