Mental Health Findings Population Studies

Psychiatrists from the Soviet Union were involved in the enormous civil operation that was mounted immediately after the nuclear catastrophe and an assessment of the psychological damage was made [9]. Unfortunately, most of these early Eastern European studies, as well as most of those that followed in later years, used non-standardized methodology and had other methodological shortcomings [10,11]. Rumyantseva et al. [12] assessed psychological adjustment and mental health in the first year after the event and found higher rates of psychological distress among people in the exposed areas. The clean-up workers (called ''liquidators'' in the Russian vernacular) were at greatest risk, with 84% showing signs of psychological disorder.

Later studies by Western investigators, using internationally accepted methodology and instruments, by and large confirmed these initial findings. Viinamaki et al. [13] reported higher rates of psychological distress as measured with the General Health Questionnaire (GHQ) in an exposed compared to an unexposed population 6-7 years after the accident. The highest rates were found among women. Havenaar et al. [14,15] confirmed these findings in a large-scale population-based study in the severely polluted Gomel region in Belarus and a non-affected but socioeconomically comparable area of Russia (the Tver region). Using the GHQ, these authors also found elevated rates of psychological distress among evacuees but not among liquidators. Importantly, this study also showed that the differences in mental health problems were limited to self-report measures of psychological distress. Differences in the prevalence of psychiatric diagnoses in terms of DSM-III-R, particularly anxiety disorders, were only found among evacuees (odds ratio, OR 3.78; 95% confidence interval, CI 1.09-13.14) and mothers of young children (OR 2.84; 95%CI 1.64-4.92).

More recently, other Eastern European studies have investigated the mental health impact of the disaster. Rahu et al. [16] reported that suicide was the leading cause of death among Estonian clean-up workers. However, methods of registration of causes of death among the heavily monitored clean-up workers group differed substantially from those used in the general population, thereby making comparison with the general population risky. Another report suggested that there was an increase in the rates of schizophrenia and dementia in clean-up workers [17], but this finding has not been verified. More likely, selection bias, non-blind evaluations, confounding variables (especially alcoholism), and other methodological factors explain these implausible findings.

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