Title: The Mental Health Consequences of Chornobyl for Children and Mothers
1The Mental Health Consequences of Chornobyl for
Children and Mothers
- Evelyn J. Bromet, Ph.D.
-
- September, 2007
2 Chornobyl Exploded
3UPA-Stony Brook Research Program
- How it came about
- Design
- Main findings from 1997 study (published)
- New findings follow-up in 2005-6
4Events leading to study
- TMI experience
- WHO conference in Kyiv May 1990
- Richard Days study of cataracts in children
- Feasibility grant from NIH to consider whether we
could design a study similar to TMI in Kyiv (July
1, 1991 June 30, 1992)
5 Planning Stage
- Moved from Pittsburgh to SB in 1986 did not know
that Dr. Gluzman was collaborating with colleague
in Pgh - Shortly after grant period started, Soviet Union
dissolved - December 1991, Ints Calitis, Latvian dissident
and democratic nationalist, attended a human
rights meeting in NY.
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11Result of feasibility grant
- Developed a set of questions and basic study
design - Submitted a grant to National Institute of Mental
Health - Review panel did not like the school-based sample
design - Zenya got access to a community list of evacuees
12First grant 1995-1998
- Grant from NIMH to study the mental health of
evacuee children in Kyiv - Evaluated depression, anxiety, somatization
symptoms and neuropsychological performance - Compare evacuee children with classmates
- Examine role of Chornobyl-related stress
- Rule out other risk factors (parental depression
and alcoholism physical health issues)
13First grant 1995-1998
- Focused on a high risk group (children who were
in utero 15 months in April 1986) - Sampling frame created from Registry and 2 other
lists N721 families with target child 693
lived in Kyiv in 1997 - 300 randomly selected evacuee children
- 300 gender-matched classmates
- Response rate 92 evacuees 85 comparison
14 Assessments
- Interviewers from SOCIS-Gallop
- Standard mental health and culture-free
neuropsychological testing - Translated and back-translated
- Children mothers interviewed in their homes by
2 interviewers at same time - Schools grades absenteeism teacher
questionnaire - Clinic basic physical exam and blood test
15 Characteristics
- Evacuees (N300)
- Median age, 11
- Male, 48
- In utero, 33
- Either parent univ, 25
- Mom unempl, 39
- Dad unempl, 12.5
- Russian Orth, 61
- Pripyat, 81
- Classmates (N300)
- Median age, 11
- Male, 48
- In utero, 28
- Either parent univ, 28
- Mom unempl, 20
- Dad unempl, 7
- Russian Orth, 70
16Main findings
- No unusual medical findings no group diffs
- No differences in neuropsychological performance
- No differences in school grades although evacuee
children had more absences - Evacuee children perceived their well-being
similar to classmates (self-esteem depression
and anxiety symptom scales social competence) - Exception measure of post-traumatic stress sx
17PTS symptoms
- 15 items rated never (0) to always (4)
- Examples
- Get scared or upset when think about Chernobyl
- Have headaches, stomach aches or other sick
feelings because of Chornobyl - Have bad dreams about Chornobyl
18Post-traumatic stress symptoms in children
ANOVA Grp Sexns
19But
- Evacuee mothers and teachers reported more health
problems than classmates - More evacuee mothers said children had memory
problems - On some measures, evacuee children rated their
health more poorly (18 vs 12 bad/very bad
health plt0.05) - Evacuee children rated their scholastic
competence lower (3.01.5 v 3.31.6 plt0.05)
20Percents rating kids health as bad/very bad in
1997
218-years later
- Finished the World Mental Health Survey with KIIS
- Grant to do a follow-up of the Chornobyl children
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23Panel study when kids were 18-19
- Specific aims
- Evaluate if evacuee mothers continue to rate
their childrens health more negatively - Evacuee adolescents would internalize these
concerns about their physical health - Medical effects
- Other adverse outcomes neuropsychological,
psychological, role performance - Compare with a population-based sample
24Grant 2004-2008
- (Last time Soviet Union broke up this time,
Orange Revolution set our time-table back) - First step Focus group at KIIS
- 10 mothers
- evacuee childrens health problems
- husbands alcoholism
- Their 10 adolescent children
- bored by Chornobyl
25Methods
- Interviews with adolescents and mothers (KIIS
laptops) - Natasha used same measures when we could
- Neuropsychological testing (expanded)
- Medical examinations
- Blood tests (including TSH thyroid stimulating
hormone) - Added population-based control group from Kyiv
(national survey?not use national sample)
26Evacuee Mom-Child Dyads 300
interviewed ? 275 medical exam
Classmate control Mom-Child Dyads 300
interviewed ? 272 medical exam
Baseline
Evacuee Moms 6 deceased 9 unlocated 31
refused 254 interviewed
Classmate Moms 5 deceased 15 unlocated 41
refused 239 interviewed
Evacuee Children 1 deceased 12 unlocated 22
refused 265 interviewed
Classmate Children 0 deceased 15 unlocated 24
refused 261 interviewed
Population-based control Moms 304 interviewed
Population-based control Children 32
7 interviewed
Follow-up
220 medical exam
229 medical exam
229 medical exam
27Response rates for surviving cohort
- Adolescents
- Evacuees 89
- Classmates 87
- (Population-based controls 85)
- Mothers
- Evacuees 86
- Classmates 81
- (Population-based controls 79)
28Analysis of loss to follow-up
- Only variable that predicted childrens
participation was their mothers participation - Other predictors of mothers participation
- --initial concerns about the childs health
- --psychological distress
- --risk perceptions
- Evacuee status NOT a predictor
29Analysis of clinic attendance
- Initial clinic attendance (mothers brought kids)
associated with mothers health concerns. - Follow-up clinic attendance (kids came
themselves) associated with female sex, lower
standard of living, diagnosis of depression or
generalized anxiety disorder, poor health
ratings, and kids concerns regarding Chornobyl.
30Medical exam and blood test results at follow-up
- No significant differences
- Enlarged thyroid
- 17 evac 13 classmates 16 new control
- Thyroid removal
- 4 evacuees 1 population control
- Enlarged lymph nodes
- 5 evacuees 3 classmates 8 new controls
- Cataracts 4 evacuees
- Blood test values in normal range
31Self-assessed health and health risk factors
- No significant differences
- Rate health bad/very bad (7.1 overall)
- Heavy alcohol use (13.8)
- Frequent headaches (23.0)
- Body mass index (21.23.0)
- Childrens Somatization Scale (13.610.9)
- Fewer evacuees smoked (48 vs 53 of controls)
32Even though
- Significant differences
- Medical check-up in past year
- 40.5 evac 28 classmates 27 new
controls - Hospitalized 2 times in past 5 years
- 33 evac 20 classmates 18 new controls
- Reported diagnosis of vascular dystony
- 34 evac 21 classmates 17 new controls
33Mothers perceptions of adolescents health
- Significant differences
- Diagnosed with vascular dystony (2x what kids
said) - 69 evac 30 classmates 29 new controls
- Rate health bad/very bad
- 17 evac 8 classmates 10 new controls
- More than 1 chronic disease
- 62 evac 31 classmates 31 new controls
34Mothers views
- Evacuee mothers continued to view their
childrens health as worse than the control
mothers. - But compared to 1997, not as much worse
35Mom-CSI 1997 and 2005
Repeated measures Grp Time Interaction
36Mom Rates Childs Health as Bad 1997 and 2005
37Mom Rates Childs Health as Worse than Peers
1997 and 2005
38Mom Says Child Dx with Vascular Dystony 1997 and
2005
39How are the adolescents functioning?
40Main role in 2005-2006
41Neuropsychological performance
- Intelligence tests WAIS Similarities,
Information, Picture Completion, Block Design - Attention Trails, VSAT, Underline-the-Words
- Memory Hopkins Verbal Learning Task, Benton
- Population controls normative sample
- Stratified evacuees and classmates by parent
university education - No significant differences (stratified on parent
education)
42Mental health at follow-up
- No significant differences
- Major depression/generalized anxiety disorder in
past year (5 evac 9 2 control grps) - Emotional self-esteem scale
- Depression self-rating scale
- Childrens Manifest Anxiety scale
43Mental health 1997 and 2005Childrens Manifest
Anxiety Scale (C-MAS)
Repeated measures Grpns, time interactionns
44What about Chornobyl?
- How do the adolescents view Chornobyl?
45Effects on health
- Think health very much affected by Chornobyl
- 20 evac 9 classmates 14 new controls
- According to their mothers
- 56 evac 26 classmates 24 new controls
- Relationships between mothers and childrens
perceptions (plt0.001)
46Importance of Chornobyl as life event
- Natashas item
- How did Chornobyl influence life compared to
other events - 1. more influence than any other event
- 2. among the events that influenced my life the
most - 3. important event but less influential than
other events - 4. not a very important event in my life
47Influence of Chornobyl event adolescents
48Focus group discussions
- Bored by discussing Chornobyl, the adolescents in
the focus group said - Not our issue. Its our mothers issue.
49Influence of Chornobyl event mothers
50Bottom line
- Would you marry an evacuee? YES
- 90 evacuees
- 90 classmates
- 81 new controls
- Plt0.001
51 Mental health of mothers
- In 1997, evacuees had poorer mental health on all
of the measures (especially somatization PTSD) - In 2005-6, very little change, and evacuees still
had poorer mental health
52The mothers in 2005-2006
53Mothers GSI in 1997 and 2005
Repeated measures (evac vs classmates) Grp,
time interactionns
54Mothers Rating that Health Bad/Very Bad
55Mothers Proxy Chornobyl-related PTSD
56Mothers Belief that Chornobyl had VERY Adverse
Effect on her Health
57 Conclusions and Future Analyses
- 8 evacuee children have had significant health
problems (4 thyroid removal 4 cataracts) - Evacuee children remained healthy
- Mothers remain concerned
- Evacuee children are functioning like their peers
- Evacuee mothers mental health same or a bit
worse - Identify other Chornobyl and non-Chornobyl risk
factors for poor outcomes
58 Team of Architects
- Kyiv
- Semyon Gluzman
- Daniil Gluzman
- Evgenii Golovakha
- Natalia Panina
- Vladimir Paniotto
- Victoria Zakhozha
- Ihor Rishko
- Julia Pievskaya
- Margarit Abramova
- USA
- Gabrielle Carlson
- Joseph Schwartz
- Thomas Gilbert
- Sergei Lyubsky
- Johan Havenaar
- Joost Bijlsma
- Charles Webb
- David Taormina
- Lin Tung
- Roman Kotov
deceased