Following any disaster, behavioral and mental health effects should be anticipated within a substantial proportion of the affected population; effects may be significant, especially following large-scale or intentional incidents. These effects can include a negative perception of individuals, families, communities, ethnic/racial groups, or even certain professions that may become associated with the incident via media and other reports. In stressful situations, feelings of distress and anxiety about safety, health, and achieving recovery outcomes are also common. Survivors, responders, and community members can be expected to display a variety of symptoms and reactions, including:68
- Emotional symptoms such as irritability or excessive sadness
- Cognitive dysfunction such as difficulty making decisions or following directions
- Physical symptoms such as headache, stomach pain, or difficulty breathing
- Behavioral reactions such as increased dependency or abuse of drugs/alcohol or exacerbated interpersonal conflict
- Failure to adhere to needed physical or psychiatric medication needs
Chemical incidents can present special behavioral and mental health challenges in comparison with other types of disasters. On the one hand, exposures to many chemicals themselves may negatively impact an affected individual’s mental status and mental health. Occupational exposures to a host of industrially-used chemicals, especially heavy metals and solvents, have long been known to be associated with the development of delirium, dementia, and delusional, mood, and anxiety disorders, and have been linked to disorders such as schizophrenia.69 For agricultural workers, exposures to organophosphate pesticides (such as the event discussed in the Prologue) are linked to increased risk of depression and suicide. Memory impairment, anxiety, confusion, and irritability following exposure have been reported among these agricultural workers for over 50 years.70
From a community perspective, chemical incidents can leave a unique psychological footprint on affected populations because they often occur without warning, produce unfamiliar or unknown health effects, and can pose long-term threats to the community at large. Communities recovering from chemical disasters may experience higher levels of fear and uncertainty as well as increased feelings of blame and loss of control.71 Questions about delayed health effects such as delayed onset of symptoms or long-term health effects such as cancer, effects on pregnant women, or children’s developmental risks, will be on everyone’s mind. In fact, for those released from care after exposure as well as those displaced (but not injured) by the incident, feelings of anxiety following a chemical exposure can be overwhelming. News stories and images of intensive decontamination procedures may instill the belief in survivors that everyone requires a high level of decontamination or other medical interventions. Addressing these fears should be a high priority action. Expert risk communication messages that coordinate information from Incident Command, poison control centers, public health experts, and state and local officials must be provided to the community and updated regularly. Rapid dissemination of risk information, frequently updated with new information, is one of the most effective ways of decreasing public fear and avoiding/defusing the potential for widespread civil/social unrest. Decreased anxiety will additionally benefit already strained healthcare resources, as fewer minimally exposed individuals will feel compelled to seek medical evaluation.
Chemical incidents can have unique psychological impacts because they often occur without warning, produce unfamiliar or unknown health effects, and can pose long-term threats.
Affected communities may also face a decreased willingness from outsiders to provide assistance after a chemical incident, whether intentional or not, out of fear of contamination hazards. This increases the survivors’ risk of experiencing mental health effects over that seen for other types of disasters. In addition to addressing community concerns, expert risk communication messages can also serve to decrease outsider anxiety. On the other hand, the health impacts of psychological exposure to chemicals can extend far beyond the geographical area in which the actual physical exposure occurs. In a study comparing oil-exposed and non-exposed communities, perceived exposure to spilled oil (perceived risk) was associated with greater levels of anxiety and depression than was actual physical exposure to oil. In fact, many studies report that populations affected by oil spills have elevated anxiety, depression, and post-traumatic stress disorder (PTSD).72,73
At the individual level, survivors of chemical disasters are at heightened risk for chronic stress due to a fear of uncontrollable and invisible physical deterioration.74 For example, suffering the effects of a chemical incident, such as a chlorine gas exposure resulting from a train derailment, has been associated with long-term increased post-traumatic stress (PTS) symptoms.75
Individuals exposed to chemical substances in the context of war have been known to experience anxiety, depression, and symptoms of PTSD (decades later) at rates far higher than individuals within the same conflict, but not exposed to chemical weapons.76 Over the long term, individuals exposed to the chemical warfare agent sulfur mustard in Iraqi Kurdistan described feeling that the agent had become permanently integrated into their bodies and was continuing to damage their organs years later, with profound long-term negative effects on their quality of life.77 Even three decades later, survivors reported experiencing difficulty sleeping, depression, irritability, anxiety, suicidal ideation, and symptoms of PTSD.
In large-scale or intentional chemical incidents, many individuals may suffer behavioral and mental health effects and may seek medical assistance. If not mitigated by behavioral and medical triage, the ability of medical facilities and workers to assist those with physical injuries can be quickly overwhelmed. The provision medical care for physical injuries is discussed in KPF 6, Augment Provision of Health and Medical Services to Affected Population.
Behavioral health issues may be significant and could overwhelm existing counseling professionals and facilities, especially since these issues will call for less traditional methods of delivering psychological support.
Footnotes
68. Dembert, M., & Mark, L., (1991). Occupational Chemical Exposures and Psychiatric Disorders. Jefferson Journal of Psychiatry, 9(1). Print.; Attademo, L., Bernardini, F., Garinella, R., & Compton, M. T. (2017). Environmental pollution and risk of psychotic disorders: A review of the science to date. Schizophrenia research, 181, 55–59.
69. Khan, N., Kennedy, A., Cotton, J., & Brumby, S. (2019). A Pest to Mental Health? Exploring the Link between Exposure to Agrichemicals in Farmers and Mental Health. International Journal of Environmental Research and Public Health, 16(8), 1327.; Holmes, J. H., & Goan, M. D. (1957). Observations on acute and multiple exposure to anticholinesterase agents. Transactions of the American Clinical and Climatological Association, (68), 86–103.
70. MCCormick, L.C., Tajeu, G.S., & Klapow, J. (2015). Mental health consequences of chemical and radiologic emergencies: a systematic review. Emergency medicine clinics of North America, 33(1), 197–211.
71. Gallacher, J., Bronstering, K., Palmer, S., Fone, D., & Lyons, R. (2007). Symptomatology attributable to psychological exposure to a chemical incident: a natural experiment. Journal of epidemiology and community health, 61(6), 506–512.
72. Croisant, S. A., Lin, Y. L., Shearer, J. J., Prochaska, J., Phillips-Savoy, A., Gee, J., et al. (2017). The Gulf Coast Health Alliance: Health Risks Related to the Macondo Spill (GC-HARMS) Study: Self-Reported Health Effects. International Journal of Environmental Research and Public Health, 14(11), 1328.
73. Young, B.H., Ford, J.D., Ruzek, J.I., Friedman, M.J., Gusman, F.D. (1998). Disaster Mental Health Services: A Guidebook for Clinicians and Administrators. Department of Veteran Affairs, The National Center for Post-Traumatic Stress Disorder.
74. Ginsberg, J. P., Holbrook, J. R., Chanda, D., Bao, H., & Svendsen, E. R. (2012). Posttraumatic stress and tendency to panic in the aftermath of the chlorine gas disaster in Graniteville, South Carolina. Social Psychiatry and Psychiatric Epidemiology, 47(9), 1441–1448.
75. Hashemian, F., Khoshnood, K., Desai, M.D., Falahati, F., Kasl, S., & Southwick, S. (2006) Anxiety, Depression, and Posttraumatic Stress in Iranian Survivors of Chemical Warfare. JAMA 296(5), 560-66.
76. Moradi, F., Söderberg, M., Moradi, F., Daka, B., Olin, A. C., & Lärstad, M. (2019). Health perspectives among Halabja's civilian survivors of sulfur mustard exposure with respiratory symptoms-A qualitative study. PloS ONE, 14(6), e0218648.
77. Chance, G. W. (2001). Environmental contaminants and children's health: Cause for concern, time for action. Paediatrics & child health, 6(10), 731–743. ; Kwok, R. K., McGrath, J. A., Lowe, S. R., Engel, L. S., Jackson, W. B., Curry, M.D., et al. (2017). Mental health indicators associated with oil spill response and clean-up: cross-sectional analysis of the Gulf Study cohort. The Lancet Public health, 2(12), e560–e567.