Overview of Monkeypox

Over 32 deaths have been registered in 2024 in 15 African countries due to monkeypox virus, currently known as Mpox. Mpox is a viral infection caused by the monkeypox virus which was first discovered in the 1958 in Congo, transmitted from animals (monkeys of different species, squirrels, andrats) to humans.^1,6 Monkeypox virus(MPXV) has 2 clades: Clade I having two subtypes Ia, Ib, and Clade II.^1,2 People who have Mpox virus usually present with:

• Body rash, which can be painful or itchy
• Fever
• Enlarged lymph nodes
• Body ache (headache, muscle ache and back ache)
• Cough, sore throat, and nasal congestion
• Fatigue^1,5

Transmission of the virus from one person to another can happen through: 

• Contact with infected people (touching, kissing, sex)
• Face to face speaking with infected persons and breathing close to one another
• Contact with contaminated objects such as clothes or linens
• Needle injuries, for example caused by health professionals or tattoo parlours
• From pregnant mother to child.^1,9

Recent Outbreak Context 

The recent Mpox outbreak started in May 2022. As of August 2024 statistics, WHO has reported a total of 186 probable cases and 103 048 confirmed cases, with 229 deaths recorded worldwide. Currently in Africa, 5,759 cases have been noted with Democratic Republic of Congo having the most of the cases in 2024 due to MPXV clade I.² 

During Mpox outbreaks, management plans involve medical treatment such as pain management, skin care, and isolation for a period of time until the patient heals and is no longer contagious.⁶ Isolation of patients helps to stop the spread of infection, however it contributes to the various mental outcomes for the patient, caretakers and, inevitably, the society at large. 

Travelling restrictions were also put in place to reduce the spread of the virus by some countries. Miscommunication and lack of awareness in local communities also impact individual and societal mental health status during outbreaks, monkeypox inclusive.⁷

Monkeypox Outbreak Impact on Mental Health

Impact on infected individuals

People infected from Mpox infection have been seen to suffer from various mental disorders, some of which are discussed below. 

Anxiety disorders, stress and depression 

These can be caused by long periods of isolation and the  fear of spreading the virus and infecting others. In developing countries, anxiety disorders were caused by financial constraints where  patients felt they were a burden to their caretakers. Anila and collaborators reported that  25% to 50% of patients infected with mpox virus have anxiety and depression.^3,4

• Self harm and suicidal tendencies are prominent in infected persons who have experienced prolonged isolation³
• Social stigma from the community and  social isolation lead to loneliness and depression³ 
• Low self esteem and self worth are experienced even after healing due to scars from the body rash⁴ 
• Mental illnesses like depression and schizophrenia worsen in infected individuals due to isolation and loneliness associated with management guidelines of mpox infection

Impact on close contacts and families

Family members, close contacts and caretakers also faced mental issues during the monkeypox outbreak. These include:

• Fear of getting the  monkeypox virus from the infected⁴
• Stress and anxiety related to financial burden of taking care of infected persons⁴
• Stigma and discrimination experienced by patients from hospital staffs and the community⁴ 
• Long period of isolation and loneliness of infected people and inability to see loved ones can lead to depression in family members and caretakers⁷

Impact on Healthcare Workers

Health professionals: doctors, nurses, laboratory technicians and other hospital staffs were also affected mentally during this recent mpox outbreak in the following ways:

• Exhaustion and burnout from increased workload as the Mpox outbreak followed after the COVID-19 Pandemic and healthcare workers had not yet fully recovered^3,4
• Fear of being infected: working in the hospital on a daily basis exposes healthcare workers to all kinds of infections, especially monkeypox infections during the outbreak⁴

Societal-Level mental health impact

Communities where monkeypox virus was diagnosed also suffered various mental health impacts as seen below:

• Anxiousness and panic caused by misinformation and lack of adequate information about monkeypox, its management, and containment strategies³
• People were frustrated due to the travel restrictions implemented to restrict the spread of the virus, hence disrupting daily activities, businesses, etc⁴
• Depression is a major mental impact of Mpox in society^3,7
• Increase in stress is a major risk factor for developing diseases such as diabetes or hypertention⁴

Approaches and Actions to Manage the Mental Health Effects of Monkeypox

Understanding the impact of the monkeypox outbreak on mental health of patients, their families and friends, and the affected society, strategies has to be put in place to mitigate them. The following are various ways in which these strategies could be carried out:

• Public health Organisations: Governments of countries with mpox infections as well as other non-government organisations should put in place guidelines for management of Mpox infected individuals, both physically and mentally, for health professionals to follow³
• Raise awareness with clear and concise information about mpox infection through workshops, conferences, and other community interventions to reduce fear and panic in the society⁷
• Establishment of support groups, mindfulness exercises, and recreational programmes to manage the mental health impact of the outbreak on individuals, and society at large
• Provide protective measures for healthcare workers at the frontline of treating infected individuals, creating support programmes to nourish their mental state 
• Recruit more healthcare workers to relieve exhausted health workers^7,8

Long-Term Mental Health Considerations

• People affected by monkeypox virus are prone to have Post Traumatic Stress Disorders(PTSD) following stigmatisation and loneliness. Continuous follow up is needed to manage these cases as well as psychological evaluation and counselling to help manage cases of PTSD⁷
• Due to prolonged isolation and loneliness, patients post-recovery sometimes find it difficult to re-integrate into the society and need support in this aspect⁷
• Continuous support programmes and recreational programs should be implemented in affected communities in order to mitigate the mental health challenges in these communities⁷

Summary

The recent monkeypox outbreak that started in 2022 till present has spread to many countries all around the world, affecting individuals physically, socially, and financially, and have also greatly impacted healthcare providers as well as the affected society mentally. Strategies put in place to stop the spread of the monkeypox virus have contributed greatly in leading to depression and anxiety in affected populations. This calls for action to mitigate these mental health challenges in the infected individuals, friends and families, and communities by implementing public health strategies, support groups, recreational programmes, and continuous monitoring that will help in managing PTSD and other potential mental health disorders after recovery.