Implications of psychological research on stress and technological accidents

Health and Psychological Concerns of Communities Affected by Per- and Poly-Fluoroalkyl Substances: The Case of Residents Living in the Orange Area of the Veneto Region

Residents of an extensive area of the Veneto Region (Italy) face one of the largest technological disasters due to per- and polyfluoroalkyl substances (PFAS). On the basis of a risk gradient of contamination, the affected territories were divided into 4 areas: Red (of maximum exposure, where a human biomonitoring programme (HBM) was activated), Orange, Yellow, and Green. This article presents a case study of residents who live in the Orange Area, the second area in terms of contamination, excluded from the HBM. Semi-structured interviews were conducted with 17 residents engaged in promoting a legal procedure to exercise their right to know. Grounded theory and a thematic analysis method were used. Overall, the findings revealed that experiencing contamination causes a negative psychosocial impact on the residents' lives; difficulty accessing information; living with uncertainty, caused by the lack of institutional and health support and medical consultation; a sense of abandonment; difficulty managing preventive and protective actions; and the deterioration of relationships, on the basis of the social comparison with residents of the Red Area, to whom HBM was granted and where the concept of health ostracism has emerged. This study demonstrated that biomonitoring may help reduce discomfort in the case of contamination by informing people of their chemical exposure.

Breaks and productivity: An exploratory analysis

The Fair Labor Standards Act suggests that short rest periods of 5-20 min may improve employee productivity, but there is limited experimental research on the topic. The current study compared productivity when breaks were not required (i.e., control session) compared with when breaks were programmed by the experimenter (i.e., experimental session). Sixteen undergraduate students completed two 2-hr sessions of a simulated check-processing task. Half of the participants were randomly assigned to receive the experimental session (5-min breaks every 20 min) first with the control session second, and the other half received the control first and the experimental session second. The results showed that 75% of participants completed more checks during the experimental session than during the control session and the difference was statistically significant. Most participants took more unprogrammed break time during control sessions compared with experimental sessions. Implications for future research and the value of work breaks are discussed.

How Does Organizational Toxicity Affect Depression? A Moderated Mediation Model

Organizational toxicity is a key organizational issue today, impacting the success of both employees and organizations negatively alike. Negative working conditions revealed by organizational toxicity pave the way for an organizational atmosphere to arise, which negatively influences the physical and psychological well-being of employees, causing burn-out syndrome and depression. Thus, organizational toxicity is observed to have a destructive impact on employees and can threaten the future of companies. In this framework, this study examines the mediating role of burnout and moderator role of occupational self-efficacy, in the relationship between organizational toxicity and depression. Conducted as cross-sectional, this study adopts a quantitative research approach. To that end, convenience sampling was used to collect data from 727 respondents who are employed at five-star hotels. Data analysis was completed with SPSS 24.0 and AMOS 24 packages. Consequent to the analyses, organizational toxicity was determined to have a positive effect on burnout syndrome and depression. Moreover, burnout syndrome was found to have a mediating effect on the relationship between organizational toxicity and depression. In addition, occupational self-efficacy was found to have a moderator role on the effect of employees' burnout levels on their depression levels. According to the findings, occupational self-efficacy is an influential variable on reducing the impact that organizational toxicity and burnout have on depression.

The Psychological Impact of Per- and Poly-Fluoroalkyl Substances (PFAS) Pollution in the Veneto Region, Italy: A Qualitative Study with Parents

Little is known about the psychosocial impact on people who live in polluted areas, and its consequences for the parental role have been neglected. This study addresses this gap, proposing qualitative research referring to the case of per- and poly-fluoroalkyl substances (PFAS) water pollution in the Veneto Region of Italy. The purpose of this study was to investigate the chronic exposure contamination (CEC) experience of parents. Semi-structured interviews were conducted with 32 parents living in the so-called 'Red Area' considered to have had maximum exposure. Grounded theory was used to analyse the data. The three themes to emerge were three phases of a dynamic process: shock around the discovery (phase 1), lifestyle change (phase 2), and living with PFAS (phase 3). The two transitions (loss of innocence and environmental adaptation) linked the phases. Our findings show that PFAS CEC experience is a process whereby parents need to move from the shock of discovery to adapting to the new situation in order to incorporate a change into their daily life, especially in regard to children. Two emerging aspects that characterised the process as a constant were uncertainty and health concerns, while role strains could be a stress source in the context of CEC. We suggest introducing the notion of chronic role strain (CRS).

Prevalence of Depression and Posttraumatic Stress Disorder in Flint, Michigan, 5 Years After the Onset of the Water Crisis

IMPORTANCE

Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using standardized diagnostic measures.

OBJECTIVE

To investigate the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among Flint residents 5 years after the onset of the crisis.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, a household probability sample of 1970 adults living in Flint, Michigan, during the crisis were surveyed about their crisis experiences, their psychological symptoms 5 years later, and their access to and use of mental health services in the intervening years. Analyses were weighted to produce population-representative estimates.

MAIN OUTCOMES AND MEASURES

Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD.

RESULTS

Among 1970 respondents, 1061 of 1946 reporting sex (54.5%) were women; 1043 of 1951 reporting race (53.5%) were Black or African American and 829 (42.5%) were White; and 1895 of 1946 reporting ethnicity (97.4%) were non-Hispanic. Overall, 435 (22.1%) met DSM-5 criteria for presumptive past-year depression, 480 (24.4%) for presumptive past-year PTSD, and 276 (14.0%) for both disorders. Residents who believed that their or their family's health was harmed by contaminated water (eg, risk ratio [RR] for depression: 2.23; 95% CI, 1.80-2.76), who had low confidence in public-official information (eg, RR for PTSD, 1.44; 95% CI, 1.16-1.78), who had previous exposure to PTEs (eg, RR for both disorders: 5.06; 95% CI, 2.99-8.58), or who reported low social support (eg, RR for PTSD, 2.58; 95% CI, 1.94-3.43) had significantly higher risk for depression, PTSD, and comorbidity. PTEs involving prior physical or sexual assault were especially potent risk factors (eg, both disorders: RR, 7.30; 95% CI, 4.30-12.42). Only 685 respondents (34.8%) were ever offered mental health services to assist with water-crisis-related psychiatric symptoms; most (543 [79.3%]) who were offered services utilized them.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of psychiatric disorder in Flint, Michigan, presumptive depression and PTSD were highly prevalent 5 years after the onset of the water crisis. These findings suggest that public-works environmental disasters have large-scale, long-term psychological sequelae. The Flint community may require expanded mental health services to meet continued psychiatric need. National disaster preparedness and response programs should consider psychiatric outcomes.

Chronic environmental contamination: A systematic review of psychological health consequences

We sought to undertake a systematic review to assess the current research and to provide a platform for future research on the psychological health impact of chronic environmental contamination (CEC). CEC is the experience of living in an area where hazardous substances are known or perceived to be present in air, water, or soil at elevated levels for a prolonged and unknown period of time. We employed a systematic review approach to assess the psychological health impact of CEC in literature from 1995 to 2019, and conducted a meta-analysis of available findings (k = 60, N = 25,858) on the impact of CEC on anxiety, general stress, depression, and PTSD. We also present a narrative synthesis of findings that suggest risk factors for the experience of psychological health impacts in the wake of CEC. Likely factors increasing risk for elevated psychological health impact from CEC experience are institutional delegitimization of community concerns and the real or perceived presence of health effects from CEC. The meta-analyses observed small-to-medium effects of experiencing CEC on anxiety, general stress, depression, and PTSD. However, there was also evident risk of bias in the data. Our review suggests that psychological health in the context of CEC is an important potential public health burden and a key area for future improved research.

Chronic disaster impact: the long-term psychological and physical health consequences of housing damage due to induced earthquakes

OBJECTIVES

To evaluate the long-term (psychosomatic) health consequences of man-made earthquakes compared with a non-exposure control group. Exposure was hypothesised to have an increasingly negative impact on health outcomes over time.

SETTING

Large-scale gas extraction in the Netherlands causing earthquakes and considerable damage.

PARTICIPANTS

A representative sample of inhabitants randomly selected from municipal population records; contacted 5 times during 21 months (T1: N=3934; T5: N=2150; mean age: 56.54; 50% men; at T5, N=846 (39.3%) had no, 459 (21.3%) once and 736 (34.2%) repeated damages).

MAIN MEASURES

(Psychosomatic) health outcomes: self-rated health and Mental Health Inventory (both: validated; Short Form Health Survey); stress related health symptoms (shortened version of previously validated symptoms list). Independent variable: exposure to the consequences of earthquakes assessed via physical (peak ground acceleration) and personal exposure (damage to housing: none, once, repeated).

RESULTS

Exposure to induced earthquakes has negative health consequences especially for those whose homes were damaged repeatedly. Compared with a no-damage control group, repeated damage was associated with lower self-rated health (OR:1.64), mental health (OR:1.83) and more stress-related health symptoms (OR:2.52). Effects increased over time: in terms of relative risk, by T5, those whose homes had repeated damage were respectively 1.60 and 2.11 times more likely to report poor health and negative mental health and 2.84 times more at risk of elevated stress related health symptoms. Results for physical exposure were comparable.

CONCLUSION

This is the first study to provide evidence that induced earthquakes can have negative health consequences for inhabitants over time. It identifies the subpopulation particularly at risk: people with repeated damages who have experienced many earthquakes. Findings can have important implications for the prevention of negative health consequences of induced earthquakes.

Chronic environmental contamination: A narrative review of psychosocial health consequences, risk factors, and pathways to community resilience

A body of psychological and social scientific evidence suggests that the experience of technological disaster or long-term exposure to environmental contamination can be psychologically stressful. Addressing the psychosocial impact in communities living with chronic contamination is therefore a vital part of improving their resilience. Guided by a synthetic theoretical model of the unique psychosocial impact of chronic environmental contamination (in contrast to natural and technological disasters, and background pollution), we undertook a narrative review to assess the current research on this important social problem. Relevant qualitative peer-reviewed studies and grey literature were examined to derive a model identifying likely factors increasing risk for distress in chronic contamination experience and actions that may be taken by public health professionals and local leaders to enhance community resilience and take health-protective actions. Based on our initial theoretical model and the literature reviewed, we emphasize the importance of considering both the material and social dimensions of chronic environmental contamination experience. For instance, our review of the qualitative literature suggests that individuals who attribute material health impacts to contamination, and who have the social experience of their concerns being delegitimized by responsible institutions, are most at risk for psychological stress. Psychological stress in the context of chronic contamination is an important potential public health burden and a key area for additional research.

The SHAMISEN Recommendations on preparedness and health surveillance of populations affected by a radiation accident

This paper, the last in the Special Issue (SI) on the SHAMISEN project, presents an overview of the SHAMISEN Recommendations for Preparedness and Health Surveillance of Populations Affected by a Radiation Accident. The recommendations are based on the lessons learnt from previous nuclear accidents, and the engagement activities with different stakeholder groups, described in the other papers of this SI. The SHAMISEN project developed a total of 28 recommendations. They include general recommendations, applicable across all phases of an accident, and specific recommendations for each of the three main phases: preparedness, early and intermediate, and long-term recovery. The recommendations are subdivided by topic: health surveillance, epidemiological studies, dose reconstruction, evacuation, and training of and communication with health personnel and other actors involved in liaising with affected populations. Each recommendation is divided into 3 sections - why, how and who - thus providing background and concrete advice as to how each SHAMISEN recommendation should be implemented and by whom. It is notable that many recommendations are also applicable to other disaster types, including the current SARS-CoV-2 pandemic.

Mitigating Litigating: An Examination of Psychosocial Impacts of Compensation Processes Associated with the 2010 BP Deepwater Horizon Oil Spill

During the past four decades, a number of social science scholars have conceptualized technological disasters as a social problem. More specifically, research in this arena has identified individual and collective stress as a secondary trauma of processes intended to provide compensation and economic relief from disasters in general and, more specifically, technological disasters. Based on data from a 2013 household telephone survey of 1,216 residents of coastal Alabama, this article examines the relationship between psychosocial stress and compensation processes related to the 2010 BP Deepwater Horizon oil spill. We examine involvement with claims, settlement, and litigation activities; vulnerability and exposure to the spill; ties to resources; resource loss and gain; perceptions of risk and recreancy; and intrusive stress and avoidance behaviors as measured by the impact of event scale. Regression analysis reveals that the strongest contributors to intrusive stress were being part of the compensation process, resource loss, concerns about air quality, and income. Although being involved with compensation processes was a significant predictor of avoidance behaviors, the strongest contributors to avoidance behaviors were resource loss, air quality concern, income, being male, minority status, and community attachment. Beliefs that the compensation process was as distressing as the oil spill also significantly contributed to intrusive stress and avoidance behaviors. This research represents a step toward filling a gap in empirical evidence regarding the extent to which protracted compensation processes exacerbate adverse psychosocial impacts of disasters and hinder community recovery.

Decoupling social status and status certainty effects on health in macaques: a network approach

BACKGROUND

Although a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank) and relational components (perceived social status, dominance interactions). In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models) and dominance certainty (the relative certainty vs. ambiguity of an individual's status), allowing for a more complex examination of how social status impacts health.

METHODS

Behavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects). Subjects' general physical health (diarrhea) was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)).

RESULTS

Dominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea.

DISCUSSION

Social status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one's social status in status-health research. This work also suggests that in order to fully explore the mechanisms for how social life influences health, more complex metrics of social systems and their dynamics are needed.

The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations

Malignant Pleural Mesothelioma (MPM) remains a relevant public health issue, and asbestos exposure is the most relevant risk factor. The incidence has considerably and constantly increased over the past two decades in the industrialized countries and is expected to peak in 2020-2025. In Italy, a standardized-rate incidence in 2011 among men was 3.5 and 1.25 per 100,000 in men and women, respectively, and wide differences are noted among different geographic areas. The disease remains challenging in terms of diagnosis, staging and treatment and an optimal strategy has not yet been clearly defined. The Third Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Bari (Italy) in January 30-31, 2015. This Consensus has provided updated recommendations on the MPM management for health institutions, clinicians and patients.

Chronic Noise and Psychological Stress

This article illustrates the value of incorporating psychological principles into the environmental sciences Psychophysiological, cognitive, motivational, and affective indices of stress were monitored among elementary school children chronically exposed to aircraft noise We demonstrate for the first time that chronic noise exposure is associated with elevated neuroendocrine and cardiovascular measures, muted cardiovascular reactivity to a task presented under acute noise, deficits in a standardized reading test administered under quiet conditions, poorer long-term memory, and diminished quality of life on a standardized index Children in high-noise areas also showed evidence of poor persistence on challenging tasks and habituation to auditory distraction on a signal-to-noise task They reported considerable annoyance with community noise levels, as measured utilizing a calibration procedure that adjusts for individual differences in rating criteria for annoyance judgments

Chronic Noise Exposure and Physiological Response: A Prospective Study of Children Living Under Environmental Stress

Chronic exposure to aircraft noise elevated psychophysiological stress (resting blood pressure and overnight epinephrine and norepinephrine) and depressed quality-of-life indicators over a 2-year period among 9- to 11-year-old children. Data collected before and after the inauguration of a major new international airport in noise-impacted and comparison communities show that noise significantly elevates stress among children at ambient levels far below those necessary to produce hearing damage.

Onset, timing, and exposure therapy of stress disorders: mechanistic insight from a mathematical model of oscillating neuroendocrine dynamics

BACKGROUND

The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system that regulates numerous physiological processes. Disruptions in the activity of the HPA axis are correlated with stress-related diseases such as post-traumatic stress disorder (PTSD) and major depressive disorder. In this paper, we characterize "normal" and "diseased" states of the HPA axis as basins of attraction of a dynamical system describing the inhibition of peptide hormones such as corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) by circulating glucocorticoids such as cortisol (CORT).

RESULTS

In addition to including key physiological features such as ultradian oscillations in cortisol levels and self-upregulation of CRH neuron activity, our model distinguishes the relatively slow process of cortisol-mediated CRH biosynthesis from rapid trans-synaptic effects that regulate the CRH secretion process. We show that the slow component of the negative feedback allows external stress-induced reversible transitions between "normal" and "diseased" states in novel intensity-, duration-, and timing-dependent ways.

CONCLUSION

Our two-step negative feedback model suggests a mechanism whereby exposure therapy of stress disorders such as PTSD may act to normalize downstream dysregulation of the HPA axis. Our analysis provides a causative rationale for improving treatments and guiding the design of new protocols.

Meaning, Resilience, and Traumatic Stress After the Deepwater Horizon Oil Spill: A Study of Mississippi Coastal Residents Seeking Mental Health Services

The present study examines the relationship between resilience, perceived meaning in life, and traumatic stress symptoms among coastal residents of Mississippi directly affected by the Deepwater Horizon oil spill (also known as the Gulf oil spill). The study was conducted as part of a larger project that assessed the spill's effect on the mental health of individuals seeking therapeutic services. Multiple regression analyses were conducted to determine if resilience and perceived meaning are significant predictors of scores from a measure of posttraumatic stress. Descriptive data, reliability coefficients, and correlations were also calculated. Higher levels of resilience and meaning together were predictive of fewer posttraumatic stress symptoms after controlling for the effect of the spill. Resilience and meaning appeared to be similar predictors of lower posttraumatic stress scores, and meaning appears to be an important facet of what makes a person resilient.

Test of the stress sensitization model in adolescents following the pipeline explosion

PURPOSE

The stress sensitization model states that early traumatic experiences increase vulnerability to the adverse effects of subsequent stressful life events. This study examined the effect of stress sensitization on development of posttraumatic stress disorder (PTSD) symptoms in Chinese adolescents who experienced the pipeline explosion.

METHODS

A total of 670 participants completed self-administered questionnaires on demographic characteristics and degree of explosion exposure, the Childhood Trauma Questionnaire (CTQ), and the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). Associations among the variables were explored using MANOVA, and main effects and interactions were analyzed.

RESULTS

Overall MANOVA tests with the PCL-C indicated significant differences for gender (F=6.86, p=.000), emotional abuse (F=6.79, p=.000), and explosion exposure (F=22.40, p=.000). There were significant interactions between emotional abuse and explosion exposure (F=3.98, p=.008) and gender and explosion exposure (F=2.93, p=.033).

CONCLUSIONS

Being female, childhood emotional abuse, and a high explosion exposure were associated with high PTSD symptom levels. Childhood emotional abuse moderated the effect of explosion exposure on PTSD symptoms. Thus, stress sensitization influenced the development of PTSD symptoms in Chinese adolescents who experienced the pipeline explosion as predicted by the model.

Disaster Management: Mental Health Perspective

Disaster mental health is based on the principles of 'preventive medicine' This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six 'R's such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.

Does exposure type impact differentially over time on the development of mental health disturbances after a technological disaster?

Background

A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (July 30th, 2004) on physical, mental and social health in the affected population. The present study explored the risk for the development of four types of mental health disturbances (MHD) due to exposure to different aspects of this technological disaster in comparison with data obtained from previous health surveys among the population of the same province.

Methods

Surveys were conducted 5 months (T1) and 14 months (T2) after the disaster. Potential adult victims (≥15 years) were included (n = 1027 and 579 at T1 and T2 respectively). The “Symptom Checklist-90-Revised” (SCL-90-R) has been used in order to compute actual prevalence rates of somatization-, depression-, anxiety- and sleeping disturbances for three defined exposure categories: direct witnesses who have seen human damage (SHD), direct witnesses who have not seen human damage (NSHD) and indirect witnesses (IW). Those prevalence rates were compared with overall rates using the inhabitants of the province of Hainaut (n = 2308) as reference population. A mental health co-morbidity index was computed. Relative risks were estimated using logistic regression models.

Results

Prevalence rates of the four MHD were much higher for the SHD than for the other exposure groups, at T1 and T2. Moreover, NSHD and IW had no increased risk to develop one of the 4 types of MHD compared to the reference population. The SHD had at T1 and T2 good 5-times a higher risk for somatization, about 4-times for depression and sleeping disorders, and 5- to 6-times for anxiety disorders respectively. Further, they suffered 13 times, respectively 17 times more from all mental disorders together.

Conclusions

The present study calls attention to the fact that mental health problems disturbances are significantly more prevalent and long-lasting among survivors who have directly been exposed to human damage.

Belief in a just what? Demystifying just world beliefs by distinguishing sources of justice

People’s Belief in a Just World (BJW) plays an important role in coping with misfortune and unfairness. This paper demonstrates that understanding of the BJW concept, and its consequences for behavior, is enhanced if we specify what (or who) the source of justice might be. We introduce a new scale, the 5-Dimensional Belief in a Just Treatment Scale (BJT5), which distinguishes five causal dimensions of BJW (God, Nature, Other People, Self, Chance). We confirm the 5-factor structure of the BJT5. We then address whether the BJW should be considered a uni- and/or multi-dimensional construct and find support for our multi-dimensional approach. Finally, we demonstrate convergent and discriminant validity with respect to important correlates of BJW as well as action in response to important negative life events and societal attitudes. This work illustrates the importance of distinguishing causal dimensions with regard to who distributes justice.

The resilience activation framework: a conceptual model of how access to social resources promotes adaptation and rapid recovery in post-disaster settings

A number of governmental agencies have called for enhancing citizens' resilience as a means of preparing populations in advance of disasters, and as a counterbalance to social and individual vulnerabilities. This increasing scholarly, policy, and programmatic interest in promoting individual and communal resilience presents a challenge to the research and practice communities: to develop a translational framework that can accommodate multidisciplinary scientific perspectives into a single, applied model. The Resilience Activation Framework provides a basis for testing how access to social resources, such as formal and informal social support and help, promotes positive adaptation or reduced psychopathology among individuals and communities exposed to the acute collective stressors associated with disasters, whether human-made, natural, or technological in origin. Articulating the mechanisms by which access to social resources activate and sustain resilience capacities for optimal mental health outcomes post-disaster can lead to the development of effective preventive and early intervention programs.

Longitudinal analysis of health outcomes after exposure to toxics, Willits California, 1991-2012: application of the cohort-period (cross-sequential) design

BACKGROUND

About 1963, a factory in Willits, Mendocino County (County), California added chrome plating to the manufacture of steel products. After years of residents reporting high illness rates, the State undertook a series of investigations. They found exposures had been high and warranted further research into possible health effects. Applying the seldom-used cross-sequential design, we tested if Willits had an excess rate of adverse health conditions, compared to people of the same sex and cohort living in the rest of county (ROC). This is the first report on long-term health outcomes for Willits.

METHODS

Hospital discharge data for 1991-2012 were searched to find admissions for people born between 1940 and 1989 who ever gave the County as their residence. Diagnoses and procedures were classified to Level 1 (body systems) of the Multi-level Clinical Classification Software (CCS). We analyzed 796,917 diagnoses and 289,980 procedures found on 117,799 admissions of 43,234 patients who lived in the County at some time between 1991 and 2012. Of these, 7,564 lived in Willits. We summarized data to the person-level then the group level over cohort-period (cross-sequential) to control the age by time relationship, then calculated incidence rates, relative risk, and excess case statistics, each with confidence limits. A secondary analysis focused on whether Willits differed markedly from the rest of County (ROC). Specifically, other than the presence of the Plant, did Willits differ so much that those differences could plausibly explain outcome differences?

RESULTS

Illness was excessive in the exposed group (Willits) compared to the unexposed (ROC). Overall number of excess cases attributable to living in Willits was estimated: Men, 301 (95% confidence limit (CL) 200-398), women: 696 (CL 569-820).

CONCLUSIONS

This study demonstrates the strength of the cross-sequential design. Willits and ROC had comparable disadvantages relative to the State. Yet, when stratified by cohort, Willits had more illness per population. Little is known about the health effect of chemicals used at Willits on a non-occupationally exposed population. We recommend a follow-up study to evaluate the long-term health of people who lived in Willits during childhood and the reproductive age.

The Impact of Disasters on Populations With Health and Health Care Disparities

Context:A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden.

Objective:To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community's health, access to health resources, and quality of life.

Methods:We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas.

Results:There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively.

Conclusions:The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster.

(Disaster Med Public Health Preparedness. 2010;4:30-38)

Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill

OBJECTIVES

In the aftermath of an environmental public health disaster (EPHD) a healthcare system may be the least equipped entity to respond. Preventable visits for ambulatory care-sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access postdisaster. The objective of this study was to examine whether ACSC rates among vulnerable subpopulations are sensitive to the impact of a disaster.

METHODS

We conducted a retrospective analysis on the 2005 chlorine spill in Graniteville, South Carolina using a Medicaid claims database. Poisson regression was used to calculate change in monthly ACSC visits at the disaster site in the postdisaster period compared with the predisaster period after adjusting for parallel changes in a control group.

RESULTS

The adjusted rate of a predisaster ACSC hospital visit for the direct group was 1.68 times the rate for the control group (95% confidence interval [CI] 1.47-1.93), whereas the adjusted ACSC hospital rate postdisaster for the direct group was 3.10 times the rate for the control group (95% CI 1.97-5.18). For ED ACSC visits, the adjusted rate among those directly affected predisaster were 1.82 times the rate for the control group (95% CI 1.61-2.08), whereas the adjusted ACSC rate postdisaster was 2.81 times the rate for the control group (95% CI 1.92-5.17).

CONCLUSIONS

Results revealed that an increased demand on the health system altered health services delivery for vulnerable populations directly affected by a disaster. Preventable visits for ACSCs may advance public health practice by identifying healthcare disparities during disaster recovery.

Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery

Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans.

Prediction of unmet primary care needs for the medically vulnerable post-disaster: an interrupted time-series analysis of health system responses

Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

A conceptual framework for understanding the mental health impacts of oil spills: lessons from the Exxon Valdez oil spill

This paper introduces a conceptual framework for understanding and responding to the currently unfolding social and psychological impacts of the Deepwater Horizon oil spill. Drawing from the concept of corrosive communities and its relationship to theories of conservation of resources, cognitive activation, and risk and resilience, the conceptual model identifies three levels or tiers of impacts: biopsychosocial impacts that are direct consequences of the contamination of the physical environment; interpersonal impacts that are direct consequences of the biopsychosocial impacts; and intrapersonal or psychological impacts that are consequences of both the biopsychosocial and the interpersonal impacts. The model is then evaluated in light of research conducted in the aftermath of the Exxon Valdez oil spill as well as studies of other manmade disasters, and offers a set of testable hypotheses that predict likely impacts of the Deepwater Horizon oil spill. The conceptual framework may be used to identify strategies to develop community resilience and target specific services to prevent and mitigate these adverse effects.

Critical biological pathways for chronic psychosocial stress and research opportunities to advance the consideration of stress in chemical risk assessment

Emerging evidence suggests that psychosocial stress and toxicants may interact to modify health risks. Stress-toxicant interactions could be important in chemical risk assessment, but these interactions are poorly understood and additional research is necessary to advance their application. Environmental health research can increase knowledge of these interactions by exploring hypotheses on allostatic load, which measures the cumulative impacts of stress across multiple physiological pathways, using knowledge about physiological pathways for stress-related health effects, and evidence of common target pathways for both stress and toxicants. In this article, critical physiological pathways for stress-related health effects are discussed, with specific attention to allostatic load and stress-toxicant interactions, concluding with research suggestions for potential applications of such research in chemical risk assessment.

Determining satisfaction with access and financial aspects of care for persons exposed to Libby amphibole asbestos: rural and national environmental policy implications

Libby, Montana is a Superfund site and epicenter of one of the worst environmental disasters in the USA history in terms of asbestos-related mortality and morbidity. Perceptions of access and financial aspects of care were explored among a national cohort of persons postasbestos exposure and prior to a 2009 Public Health Emergency Declaration. Our findings indicated the Libby cohort was significantly less satisfied with access and financial aspects of care as measured by two PSQ-III scales when compared to an adult, chronically ill patient sample. Participants with higher levels of respiratory morbidity and depression had significantly lower satisfaction scores.

Psychosocial health status of persons seeking treatment for exposure to libby amphibole asbestos

A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status.

Disasters and perinatal health:a systematic review

BACKGROUND

The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health.

METHODS

A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birth weight, congenital anomalies), mental health, and child development. A total of 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria.

RESULTS

Studies addressing the World Trade Center disaster of September 11 and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, although there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. After a disaster, mental health of the mother may more strongly influence on child development than any direct effect of disaster-related prenatal stress.

CONCLUSIONS

There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly exposed women. Future research should focus on understudied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health.

TARGET AUDIENCE

Obstetricians & Gynecologists.

LEARNING OBJECTIVES

After completion of this educational activity, the obstetrician/gynecologist should be better able to compare and contrast the effects of different types of disasters (hurricanes, earthquakes, chemical spills) on pregnant and postpartum women in order to prepare for patient care in the aftermath of such disasters; differentiate the birth outcomes likely to be affected by disaster, in order to identify patients likely to be at high risk; and assess the extent to which pregnant and postpartum women are a uniquely vulnerable population after disaster, to assist in organizing care under such circumstances.

Community responses to naturally occurring asbestos: implications for public health practice

We used a qualitative community case study design to examine stakeholder responses to naturally occurring asbestos (NOA), a newly emerging environmental threat. The community of interest represents the first residential setting in the United States to receive substantial federal, state and local regulatory attention where NOA exposures largely resulted from local development. Because NOA is an emerging problem that will require evidence-based public health responses in the United States and elsewhere, we explored stakeholder responses to NOA and examined how these responses fit with what is known about individual, community and institutional responses to environmental hazards. The convergence of findings from multiple data sources, including interviews with stakeholder groups and documents, revealed a myriad of challenges associated with environmental and public health interventions in this community. What unfolded was consistent with the social sciences literature about communities facing similar hazards. 'Natural' and 'human-made' elements, the toxic nature of the threat and inadequate institutional responses to the threat combined to spark community conflict and other significant challenges. Implications for improved public health practice are discussed.

Katrina as a Natech Disaster: Toxic Contamination and Long-Term Risks for Residents of New Orleans

Hurricane Katrina's impacts have been debated and discussed as resulting from either natural forces or from the failure of man-made levees. However, both the immediate (3 years) and, most important, long-term (20 years or more) social and health consequences of Katrina must be understood in terms of natech disasters. Natech disasters combine etiological elements of both natural and technological disasters, and this conceptual framework forces a recognition of the risks of toxic contamination. A review of available information on the air quality and sediment contamination in New Orleans following Katrina's destruction and subsequent flooding provides data for justifying this natech classification. Furthermore, data on the awareness of contamination for residents of Orleans parish are presented, revealing that a majority feel they have been exposed, and one out of three are worried about neighborhood contamination. Suggestions for changes in risk assessment and public policy are also provided to mitigate the impacts of future natech disasters.

Mortality among former Love Canal residents

BACKGROUND

The Love Canal is a rectangular 16-acre, 10-ft deep chemical waste landfill situated in a residential neighborhood in Niagara Falls, New York. This seriously contaminated site first came to public attention in 1978. No studies have examined mortality in the former residents of the Love Canal neighborhood (LC).

OBJECTIVE

The aim of this study was to describe the mortality experience of the former LC residents from the years 1979-1996.

METHODS

From 1978 to 1982, 6,181 former LC residents were interviewed. In 1996, 725 deaths from 1979-1996 were identified in this cohort, using state and national registries. We compared mortality rates with those of New York State (NYS) and Niagara County. Survival analysis examined risks by potential exposure to the landfill.

RESULTS

We were unable to demonstrate differences in all-cause mortality for either comparison population for 1979 1996. Relative to NYS, the standardized mortality ratio (SMR) was elevated [SMR = 1.39; 95% confidence interval (CI), 1.16-1.66] for death from acute myocardial infarction (AMI), but not relative to Niagara County. Death from external causes of injury was also elevated relative to both NYS and Niagara County, especially among women (SMR = 1.95; 95% CI, 1.25 2.90).

CONCLUSIONS

The role of exposure to the landfill in explaining these excess risks is not clear given limitations such as multiple comparisons, a qualitative exposure assessment, an incomplete cohort, and no data on deaths prior to 1978. Lack of elevation for AMI when compared with Niagara County but not NYS suggests possible regional differences. However, direct cardiotoxic or neurotoxic effects from landfill chemicals or indirect effects mediated by psychological stress cannot be ruled out. Revisiting the cohort in the future could reveal patterns that are not yet apparent.

Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters

BACKGROUND

On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work.

OBJECTIVES

To examine the long term health complaints in rescue workers exposed to a disaster.

METHODS

A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes.

RESULTS

Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found.

CONCLUSIONS

This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.

Overview of the psychosocial impact of disasters

The psychosocial sequelae can be intense and of long duration in the aftermath of natural and technological disasters, as well as terrorist attacks. Post-traumatic stress symptoms and full syndrome disorder, depression, anxiety, somatic complaints, and excessive alcohol use have been demonstrated consistently, particularly following large-scale disasters. This paper examines the psychological research conducted at various intervals after extensive natural disasters, the Three Mile Island and Chernobyl technological accidents, and recent terrorist events in the United States. Factors predictive of the emergence of emotional distress and psychological and physical problems following a disaster also are discussed.

A broader view of trauma: A biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth

The main goal of this paper is to articulate a biopsychosocial evolutionary approach to understanding the traumatic stress response. The secondary goal of this paper is to draw out the general clinical implications of this approach. I articulate seven interconnected and overlapping empirically grounded theoretical conclusions: (1) Stress is best understood as a prerational form of biopsychological feedback regarding the organism's relationship with its environment; (2) The normal outcome of traumatic stress is growth, rather than pathology; (3) Most psychopathology is a function of the maladaptive modulation of the stress response; (4) Trauma always leaves the individual transformed on a biological, as well as psychological, level; (5) The general biological process underlying stress responses is universal, but the specific dynamics are always a function of the unique sociocultural environment and psychological makeup of the individual; (6) The biology underlying stable psychopathological symptoms may change even as the psychological symptoms remain the same; and (7) Rationality is humanity's evolutionarily newest and most sophisticated stress-reduction behavioral mechanism, and the most important aspect of restoring psychological health to the trauma victim.

Impacts of an environmental disaster on psychosocial health and well-being in Karakalpakstan

The people of Karakalpakstan, along with those of the entire Aral Sea region, are facing a multitude of health problems corresponding to the drying of the Aral Sea and accompanying ecological consequences. In case studies of other environmental disasters, research has shown that environmental exposures may impact not only the physiological but also the psychosocial health of individuals. This research aims to determine the contribution of the environmental disaster to the psychosocial health of people living in Karakalpakstan, a semi-autonomous Republic in Uzbekistan. An interview survey was carried out by Médecins Sans Frontières, with the assistance of the McMaster Institute of Environment and Health, local Universities and local health care workers, on a random sample of 1118 individuals aged 18 years and older in three communities in Karakalpakstan in May/June 1999. The communities were chosen according to distance from the former seashore, urban/rural characteristics and ethnic composition. The survey included questions about perceived general health, the General Health Questionnaire, the somatic symptom checklist of the Symptom Check List-90, questions about perceptions of the environmental disaster, social support as well as socio-demographic and socio-economic characteristics. Findings show that 41% of all respondents reported environmental concern while 48% reported levels of somatic symptoms (SCL-90) associated with emotional distress, above the normalized cut-point. Significant differences in levels of emotional distress were reported between men and women as well as between ethnic groups. Environmental problems are commonly perceived to be the cause of somatic symptoms and are significantly related to self-rated health status.

The long-term mental health effects of nuclear trauma in recent Russian immigrants in the United States

The long-term mental health sequelae (15 years) of the 1986 Chernobyl nuclear disaster in the former Soviet Union (FSU) were assessed in survivors migrated to the United States, as part of an ongoing study. Using a retrospective, cross-sectional design with standardized Russian mental health measures, a sample of 261 Russians residing in the New York tristate area were tested for multiple domains of mental health functioning. Multivariate analyses pointed to aspects of the accident and its negative repercussions as reliable predictors of current psychological distress. Russians who had lived closer to the disaster, and had greater exposure to it, currently experience higher levels of anxiety (p < .0004) and posttraumatic reactions (p < .03) than those who had lived at a further distance. These findings are consistent with reports of long-term sequelae in Chernobyl survivors migrated to Israel (Remennick, 2002), as well as those remaining in the FSU (Havenaar et al., 1997). Implications of long-term traumatic sequelae, especially in the complex perimigration context, are discussed.

Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder, and stress-related bodily disorders: the role of the hypothalamus-pituitary-adrenal axis

Following the assumption that stressors play an important part in the etiology and maintenance of psychiatric disorders, it is necessary to evaluate parameters reflecting stress-related physiological reactions. Results from these examinations may help to deepen the insight into the etiology of psychiatric disorders and to elucidate diagnostic uncertainties. One of the best-known stress-related endocrine reactions is the hormonal release of the hypothalamic-pituitary-adrenal (HPA) axis. Dysregulations of this axis are associated with several psychiatric disorders. Profound hyperactivity of the HPA-axis has been found in melancholic depression, alcoholism, and eating disorders. In contrast, posttraumatic stress disorder, stress-related bodily disorders like idiopathic pain syndromes, and chronic fatigue syndrome seem to be associated with diminished HPA activity (lowered activity of the adrenal gland). Hypotheses referring to (a) the psychophysiological meaning and (b) the development of these alterations are discussed.

Coping with technological disaster: an application of the conservation of resources model to the Exxon Valdez oil spill

One hundred twenty-five commercial fishers in Cordova, Alaska, completed a mailed survey regarding current mental health functioning 6 years after the Exxon Valdez oil spill. Economic and social impacts of the oil spill and coping and psychological functioning (modified Coping Strategies Scales, Symptom Checklist 90-R) were measured. Multiple regression was used to test the utility of the Conservation of Resources stress model for explaining observed psychological symptoms. Current symptoms of depression, anxiety, and Posttraumatic Stress Disorder were associated with conditions resource loss and avoidant coping strategies. The Conservation of Resources model provided a framework for explaining psychological impacts of the oil spill. Future research is needed to identify factors related to recovery.