PSYCHOLOGICAL EFFECTS OF LONG TERM EXPOSURE AND RADIATION INJURY

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PSYCHOLOGICAL EFFECTS OF LONG TERM EXPOSURE AND
RADIATION INJURY

• Module XX

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Syllabus

• Introduction
• Medical consequences of radiation accidents
• Psychological consequences of radiation accidents
  
• What is psychological stress caused by the
  accident?
• What can we do about stress?
• Management of psychological effects
• Summary

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Introduction

• Importance of psychological impact of radiation
  accidents underestimated in past
• Psychosocial effects may far outnumber any direct
  health effects
• Reactions to nuclear and radiological accidents
  similar
• Role of scientific community, and physicians in
  particular, in influencing public perception of
  risk - and addressing psychological consequences
  of accidents

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Medical consequences of radiation accidents

• Health effects directly related to radiation
  exposure
• Deterministic
• Stochastic
• Health effects indirectly related to radiation
  exposure
• Caused by accident
• Caused by intervention

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Health effects directly related to radiation
exposure

• Not related to awareness of exposure or to
  subjective perception of risk
• Can be prevented or reduced by protective action
  minimizing public exposure

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Health effects indirectly related to radiation
exposure

• Can far outnumber any direct effects
• Need to be taken into account
• Can affect hundreds of thousands
• Can last for many years
• Do not correlate well with actual exposure but
  with subjective perception of risk
• Protective action to reduce exposure may be
  counterproductive with regard to such effects

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Why do people fear ionizing radiation?

• Unknown threat
• Can not be seen or felt
• Conflicting information in mass media
• Contradictory data from different scientists
• Use of radiation theme in economic and
  political discussions
• Long term consequences of radiation exposure
• Lack of education of general public, physicians
  and other professionals
• Social understanding of any situation involving
  radiation is negative

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Psychological effects

• Psychological effects include
• Mental suffering
• Changes in risk perception
• Modification in individual and social behaviour

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Psychological effects

• Major accidents (Chernobyl, TMI, Goiânia) show
  that affected people
• believe health threatened
• doubt reports about accident and resulting
  radiation doses
• get life style modified
• have somatic complains
• abuse drugs (alcohol, tranquilizers, sleeping
  pills)

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Severity of psychological reactions

• Depends on
• factors related to accident
• abruptness, intensity, duration, availability of
  social support, etc.
• factors related to individual
• experience, personal loss, perception of threat,
  personal coping ability, etc.

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What is psychological stress caused by accident?

• Normal reaction to abnormal event
• Unusually strong psychological and emotional
  reactions which could interfere with ability to
  function during or after accident
• Can become post traumatic stress disorder

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What is psychological stress caused by accident?

• New diagnostic entity chronic environmental
  stress disorder proposed
• Principal characteristics
• apathy, asthenia, diminished interest and
  learned helplessness

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Changes in health behaviour of affected people

• Extensive medical examinations (active screening)
  increase anxiety about current and future effects
• Change in illness behaviour and greater
  diagnostic capability together with vast
  screening programmes increase disease diagnoses
  in most organs and systems

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Stress reactions
Physical

• Early
• Nausea
• Muscle tremors
• Sweating
• Dizziness
• Chills
• Increased heart rate
• Increased blood pressure
• Hyperventilation

• Late
• Fatigue
• Increased use of alcohol and drugs
• Exaggerated startle response
• Sleep - related difficulties

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Stress reactions
Cognitive

• Delayed
• Decreased attention span
• Poor concentration
• Memory problems
• Flashbacks

• Early
• Confusion
• Difficulty in making decisions
• Impaired thinking
• Difficulty problem solving
• Memory loss
• Calculation difficulties
• Difficulty remembering names

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Stress reactions
Emotional

• Delayed
• Feeling abandoned
• Resentment
• Feeling alienation
• Withdrawal
• Numbness
• Depression

• Early
• Anxiety
• Anger
• Fear
• Irritability
• Guilt
• Feeling overwhelmed
• Grief
• Hopelessness

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Psychological problemsLate

• Continuation of some early problems
• Discrimination by other people
• Establishment of illness behaviour
• Concern about consequences of exposure

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Psychological effects of relocation

• Relocation dubious
• Negative impact on mental well being
• If aimed to reduce risk of stochastic effects
• Consider only future avoidable dose
• Dose already achieved cannot be reduced
• Involuntarily relocated people suffer most
• Elderly people especially likely to suffer

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What can we do about stress?

• Accidents can not be predicted
• BUT
• Psychological reaction to radiation accident
  could be
• prevented / mitigated
• using different methods applied
• before / during / after accident

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Management of psychological consequences after
accident

• Response to reduce psychological consequences
• Medical response
• Public health follow-up
• Social assistance
• Government action guidelines
• Community accountability

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How to reduce psychological effects

• Have ongoing information programme
• Give clear, simple and timely advice
• Provide consistent advice and assessment (one
  official point)
• Use international guidance
• Ensure protective action justified
• Correct false information
• Consider education and counselling

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Warning population

• Timely warning one of most important
  psychological aspects of dealing with accidents
• Provide people with sense of control over
  situation
• Call for active attitude
• Searching process
• Preparation for protective action

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Requirements for warning message

• Consistent
• Accurate, timely and complete
• Clear
• Simple
• Sufficient
• Concrete
• Provided through multiply channels
• Frequently repeated

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Psychological support in different types of
accidents
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Psychological stress of injured individuals

• Patient needs
• Comfort, relief of symptoms
• Stability and authoritative support
• Information
• Concern
• Hope
• Control
• Stimulation

• Patient problems
• Overly scientific approach
• Repeated tests, examinations
• Photographs
• Reactions of others
• Too many experts
• Too much media attention

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Medical staff problems

• Fear / anxiety
• Isolation by others
• Lack of knowledge (medical treatment, long term
  effects, etc.)
• New experience
• Interactions with experts, public officials,
  reporters, etc.
• Loss of autonomy (activities may be
  monitored/managed by authorities)

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Mitigation of psychological consequences

• One of the functional requirements
• Applicable for all planning categories
• Should be performed by facility, local or
  national level of response
• Depending on planning category

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Mitigation of psychological consequences

• Establish written process for justifying,
  optimizing and authorizing different intervention
  or action levels following event for longer term
  protective action
• Consider effects on mental health, economic
  conditions, employment, long term needs for
  social welfare and other non-radiological impact
  caused by taking longer term protective action

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Mitigation of psychological consequences

• Establish capability for addressing public
  concerns and reactions during actual or perceived
  nuclear or radiological emergency

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Mitigation of psychological consequences

• Ensure that affected people perceive, understand,
  believe, personalize, and respond to warning

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Mitigation of psychological consequences

• Before long term monitoring or other activities
  are conducted in areas designed for unrestricted
  use after accident, ensure public understand
  reasons for these continuing activities (e.g.
  scientific investigations of behaviour of
  radioisotopes in environment)

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Mitigation of psychological consequences

• Establish process to develop system of
  compensation for emergency workers and public
  following emergency after careful consideration
  of benefits and long term social, psychological
  and economic effects

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Summary

• Psychological effects more important in current
  situation
• What is stress caused by accident?
• What can we do about stress?
• Management of psychological effects
• Psychological support in different types of
  accidents
• Mitigation of psychological consequences