The Mental Health Consequences of Chornobyl for Children and Mothers PowerPoint PPT Presentation

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Title: The Mental Health Consequences of Chornobyl for Children and Mothers


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The Mental Health Consequences of Chornobyl for
Children and Mothers
  • Evelyn J. Bromet, Ph.D.
  • September, 2007

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Chornobyl Exploded
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UPA-Stony Brook Research Program
  • How it came about
  • Design
  • Main findings from 1997 study (published)
  • New findings follow-up in 2005-6

4
Events 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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Result 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

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First 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)

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First 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

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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

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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

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Main 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

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PTS 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

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Post-traumatic stress symptoms in children
ANOVA Grp Sexns
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But
  • 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)

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Percents rating kids health as bad/very bad in
1997
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8-years later
  • Finished the World Mental Health Survey with KIIS
  • Grant to do a follow-up of the Chornobyl children

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Panel 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

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Grant 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

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Methods
  • 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)

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Evacuee 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
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Response rates for surviving cohort
  • Adolescents
  • Evacuees 89
  • Classmates 87
  • (Population-based controls 85)
  • Mothers
  • Evacuees 86
  • Classmates 81
  • (Population-based controls 79)

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Analysis 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

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Analysis 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.

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Medical 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

31
Self-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)

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Even 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

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Mothers 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

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Mothers views
  • Evacuee mothers continued to view their
    childrens health as worse than the control
    mothers.
  • But compared to 1997, not as much worse

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Mom-CSI 1997 and 2005
Repeated measures Grp Time Interaction

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Mom Rates Childs Health as Bad 1997 and 2005
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Mom Rates Childs Health as Worse than Peers
1997 and 2005
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Mom Says Child Dx with Vascular Dystony 1997 and
2005
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How are the adolescents functioning?
  • The same as their peers

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Main role in 2005-2006
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Neuropsychological 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)

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Mental 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

43
Mental health 1997 and 2005Childrens Manifest
Anxiety Scale (C-MAS)
Repeated measures Grpns, time interactionns
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What about Chornobyl?
  • How do the adolescents view Chornobyl?

45
Effects 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)

46
Importance 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

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Influence of Chornobyl event adolescents
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Focus group discussions
  • Bored by discussing Chornobyl, the adolescents in
    the focus group said
  • Not our issue. Its our mothers issue.

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Influence of Chornobyl event mothers
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Bottom line
  • Would you marry an evacuee? YES
  • 90 evacuees
  • 90 classmates
  • 81 new controls
  • Plt0.001

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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

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The mothers in 2005-2006
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Mothers GSI in 1997 and 2005
Repeated measures (evac vs classmates) Grp,
time interactionns
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Mothers Rating that Health Bad/Very Bad


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Mothers Proxy Chornobyl-related PTSD


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Mothers Belief that Chornobyl had VERY Adverse
Effect on her Health


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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

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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
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