OBJECTIVE: Previous research suggests that adult survivors of Ebola virus disease (EVD) experience mental health problems following their infection. This study examines long-term mental health consequences of EVD for child survivors, and those affected by EVD but not themselves infected, compared to controls. This study also examines the mediating effects of caregiver mental health on children's mental health outcomes. METHOD: Using a case-control study design, we recruited 663 children and adolescents ("children" throughout
aged 10-17 years) and their caregivers at 2 time points, from 6 geographically diverse districts in Sierra Leone. Our analytic sample included 217 EVD-infected children, 206 EVD-affected children (ie, children who were not themselves infected but someone in their household was infected), 230 control children, and 1 caregiver per child (N = 653). Using a structural equation model, we examined the mediating effects of caregiver anxiety and depression at time 1 on the relationship between study condition and children's prosocial behaviors and behavioral difficulties at time 2, controlling for child's age, sex, household wealth, urban vs rural residential environment, and district. RESULTS: EVD-infected and -affected children were more likely to demonstrate behavioral difficulties compared to controls. Caregiver depression mediated the relationship between being affected by EVD and children's behavioral problems. Caregiver anxiety mediated the relationship between being EVD affected and children's prosocial behaviors. CONCLUSION: The mental health consequences of EVD are long-lasting for EVD child survivors and those affected, as well as caregivers. Policy and programmatic responses need to account for the heightened vulnerability introduced not only to survivors after an infectious disease outbreak, but to their families and household members. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.