The Mental Health Consequences of Chornobyl

Psychological Impact of the Chornobyl Disaster : 

Psychological Impact of the Chornobyl Disaster Evelyn J. Bromet, Ph.D. Professor of Psychiatry & Preventive Medicine Stony Brook University April 2008

2006 Report of the Chornobyl Forum : 

2006 Report of the Chornobyl Forum “The mental health impact of Chernobyl is the largest public health problem caused by the accident to date.”

Significance of mental health impacts: 

Significance of mental health impacts Poor mental health  A leading cause of disability worldwide Poor quality of life Decreased productivity Poor physical health Greater use of medical services Mortality

Psychological consequences of disasters: 

Psychological consequences of disasters Over the past 100 years, many studies showing that natural and human-made disasters have a large mental health impact. Depression (suicide and suicide attempts) Anxiety (especially post-traumatic stress disorder) Somatic symptoms (fatigue, headaches, joint pain) Substance abuse Highly inter-correlated

Magnitude: 

Magnitude 20% excess psychological morbidity in 1st year Every disaster is unique; psychological impact varies a lot Varies depending on who was studied, and how much they endured and lost Varies depending on level of chaos before & after Toxic events (Bhopal, Three Mile Island, Chernobyl)  severe and prolonged -- perhaps because:

Radiation events and stigma: 

Radiation events and stigma Stigma from society A-bomb survivors – hibakusha (explosion-affected people) Chornobyl evacuees - pereselentsy (resettlers) Stigma from medical community: disparaging diagnoses for patients with health-related anxiety A-bomb neurosis radiophobia

Mental health aftermath of Chornobyl: 

Mental health aftermath of Chornobyl

Who were studied?: 

Who were studied? General population evacuated or living nearby Exposed children Liquidators

General population studies: 

General population studies Bryansk Gomel Kyiv 2 general pop. surveys in Ukraine

Bryansk : 

Bryansk 1. Compared 325 adults in a contaminated village with 278 controls non-contaminated village 2. 7 years later 3. Standard psychological tool (GHQ) 4. Exposed more symptomatic than controls, especially women (48% vs 34% “minor mental disorder”) Viinamäki et al., 1995

Gomel : 

Gomel 1. Compared 1,617 adults in Gomel to 1,427 controls in Tver 2. 6.5 years later 3. 2-stage study Havenaar et al. 1997

Gomel vs Tver: 

Gomel vs Tver

Kyiv: 

Kyiv 1. 300 evacuee mother-child dyads (in utero-15 mos. at time of accident) with gender-matched classmates 2. 11 and 19 years after accident 3. Mothers: PTSD, self-rated health, and major depression *Funded by NIMH; Bromet et al. 2000

Psychological well-being: 

Psychological well-being

Chornobyl studies: 

Chornobyl studies Methodological concern: over-estimated effects because focused on Chornobyl. (applies to all disaster studies) Findings from surveys not focused explicitly on Chornobyl?

2 national surveys conducted by KIIS: 

2 national surveys conducted by KIIS National sample of 1606 adults 12 years later (1998) National survey of 4,725 adults 16 years later (2002) asked about Chornobyl exposure at end of interview Diagnosable episode of depression since 1986: Women: 23% exposed vs 19% not Men: 14% exposed vs 9% not Severe headaches: Women: 55% exposed vs 45% not Men: 28% exposed vs 19% not

General population: 

General population There are long-term psychological effects Found even in studies that are not explicitly about Chornobyl

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Children: main issue is cognitive impairment

Sources of evidence: 

Sources of evidence WHO International Pilot Study of Brain Damage In-Utero (age 7) Additional follow-up in Belarus Additional work in Kyiv Stony Brook/Kyiv research (ages 11 and 19) Israeli study of children expo < age 4 or in utero in 1986 Neuropsychological tests of memory, intelligence, attention

No differences between exposed children and controls: 

No differences between exposed children and controls WHO study Stony Brook/Kyiv Israeli study

Belarus study: 

Belarus study 1. Ages 6-7; follow-up ages 10-11 2. Higher rate of mental retardation in exposed vs controls (1.5% vs 0.8%) 3. Higher rate of ICD-10 diagnosis: 41% expo vs 21% controls 4. No dose-response relationship 5. Did not attribute their findings to radiation *developmental delays, emotional disorders, tic disorders, etc.

Kyiv RCRM study: 

Kyiv RCRM study 1. Exposed vs controls (Kharkiv) 2. Significant diff’s in rates of borderline intelligence, mental retardation, emotional disorders, and EEG measures. 3. Subsample of 50 expo and 50 controls 72% expo vs 28% controls ICD-10 dx 4. Dose response relationship 5. Attributed differences to radiation exposure

Summary of neurocognitive effects in kids : 

Summary of neurocognitive effects in kids Evidence equivocal All studies have serious flaws WHO: flawed execution Stony Brook: underpowered Israeli study: sample selection Belarus: appropriate controls? Kyiv RCRM: appropriate controls? No adjustment for parental IQ and SES

Mental health of liquidators: 

Mental health of liquidators Neurocognitive impairment from radiation Emotional consequences of stress

Neurocognitive impairment: hypotheses: 

Neurocognitive impairment: hypotheses 1. Radiationpsychosis (RCRM) 2. Radiationaccelerated aging (Institute of Gerontology) 3. Radiationimpairment in brain functioning (Florida/Kyiv Polytechnic Institute) My conclusion: studies serious bias; untested hypotheses

Emotional consequences: suicide: 

Emotional consequences: suicide Estonian liquidators No significant excess of cancer deaths (1986-1993) Significant excess of suicide (SMR=1.52; 95% CI=1.01-2.19)

RCRM/WMH study: 

RCRM/WMH study Diagnostic interviews by KIIS With liquidators from 5 regions in 2003 With controls from these regions in 2002 Liquidators > depression, anxiety, suicide ideation, and severe headaches

Summary on mental health of liquidators: 

Summary on mental health of liquidators Studies of neurocognitive effects are unverified and flawed Emotional consequences are compelling

Conclusion of research: 

Conclusion of research The evidence supports the WHO conclusion about public mental health impact of Chornobyl. Findings are consistent with research on other toxic exposures.

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Radiation Evacuation -- abortion assembly-lines Battle for residency permits Alarmist reports in news media Distrust in government authorities Physicians’ attributing health problems to Chornobyl Intensive health monitoring by international community Political and social upheaval Decline in standard of living Complex web of exposures

Disconnect between need and practice of psychiatry: 

Disconnect between need and practice of psychiatry Mental health care focuses on patients in hospitals with severe psychiatric disorders and alcoholism No community mental health system of care Where to begin? *Community centers: UNESCO *Primary care doctors: Most people turn to their GPs for help with mental problems Educate GPs to recognize and treat disorders like depression & anxiety, especially in high risk groups (Chornobyl) Destigmatize emotional disorders at all levels of society

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Thank you !!! Dyakooyoo !!!