RESUMEN
The Chernobyl Forum Report from the 20th anniversary of the Chernobyl nuclear power plant disaster concluded that mental health effects were the most significant public health consequence of the accident. This paper provides an updated review of research on the psychological impact of the accident during the 25 year period since the catastrophe began. First responders and clean-up workers had the greatest exposure to radiation. Recent studies show that their rates of depression and post-traumatic stress disorder remain elevated two decades later. Very young children and those in utero who lived near the plant when it exploded or in severely contaminated areas have been the subject of considerable research, but the findings are inconsistent. Recent studies of prenatally exposed children conducted in Kiev, Norway and Finland point to specific neuropsychological and psychological impairments associated with radiation exposure, whereas other studies found no significant cognitive or mental health effects in exposed children grown up. General population studies report increased rates of poor self-rated health as well as clinical and subclinical depression, anxiety, and post-traumatic stress disorder. Mothers of young children exposed to the disaster remain a high-risk group for these conditions, primarily due to lingering worries about the adverse health effects on their families. Thus, long-term mental health consequences continue to be a concern. The unmet need for mental health care in affected regions remains an important public health challenge 25 years later. Future research is needed that combines physical and mental health outcome measures to complete the clinical picture.
Asunto(s)
Accidente Nuclear de Chernóbil , Trastornos Mentales/etiología , Traumatismos por Radiación/psicología , Estrés Psicológico/etiología , Humanos , Traumatismos por Radiación/etiología , Estudios Retrospectivos , UcraniaRESUMEN
BACKGROUND: Several studies have reported increased incidence rates of psychotic disorders among immigrant groups. Surprisingly, the cross-cultural validity of the diagnostic instruments that were used was never tested. AIMS: To examine whether the incidence rates of psychotic disorders including schizophrenia among Moroccan immigrants to the Netherlands remain increased when a cultural sensitive diagnostic interview is used. METHOD: We compared first contact incidence with a standard and a cultural sensitive version of a diagnostic interview. RESULTS: Age and gender adjusted relative risk for psychotic disorders and schizophrenia among Moroccans compared to native Dutch was 7.9 (95% CI 4.7-13.5) and 7.8 (95% CI 4.0-15.2) respectively based on the standard diagnostic interview and 4.2 (95% CI 2.3-7.9) and 1.5 (0.5-4.3) respectively based on the cultural sensitive version the diagnostic interview. CONCLUSION: First contact incidence of schizophrenia among Moroccans was no longer significantly higher than among ethnic Dutch people when a cultural sensitive diagnostic procedure was applied.
Asunto(s)
Comparación Transcultural , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Entrevista Psicológica/normas , Trastornos Psicóticos/etnología , Trastornos Psicóticos/epidemiología , Esquizofrenia/etnología , Esquizofrenia/epidemiología , Adolescente , Adulto , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Marruecos/etnología , Países Bajos , Psicometría/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Reproducibilidad de los Resultados , Esquizofrenia/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: The cognitive and academic outcomes of infants exposed to radiation after the meltdown at Chornobyl have been intensely debated. Western-based investigations indicate that no adverse effects occurred, but local studies reported increased cognitive impairments in exposed compared with non-exposed children. Our initial study found that at age 11 years, school grades and neuropsychological performance were similar in 300 children evacuated to Kiev as infants or in utero compared with 300 classmate controls, yet more evacuee mothers believed that their children had memory problems. This study re-examined the children's performance and academic achievement at age 19 years. METHOD: In 2005-2006, we conducted an 8-year follow-up of the evacuees (n=265) and classmate controls (n=261) assessed in Kiev in 1997. Outcomes included university attendance, tests of intelligence, attention, and memory, and subjective appraisals of memory problems. Scores were standardized using a local population-based control group (n=327). Analyses were stratified by parental education. RESULTS: Evacuees and classmates performed similarly and in the normal range on all tests, and no differential temporal changes were found. The results were comparable for the in utero subsample. The rates of university attendance and self-reported memory problems were also similar. Nevertheless, the evacuee mothers were almost three times as likely to report that their children had memory problems compared with controls. CONCLUSIONS: Chornobyl did not influence the cognitive functioning of exposed infants although more evacuee mothers still believed that their offspring had memory problems. These lingering worries reflect a wider picture of persistent health concerns as a consequence of the accident.
Asunto(s)
Encéfalo/efectos de la radiación , Accidente Nuclear de Chernóbil , Trastornos del Conocimiento/diagnóstico , Discapacidades para el Aprendizaje/diagnóstico , Traumatismos por Radiación/diagnóstico , Adolescente , Adulto , Atención/efectos de la radiación , Actitud Frente a la Salud , Niño , Preescolar , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/psicología , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Inteligencia/efectos de la radiación , Discapacidades para el Aprendizaje/epidemiología , Discapacidades para el Aprendizaje/psicología , Masculino , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/epidemiología , Trastornos de la Memoria/psicología , Recuerdo Mental/efectos de la radiación , Pruebas Neuropsicológicas , Embarazo , Efectos Tardíos de la Exposición Prenatal , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/psicología , UcraniaRESUMEN
BACKGROUND: The psychological aftermath of the Chernobyl accident is regarded as the largest public health problem unleashed by the accident to date. Yet the mental health of the clean-up workers, who faced the greatest radiation exposure and threat to life, has not been systematically evaluated. This study describes the long-term psychological effects of Chernobyl in a sample of clean-up workers in Ukraine. METHOD: The cohorts were 295 male clean-up workers sent to Chernobyl between 1986 and 1990 interviewed 18 years after the accident (71% participation rate) and 397 geographically matched controls interviewed as part of the Ukraine World Mental Health (WMS) Survey 16 years after the accident. The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was administered. We examined group differences in common psychiatric disorders, suicide ideation and severe headaches, differential effects of disorder on days lost from work, and in the clean-up workers, the relationship of exposure severity to disorder and current trauma and somatic symptoms. Analyses were adjusted for age in 1986 and mental health prior to the accident. RESULTS: Relatively more clean-up workers than controls experienced depression (18.0% v. 13.1%) and suicide ideation (9.2% v. 4.1%) after the accident. In the year preceding interview, the rates of depression (14.9% v. 7.1%), post-traumatic stress disorder (PTSD) (4.1% v. 1.0%) and headaches (69.2% v. 12.4%) were elevated. Affected workers lost more work days than affected controls. Exposure level was associated with current somatic and PTSD symptom severity. CONCLUSIONS: Long-term mental health consequences of Chernobyl were observed in clean-up workers.
Asunto(s)
Accidente Nuclear de Chernóbil , Restauración y Remediación Ambiental , Enfermedades Profesionales/epidemiología , Traumatismos por Radiación/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Absentismo , Adulto , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Alcoholismo/psicología , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Estudios de Cohortes , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/diagnóstico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/psicología , Femenino , Estudios de Seguimiento , Cefalea/diagnóstico , Cefalea/epidemiología , Cefalea/psicología , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/psicología , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/psicología , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/epidemiología , Trastornos Somatomorfos/psicología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , UcraniaRESUMEN
OBJECTIVE: To investigate the psychological aftermath of an air show disaster using prospectively obtained epidemiologic data. METHOD: Participants in a recently completed epidemiologic mental health survey in Lviv (disaster site) and controls from western Ukraine were interviewed shortly before and 6 months after a gruesome air show disaster. RESULTS: The Lviv group reported more psychopathology and post-traumatic stress symptom severity, but less anomie than controls. Somatization symptoms were similar in the two groups. Predisaster mental health and postdisaster threat were the strongest risk factors while demographic characteristics, emotional support, and repeated television viewing of the event were only weakly associated with postdisaster mental health. CONCLUSION: This is the first prospective study to find a significantly higher rate of disorder as well as post-traumatic stress disorder symptomatology after a disaster. The risk factor findings suggest avenues for targeting postdisaster interventions.
Asunto(s)
Aviación , Desastres , Trastornos Somatomorfos/etiología , Trastornos por Estrés Postraumático/etiología , Adulto , Áreas de Influencia de Salud , Niño , Ensayos Clínicos Controlados como Asunto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Factores de Tiempo , Ucrania/epidemiologíaRESUMEN
Several studies have demonstrated that the nuclear power plant accident at Chernobyl in 1986 had a strong impact on the subjective health of the inhabitants in the surrounding regions and that the majority of these health complaints appear to be stress-related. An epidemiological survey among the adult population of the Gomel region in Belarus near Chernobyl showed higher rates of self-reported health problems, psychological distress and medical service use in this region than in a comparable unexposed region. This paper presents an analysis of data on cognitive factors that were collected in this study. The findings support the hypothesis that cognitive variables such as risk perception and sense of control play an important role as mediating factors in the explanation of the observed health differences between the exposed and non-exposed regions. A tentative model is presented to further clarify the role of risk perception in the occurrence of non-specific health complaints after such ecological disasters.
Asunto(s)
Actitud Frente a la Salud , Desastres , Exposición a Riesgos Ambientales , Explosiones , Indicadores de Salud , Traumatismos por Radiación/psicología , Liberación de Radiactividad Peligrosa/psicología , Adulto , Actitud Frente a la Salud/etnología , Cognición , Humanos , Centrales Eléctricas , Traumatismos por Radiación/complicaciones , República de Belarús , Medición de Riesgo , Federación de Rusia , Percepción Social , UcraniaRESUMEN
OBJECTIVE: To determine the use of ethanol in Dutch intensive care departments (ICUs) for the treatment of deliriant symptoms in alcohol-dependent patients, and to study the literature data concerning this use. DESIGN: Literature search and questionnaire. METHOD: In Medline a search was performed from 1993 onward with keywords 'intensive care' and 'alcohol'/'alcohol withdrawal syndrome'/'delirium'. All Dutch ICUs received a written questionnaire (n = 247) concerning the use of ethanol in this patient group. RESULTS: According to the literature the syndrome is characterized by autonomous hyperactivity, resulting in tachycardia, tachypnoea, hypertension, perspiration, fever, tremors en fear. In delirium caused by alcohol withdrawal benzodiazepines are advised, sometimes in combination with haloperidol. ICUs sometimes use ethanol, although the effectiveness in preventing or treating withdrawal symptoms has never been ascertained in scientific investigations: in a meta-analysis the conclusion is drawn that the studies are too small and insufficiently objective to determine the effectiveness. The response to the questionnaire was 55% (96/176). From all ICUs, 15 (16%) used ethanol occasionally, and treated an estimated 17% of the admitted alcohol-dependent patients. There was a tendency for large ICUs to use ethanol in these patients more frequently. Each ICU used its own method to calculate the required ethanol dosage. Calculation on the basis of these dosages indicated a plasma ethanol concentration of at most 0.5 promille. CONCLUSION: Because only a small percentage of deliriums on ICUs are caused by alcohol withdrawal, and the effectiveness of ethanol in alcohol-dependent patients with a delirium has never been proven, the use of ethanol in such cases is discouraged.
Asunto(s)
Delirio por Abstinencia Alcohólica/tratamiento farmacológico , Depresores del Sistema Nervioso Central/uso terapéutico , Cuidados Críticos/métodos , Etanol/uso terapéutico , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Depresores del Sistema Nervioso Central/administración & dosificación , Depresores del Sistema Nervioso Central/farmacología , Utilización de Medicamentos , Etanol/administración & dosificación , Etanol/farmacología , Encuestas de Atención de la Salud , Humanos , Países Bajos , Encuestas y CuestionariosAsunto(s)
Trastorno Bipolar/tratamiento farmacológico , Litio/administración & dosificación , Guías de Práctica Clínica como Asunto/normas , Teorema de Bayes , Trastorno Bipolar/sangre , Trastorno Bipolar/metabolismo , Esquema de Medicación , Humanos , Litio/sangre , Litio/farmacocinética , Psiquiatría , Sociedades Médicas , Estados UnidosRESUMEN
During recent years, the former Soviet states have witnessed enormous social and cultural changes, which have also greatly influenced the field of mental health, including psychotherapy. In this article, the historical backgrounds of Russian psychotherapy and its current practice are described. Psychotherapy in Russia and in Western countries share common roots, but have developed into different directions during the 70 years of Soviet regime. In more recent years, they have begun to slowly converge again. In the West, a trend away from insight-oriented, nondirective psychotherapy is taking place in favor of more directive approaches, aimed at changing overt behavior. In contrast, there is a tendency for therapies in Russian-speaking countries to become gradually less directive and authoritarian. In these countries there is an increasing interest in psychodynamic, insight-oriented therapies.
Asunto(s)
Trastornos Mentales/historia , Psicoterapia/historia , Actitud , Historia del Siglo XX , Humanos , Trastornos Mentales/terapia , Política , Psicoterapia/tendencias , Federación de Rusia , Condiciones Sociales , U.R.S.S.RESUMEN
OBJECTIVE: This study assessed the long-term mental health effects of the nuclear accident at Chernobyl. METHOD: Two population samples (N = 3,044), one from the Gomel region, close to the accident site, and one from Tver, 500 miles away, were studied 6 1/2 years after the event with the use of a variety of self-report questionnaires and a standardized psychiatric interview. RESULTS: The prevalence of psychological distress and DSM-III-R psychiatric disorders was exceptionally high in both regions. Scores on the self-report scales were consistently higher in the exposed region; however, a higher risk of DSM-III-R psychiatric disorders could be demonstrated only among women with children under 18 years of age in the exposed region. CONCLUSIONS: A substantial long-term mental health effect of the Chernobyl incident was demonstrated, mainly at a subclinical level.
Asunto(s)
Trastornos Mentales/epidemiología , Centrales Eléctricas , Liberación de Radiactividad Peligrosa/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Madres/estadística & datos numéricos , República de Belarús/epidemiología , Federación de Rusia/epidemiología , Ucrania/epidemiologíaRESUMEN
Exposure to toxic substances in the environment is an ever more common event, that may cause physical as well as psychological harm. When an entire community is exposed, the term 'toxicological disaster' is used. The mere threat of such an event may be a source of stress, associated with changes in mental health, physical health, and changes in health-related behaviors. A review is presented of the literature about the effects of the stressful experience of toxicological disasters on health and health-related behaviors. Three questions are examined: (a) do toxicological disasters represent a specific type of stressor, different from other stressors?; (b) which stress-mediated health effects have been observed in the aftermath of toxicological disasters? and (c) is there evidence for a higher vulnerability in certain identifiable risk groups? On the basis of the available literature, it is concluded that toxicological disasters may have profound effects on subjective health, especially on symptom reporting, and on a number of psychophysiological parameters. Evidence for a substantial impact of disaster-related stress on either physical or psychiatric morbidity remains inconclusive. In this respect toxicological disasters do not appear to differ from other stressors. There is some evidence that toxicological disasters may have a more pronounced effect on health-related behaviors, especially on reproductive behavior (number of births and abortions). Women, and especially those who have young children to care for, appear to be more at risk for the observed health effects. The evidence for a higher vulnerability in other risk groups (e.g., former psychiatric patients remains inconclusive.
Asunto(s)
Adaptación Psicológica , Actitud Frente a la Salud , Exposición a Riesgos Ambientales/efectos adversos , Sustancias Peligrosas , Estrés Psicológico/complicaciones , Estrés Psicológico/etiología , Sobrevida/psicología , Susceptibilidad a Enfermedades , Femenino , Sustancias Peligrosas/efectos adversos , Estado de Salud , Humanos , Masculino , Madres/psicología , Embarazo , Factores de Riesgo , Factores Sexuales , Rol del Enfermo , Trastornos Somatomorfos/etiología , Estrés Psicológico/epidemiologíaRESUMEN
The reliability and criterion validity of Russian versions of three psychiatric screening questionnaire (the General Health Questionnaire, 12-item version; the Goldberg scales for anxiety and depression; and, the Bradford Somatic Inventory) were assessed in the Gomel region (Belarus), one of the most severely contaminated areas that resulted from the nuclear power plant explosion at Chernobyl in 1986. All instruments were found to have good internal reliability indices. Retest reliability of the GHQ, not tested for in the other instruments, was modest. Criterion validity, using a semi-structured interview on the basis of the Munich Diagnostic Checklist for DSM-III-R as external criterion, was good for the Goldberg scales, but modest for the two other instruments.
Asunto(s)
Desastres , Explosiones , Trastornos Mentales/diagnóstico , Centrales Eléctricas , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , República de Belarús , Factores Sexuales , UcraniaRESUMEN
The epidemiology of mental problems in the Gomel region in the republic of Belarus was studied in a two-stage survey of a broad based population sample (N = 1617), using the General Health Questionnaire (12-item version) and the Munich Diagnostic Checklist for DSM-III-R. The Gomel region is one of the areas that was most severely affected by the Chernobyl nuclear disaster in 1986. In the studied population sample 64.8% had a GHQ-score above the threshold of 2. A DSM-III-R psychiatric disorder was present in 35.8%, with especially high rates for affective (16.5%) and anxiety disorders (12.6%). Dysthymia, general anxiety disorder, adjustment disorders and 'not otherwise specified syndromes' made up almost two-thirds of the observed morbidity (22.9%). A higher prevalence of mental health problems, both in terms of the GHQ and the DSM-III-R was observed among people who have been evacuated and in mothers with children under 18 years of age. These data indicate that the Chernobyl nuclear disaster may be partly responsible for the high prevalence of (milder) psychiatric disorders and psychological distress in the Gomel region, even 6 years after the event. Future studies comparing the data from Gomel region with an unexposed area will have to provide a more definite answer concerning the impact of this nuclear disaster on mental health.
Asunto(s)
Desastres , Explosiones , Trastornos Mentales/psicología , Centrales Eléctricas , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , República de Belarús , Factores de Riesgo , UcraniaRESUMEN
The interrater reliability of the Munich Diagnostic Checklist (MDCL) was assessed in a small clinical sample and two population samples in the Russian Federation and Belarus. A team of Russian and Belarussian psychiatrists made DSM-III-R diagnoses, using the MDCL as the basis for a standardized interview. The interrater reliability was found to be satisfactory (kappa = 0.86 for case vs non-case distinction). In the population samples, the interviewing psychiatrist, in addition to making a DSM-III-R diagnosis, classified each respondent on a checklist of 11 clinical syndromes familiar to Russian psychiatry and made a severity rating. The overall concurrent validity indices based on the comparison of these diagnostic ratings were fairly high (kappa 0.48-0.82), suggesting considerable agreement between the DSM-III-R and traditional Russian diagnostic concepts.
Asunto(s)
Trastornos Mentales/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Humanos , Variaciones Dependientes del Observador , Proyectos Piloto , Reproducibilidad de los Resultados , República de Belarús , Federación de RusiaRESUMEN
Culture, defined as a system of beliefs, values and behavioral patterns, plays an important role in psychotherapy, albeit a role that most psychotherapeutic theories hardly acknowledge. Psychotherapeutic and anthropological research over the last few decades has indicated that common beliefs concerning illness and cure shared by therapist and patient are a central factor in determining illness behavior and outcome of therapy. In fact, such belief systems may account for up to 60% of therapeutic efficacy. Psychotherapy thus appears by and large to be healing by culture. Training programs in psychotherapy should therefore pay more attention to the role of culture.