Mpox survivors in central Uganda carried a measurable mental health burden during recovery
Among mpox survivors in Kampala, Mukono, and Wakiso, anxiety, depression, and post-traumatic stress disorder were not rare background findings. They appeared as a substantial part of the illness experience itself. The study enrolled 385 survivors during February 2025, a period shortly after Uganda’s 2024 outbreak declaration and amid continued concentration of cases in the Kampala Metropolitan Area.
The median participant age was 29 years, with an interquartile range of 25 to 35 years, and 60% were female. Among women, 59% were sex workers, a detail that matters clinically because social position, exposure to stigma, and access to supportive care all shape how infectious disease is experienced long after lesions resolve. The psychiatric burden was not overwhelming across the entire cohort, but it was persistent enough to demand attention: 11% met criteria for anxiety, 14% for depression, and 9% for PTSD. In total, 22% reported at least one mental health disorder.
Severity of illness and the care setting tracked closely with psychological distress
The strongest associations clustered around how severe the illness felt and how the treatment environment was experienced. Survivors who stayed in a treatment unit for more than 14 days had a higher prevalence of mental health disorders, with an adjusted prevalence ratio of 2.1. A long admission in an isolation setting can convert a short-lived viral infection into a prolonged disruption of work, family contact, privacy, and bodily control. For infections that carry visible skin lesions and social fear, that separation can intensify anxiety and leave a lasting emotional imprint.
Perceived poor management at the treatment unit was associated with a markedly higher prevalence of mental health disorders as well, with an adjusted prevalence ratio of 2.7. In practice, this points to a bedside reality that often gets ignored during outbreak response: patients remember whether they were treated as contagious bodies to be contained or as people who needed explanation, reassurance, and dignity. Clinical encounters during epidemics shape mental health through uncertainty, lack of information, and perceived neglect, especially when patients are already isolated from normal social support.
One sentence captures the practical consequence. Poor care during isolation left a stronger psychiatric footprint than the infection alone.
Symptom burden and stigma amplified the risk of depression and PTSD
Disease severity was the clearest clinical driver in the analysis. Participants with moderate mpox symptoms had a higher prevalence of mental health disorders, with an adjusted prevalence ratio of 2.5, while those with severe symptoms had an adjusted prevalence ratio of 5.3. Severe symptoms likely increased distress through pain, visible lesions, functional limitation, and fear of disfigurement or prolonged contagion. In infectious disease outbreaks, symptom intensity often does more than mark biological burden; it also changes how a patient is perceived by others and how the patient perceives the self.
Perceived stigma carried its own effect, with an adjusted prevalence ratio of 2.1. That finding is clinically plausible and highly relevant in mpox, where visible rash, rumors of transmissibility, and association with marginalized groups can compound shame and avoidance. Stigma can delay care seeking, reduce disclosure, weaken adherence to instructions, and deepen post-illness distress. Mental health symptoms in that setting are not separate from the outbreak response; they are part of the same social and biological event.
Sex work was also associated with greater prevalence of mental health disorders, with an adjusted prevalence ratio of 1.7. The result does not isolate a biological pathway, but it does identify a population exposed to overlapping vulnerabilities: exposure to stigma, possible fear of disclosure, and likely dependence on unstable social and economic conditions during isolation and recovery. In a cross-sectional study, that association cannot establish causality, yet it does identify a group that may need targeted psychosocial support during future outbreaks.
What the prevalence numbers mean for outbreak response
The prevalence estimates were not extreme, but they were clinically meaningful. Depression was the most common of the three measured disorders, followed by anxiety and then PTSD. The pattern suggests that mpox survivors were not only reacting to an acute threat; many were carrying the slower, more lingering burden of disrupted routine, social withdrawal, and the stress of infection-related isolation. PTSD in 9% of participants indicates that for some survivors, the outbreak experience met a threshold of psychological trauma rather than temporary distress.
This matters because outbreak response teams often prioritize transmission chains, case counts, and isolation logistics while treating psychological care as optional. These findings argue against that separation. Mental health symptoms can affect recovery, follow-up engagement, and trust in health services. They also can remain invisible if clinicians do not ask directly, especially in settings where physical symptoms dominate the encounter.
Uganda’s mpox response needs mental health screening built into routine care
The study’s design was cross-sectional and community-based, so it captures burden at a single point in time rather than tracking symptom trajectories across recovery. Even so, the associations are coherent and operationally useful. Survivors with longer treatment stays, more severe symptoms, perceived poor unit management, and stigma were more likely to report mental health disorders. Those are not abstract risk factors; they are the same features public health teams can address through isolation protocols, communication, privacy protections, counseling access, and stigma reduction.
A practical outbreak model would screen for anxiety, depression, and PTSD in mpox treatment and follow-up settings, especially among patients with prolonged admissions or severe disease. It would also train staff to reduce perceived neglect, because the quality of care in isolation units may shape psychological recovery as much as the clinical treatment itself. The study does not answer how long these symptoms persist, whether they improve without intervention, or which mental health strategies work best in this population. It does show that psychological harm is already present in a notable share of survivors and is tied to modifiable features of care and social response.