Outcomes
Sample
Results
Method
References
Mental and psychosomatic effects in the long term
Psychological well-being
Adolescents who exposed in utero to radiation from the Chernobyl accident and their mothers, in the affected area in Norway
Adolescents themselves reported few problems; the level of problems reported by the mothers was generally lower than that reported by the adolescents
The Child Behavior Checklist (CBCL), the Youth Self- Report (YSR)
Heiervang, Mednick, Sundet, & Rund, 2011
Depression, anxiety, somatization
General population adults from two geographic areas of differing radiation contamination within Belarus
Degree of chronic daily stressors showed a significant positive relationship with psychological distress, whereas mastery/controllability showed a significant inverse relationship with distress
Brief Symptom Inventory depression, anxiety, and somatization subscale
Beehler et al., 2008
Depression, PTSD, Headaches
Cleanup workers
More frequent than controls
WHO Composite International Diagnostic Interview
Loganovsky et al., 2008
Depression, Anxiety Spectrum Complaints, PTSD
General population adults, immigrants to the USA from the former Soviet Union, within 50 km from Chernobyl
More frequent than 50–150 km or over 150 km
Beck Depression Inventory, Beck Anxiety Inventory, Revised Civilian Mississippi PTSD Scale
Foster & Goldstein, 2007
Suicide risk
Cleanup workers
Higher than controls
Standard mortality rate
Rahu, Rahu, Tekkel, & Bromet, 2006
Anxiety, depression, fear, somatization, mother’s report of psychological well-being
11-year-old children who were exposed in utero to age 15 months when the accident occurred and their mothers
No statistically significant differences on the self-report; the evacuee mothers rated their children’s well-being as significantly worse, especially with respect to somatic symptoms
The Children’s Manifest Anxiety Scale, the Depression Self-Rating Scale, the Fear Inventory, the Children’s Somatization Inventory, CBCL
Bromet et al., 2000
Anxiety
Mothers and fathers of the children who had been exposed in the prenatal period at the time of the accident in Belarus
An increased prevalence of high personal anxiety compared to the control group
The State-Trait Anxiety Inventory
Igumnov & Drozdovitch, 2000
Mood Disorders, depression symptoms, Anxiety Disorders, psychosomatic distress, psychological well-being
General population adults in the affected area in Belarus
No statistically significant differences in DSM diagnosis for mood disorders and anxiety disorders; more frequent than controls in self-rating scale
DSM-III-R, Brief Scales for Anxiety and Depression, depression subscale, Bradford Somatic Inventory score, 12-item General Health Questionnaire
Havenaar et al., 1997
Psychosomatic distress
Cleanup workers
Length of work ( <28 days) in a 10-km radius from the reactor, work ( <1 time) on the damaged reactor roof, forest work, and fresh fruit consumption were risk factors
Depression, cardiovascular physiologic malfunction arising from mental factors and unspecified disorders of the autonomic nervous system by ICD-9
Viel et al., 1997
Neurocognitive effects in the long term
IQ
Adolescents who were exposed in utero to radiation from the most contaminated areas in Norway
Scored significantly lower in full-scale IQ than unexposed adolescents; the difference was restricted to verbal IQ
Two subtests from the Wechsler Abbreviated Scale of Intelligence
Heiervang, Mednick, Sundet, & Rund, 2010
IQ, school performance, attention, memory, subjective appraisals of memory problems
Children who were in utero to age 15 months, evacuated to Kyiv from the 30 km zone and their mothers
No statistically significant differences (vs. classmates) in IQ, school performance, attention and memory; more evacuee mothers subjectively reported memory problems in their children than classmates’ mothers, but these reports were not correlated with performance on the neuropsychological tests or grades in school
The symbolic relations subtest of the Detroit Tests of Learning Aptitude, GPA, two forms of the VSAT, The Benton Visual Retention Test A
Accuracy and efficiency of cognitive performance
Cleanup workers, foresters and agricultural workers
Averaged levels of performance of the exposure groups were significantly lower than those of the controls
The ANAMUKR battery
Gamache, Levinson, Reeves, Bidyuk, & Brantley, 2005
IQ
Children who had been exposed in the prenatal period at the time of the accident in Belarus
At the age of 6–7: lower mean full-scale IQ compared to the control group; by the age of 10–12: no statistically significant differences
The Wechsler Intelligence Scale for Children
Igumnov & Drozdovitch, 2000
Mental Health Effects in the Long Term
Three groups have been the target of research on the mental health consequences of Chernobyl (Bromet et al. 2011) . The group of cleanup workers is focused upon because they worked near the damaged reactor. The second group consists of children exposed in utero or as young infants and their parents because of an elevated rate of thyroid cancer in children. The adult population with varying levels of exposure is the third group.
For cleanup workers, higher suicide risk (Rahu et al., 2006) and higher prevalence of depression and PTSD (Loganovsky et al., 2008) were observed. A research group in Latvia assessed the associations of various exposure variables with mental and psychosomatic distress in a sample of 1412 Latvian liquidators drawn from the State Latvian Chernobyl Clean-up Workers Registry (Viel et al., 1997) . They revealed that length of work ( <28 days) in a 10-km radius from the reactor, work ( <1 time) on the damaged reactor roof, forest work, and fresh fruit consumption were risk factors for mixed mental-psychosomatic disorder, which consisted of depression, cardiovascular physiologic malfunction arising from mental factors, and unspecified disorders of the autonomic nervous system, according to International Classification of Diseases (ICD)-9 coding system.
In the second group, an increased prevalence of high personal anxiety of the parents in Belarus was reported (Igumnov & Drozdovitch, 2000) . In this article, a moderate correlation between high personal anxiety in parents and emotional disorders in children was also reported. In another study (Bromet et al., 2000) , although there were no statistical differences in the self-reports of psychological well-being between the adolescents who were exposed in utero to age 15 months and controls, the evacuee mothers rated their children’s well-being as significantly worse, especially with respect to somatic symptoms. Interestingly, it seems that the geographical closeness is related to the anxiety level of the parents in the long term. A study in Norway showed that adolescents themselves reported few problems, and the level of problems reported by the mothers was generally lower than that reported by the adolescents (Heiervang et al., 2011) . A possible explanation for this discrepancy between investigations is that the mothers of the Norwegian participants experienced less Chernobyl-related anxiety, due to fortunate circumstances in Norway and perceived physical and psychological distance from the disaster (Heiervang et al., 2011) .
For general population adults in the affected area, the long-term effects might be at a moderate or subclinical level (Havenaar et al., 1997; Foster & Goldstein, 2007; Beehler et al. 2008) . Compared to the residents who had lived over 50 km from the plant, depression, anxiety, and PTSD symptoms were greater for those living within 50 km of the accident site at 15 years post Chernobyl (Foster & Goldstein, 2007) . Beehler et al. (2008) conducted a multilevel analysis and revealed that female gender, greater number of chronic stressors, and the perception of family problems were associated with psychological distress. By contrast, higher mastery/controllability was significantly predictive of lower depression, lower anxiety, and lower somatization scores, 20 years after the accident.
Neurocognitive Effects in the Long Term
Most of the studies have been focused on the exposed children who were in utero in April, 1986. The results concerning intellectual development are conflicting. The evacuee children in Ukraine who were in utero to age 15 months, evacuated to Kyiv from the 30-km zone, showed no statistically significant differences compared to their classmates, 11 and 19 years after the accident (Litcher et al., 2000; Taormina et al., 2008) . In a Belarusian study, 250 exposed in utero children at the age of 6–7 and 10–12 years were compared to a control group of 250 children of the same age from non- and slightly contaminated areas of Belarus (Igumnov & Drozdovitch, 2000) . It was a noteworthy feature that despite the lower mean full-scale IQ at 6–7 years compared to the control group (the Wechsler Intelligence Scale for Children; 89.6 ± 10.2 vs. 92.1 ± 10.5, p = 0.007), there were no statistically significant differences (94.3 ± 10.4 vs. 95.8 ± 10.9, p = 0.117) by the age of 10–12. These results suggest that the intellectual development might reduce the gap between the exposed children and the non-exposed children. However, another study conducted in Norway (Heiervang, et al., 2010) showed that the mean IQ of exposed group (84 adolescents who were exposed in utero to radiation from the most contaminated areas at 19 years) was 100.4 ± 13.1, and the mean IQ of the control group was 105.4 ± 12.1 by two subtests from the Wechsler Abbreviated Scale of Intelligence.
Another study focused on parents of the exposed children. The subjective appraisals about the memory problems of their children were examined (Litcher et al., 2000) . More evacuee mothers subjectively reported memory problems in their children than classmates’ mothers, but these reports were not correlated with performance on the neuropsychological tests or grades in school. This result is consistent with a study of Igumnov and Drozdovitch (2000) , which showed an increased prevalence of high personal anxiety in mothers and fathers.
A 4-year longitudinal study of the cognitive effects of exposure (Gamache, et al., 2005) showed that the average levels of the exposed groups, including eliminators (who are assigned “cleanup”duties at or very near the accident site), forestry workers, and agricultural workers, were significantly lower than those of the controls on most measures. They also reported the significant declines in accuracy and efficiency, as well as psychomotor slowing, for all exposed groups over the 4-year period.
Three Mile Island Accident
Brief Summary of the Accident
The accident at TMI nuclear facility on March 28, 1979 in Pennsylvania was registered as a level 5 on the International Nuclear and Radiological Event Scale by the International Atomic Energy Agency (IAEA). After the accident, there was no increase in cancer morbidity or mortality. Moreover, the evacuation was voluntary and temporary, and almost all the families returned within 2 weeks (Bromet, 2012) .
In a report of the President’s Commission on the accident at TMI, it is clearly stated that the major health effect of the accident appears to have been on the mental health of the people living in the region of TMI and of the workers (President’s Commission on the accident at TMI, 1979). The reactor restarted in October 1985, after the extended legal conflict (Dew, Bromet, Schulberg, Dunn, & Parkinson, 1987) . It should be considered that this restart also influenced the psychological consequences of the people, as discussed more fully next.
Mental Health Effects in the Long Term
Here, we reviewed the mental or psychosomatic health effects in the long term (Table 5.2). A series of longitudinal epidemiologic studies was designed to focus on the mental health of the mothers of young children living within ten miles of the plant (Dew et al., 1987; Dew & Bromet 1993) . It is noteworthy that symptom levels after restart were elevated over previous levels (Dew et al., 1987) . The results from cluster analysis of this cohort 10 years following the accident showed two major subgroups of women: those whose temporal profiles were either (a) stable and at a low, clinically non-significant psychiatric symptom level across all measurements points (65 % of the sample), or (b) at consistently elevated levels of distress (35 % of the sample; Dew & Bromet, 1993) . Multivariate analyses indicated that pre-accident characteristics as well as parameters reflecting respondents’ initial involvement with and reactions to the accident were important for distinguishing between women within the two temporal profile groups. Meanwhile, Prince-Embury and Rooney (1995) revealed that an increased lack of control, a lack of faith in the radiation experts, and an increased fear of developing cancer were observed among the residents following the restart of the nuclear-powered generator.
Table 5.2
Summary of key findings of the TMI accident
Outcomes | Sample | Results | Method | References |
|---|---|---|---|---|
Mental and psychosomatic effects in the long term | ||||
Psychological symptoms | Adult residents near TMI | A lowering of psychological symptoms between 1985 and 1989 in spite of increased lack of control, less faith in experts and increased fear of developing cancer | The Revised Symptom Checklist (SCL-90-R) | Prince-Embury & Rooney, 1995 |
Psychological symptoms, including depression, anxiety, and hostility | Mothers living within 10 miles of TMI | Pre-accident characteristics, as well as parameters reflecting respondents’ initial involvement with, and reactions to the accident, were important for distinguishing between high and low level of distress | The depression, anxiety, and hostility subscales of the Symptom Checklist-90 (SCL-90) | Dew & Bromet, 1993 |
Anxiety and depression, subjective rating of their children’s health | Pairs of mothers and children lived in communities within 10 miles of the nuclear facility | No statistically significant differences (vs. controls); mothers rated poorer mean ratings of their children than controls | The Hopkins Symptoms Checklist (HSCL) | Houts, Tokuhata, Bratz, Bartholomew, & Sheffer, 1991 |
Psychological symptoms, including depression, anxiety, and hostility | Mothers living within 10 miles of TMI | Symptom levels after restart were elevated over previous levels; history of diagnosable major depression and generalized anxiety following the accident, plus symptoms and beliefs about personal risk prior to the restart, best predicted post-restart symptoms | The depression, anxiety, and hostility subscales of the Symptom Checklist-90 (SCL-90) | Dew et al., 1987 |
Psychological symptoms | Nuclear plant workers | No statistically significant differences than another nuclear plant workers | The Symptom Checklist (SCL-90) | Parkinson & Bromet, 1983 |
Five years after the accident, another follow-up study (Houts, et al., 1991) was conducted for 1,880 mothers who gave birth within 12 months of the accident and lived in communities within 10 miles of the nuclear facility. Although the anxiety and depression symptoms had no statistically significant differences, the mothers rated their 5-year-old children’s health as poorer than the mothers who gave birth from 13 to 24 months after the accident. The lowered subjective appraisals of their children are consistent with the studies after the Chernobyl accident (Litcher et al., 2000; Igumnov & Drozdovitch, 2000) .
The mental health of 104 nuclear workers at the TMI plant was compared 2.5 years after the accident with that of 122 workers from another nuclear plant and 151 workers from two coal-fired generating plants (Parkinson & Bromet, 1983) . This was the follow-up study of a telephone survey, which showed more hostility and psychophysiological symptoms at the time of the accident (Kasl, Chisholm, & Eskenazi, 1981a; b) . Surprisingly, the coal-fired plant workers were somewhat more symptomatic than the nuclear plant workers, probably because of the workplace exposure problems. The research group suggested that the impact of the accident on workers at the plant was unremarkable in the long term.
Tokaimura Accident
Brief Summary of the Accident
On September 30, 1999, a critical accident occurred in the conversion building at the uranium conversion facility of JCO Company Limited in Tokaimura , Ibaraki Prefecture, Japan (IAEA, 1999). It resulted in three JCO workers suffering acute radiation syndrome, and a number of workers and members of the public receiving radiation doses. Some 161 people were evacuated from within about 350 m of the facility, and some 310,000 people were advised to stay indoors for about 18 h as a precautionary measure. This accident, which was ranked a level 4 on the IAEA Scale, was considered the worst civilian nuclear radiation accident in Japan prior to the Fukushima Daiichi Nuclear Power Plant accident.
Mental Health Effects
Following the Tokaimura accident, Japanese psychiatrists began performing consultations of the 59 residents 2–4 weeks after the disaster and found that residents complained about concerns of their physical health, anxiety, insomnia, and irritability (Tomita & Nakajima, 1999) . Furthermore, they also found that pregnant mothers were concerned about future risks to their pregnancy and the possible adverse effects on their child, including those who were exposed in utero.
Surveys on the symptoms of PTSD were also conducted after the interventional seminars for the residents around the site. The topics of the lectures were on PTSD symptoms and related psychological issues, titled “Care of Child (after the accident)”. Surveys were also conducted at the consultation center (Konishi & Inamoto, 1999) , and a screening questionnaire of PTSD symptoms (the Impact of Events Scale – Revised, IES-R) was also performed (Asukai, et al., 2002) . Among the 424 event participants, 31 residents (7.2 %) were considered part of the high-risk group. Meanwhile, 47.5 % (n = 19) of the consultation center visitors (n = 40) were placed in the high-risk group. They also revealed that the close proximity and the subjective threat of death had also influenced the IES-R score.
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