Post-traumatic stress disorder, depression and anxiety among mpox survivors in central Uganda: a cross-sectional study

Abstract Background: Uganda declared a monkeypox (mpox) outbreak on July 24, 2024; by the year’s end, 1,353 cases had been reported in 55 districts, two-thirds of them in the Kampala Metropolitan Area (KMA). Epidemics, including mpox have negative mental health impacts that are often overlooked during emergency response. We assessed the prevalence and associated factors of anxiety, depression, and posttraumatic stress disorder (PTSD) among mpox survivors in the most affected districts in Uganda. Methods: We conducted a cross-sectional community-based study from February 1–28, 2025, using simple random sampling of mpox survivors from Kampala, Mukono, and Wakiso districts. Survivors were selected from district-specific lists. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and PTSD using the PTSD Checklist. Modified Poisson regression was used to identify associated factors. Results: We enrolled 385 participants with a median age of 29 years (IQR: 25–35); 60% were female, and 59% of these were sex workers. The prevalence of anxiety, depression, and PTSD was 11% (n=43; 95% CI: 8%–14%), 14% (n=53; 95% CI: 11%–18%), and 9% (n=33; 95% CI: 6%–12%), respectively. Overall, 22% (n=84; 95% CI: 18%–26%) reported 1 mental health disorder. Factors associated with increased prevalence of mental health disorders included longer treatment unit stay (>14 days) (aPR=2.1; 95% CI: 1.4–3.2), being a sex worker (aPR=1.7; 95% CI: 1.1–2.8), perceived poor management at the treatment unit (aPR=2.7; 95% CI: 1.4–4.9), moderate (aPR=2.5; 95% CI: 1.3–4.7) or severe Mpox symptoms (aPR=5.3; 95% CI: 3.2–9.7), and perceived stigma (aPR=2.1; 95% CI: 1.4–3.3). Conclusions: Approximately one in five mpox survivors experienced a mental health disorder during illness or recovery, underscoring the psychological impact of the disease. Key associated factors included prolonged hospitalization, sex work, perceived poor care, severe symptoms, and stigma. These findings highlight the need to integrate mental health support into Mpox response efforts through tailored interventions that address stigma, care quality, and social support.