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The Psychological Traumas of Chernobyl Liquidators

The Chernobyl catastrophe not only ruined physiological health of many people with radiation, cancer, and various accidents during the liquidation period, but also created a whole generation of people deeply disturbed by the events of that period. Before we explain how the incident affected people psychologically, we must focus on adverse effects of ionizing radiation. There are two important types of it:

  1. External (ranging from decimals of a roentgen to hundreds roentgen);
  2. Internal occurring due to inhaling radioactive dust and sprays (the same range).

There are multiple horrendous effects that radiation has on biological organisms. Various pathological changes and significant changes in the CNS were discovered during several detailed studies by some of the best Soviet and Russian scientists Mogilintsky, Polischuk, Portugalov, and many others. Many noticed that radiation affected the CNS heavily. Some scientists including professor Kurshakov who wrote an extensive monograph on the topic noted that there is no denying that radiation induces a multitude of pathological processes leading to severe psychological disorders.

These problems are further complicated by different factors and perceived threats that dramatically reduce the quality of life of people who undergo notable changes in behavior and psychological conditions due to radiation. This affects not only irradiated individuals themselves but also their loved ones. Some adverse effects of people who receive high radiation dosages include emotional instability, changes in reflexes, problems with taste and smell, smell hallucinations, and significant worsening of memory.

 

The long term tendency

One of the problem is that people who were affected by radiation later entered a new life phase. The severe traumatizing situation of dealing with psychological and physiological consequences of radiation poisoning without a quick resolution or effective treatment. Despite possible drastic adverse effects of radiation on mind and body, there are other important factors that worsen the condition of people over a long period of time:

  • The threat of death and decreasing health.
  • The threat of decreasing health of relatives and children.
  • The feeling of guilt for what happened.
  • The threat of losing wealth and financial stability.
  • Uncertainty of present life.
  • The lack of good perspectives for future.
  • The threat of developing an impotence (in men).
  • The lack of trustworthy reliable information about radiation and its long term effects.
  • The threat of possible genetic mutations.

All these continuously present threats and irritates make the very existence of former liquidators a constant struggle. They know that radiation might be slowly killing them and many have to live with a mortal fear of cancer and possible complications of their health issues. Living with a feeling of being threatened at all times is quite hard.

For many the future does not really exist and they consciously avoid planning ahead and still live stressful low quality lives that are ruined by a single incident that occurred decades ago. This is truly a terrible trauma for a generation of people.

The psychosocial consequences of disasters have been studied for more than 100 years. The most common mental health consequences are depression, anxiety, post-traumatic stress disorder, medically unexplained somatic symptoms, and stigma. The excess morbidity rate of psychiatric disorders in the first year after a disaster is in the order of 20%. Disasters involving radiation are particularly pernicious because the exposure is invisible and universally dreaded, and can pose a long-term threat to health. After the Chernobyl disaster, studies of clean-up workers (liquidators) and adults from contaminated areas found a two-fold increase in post-traumatic stress and other mood and anxiety disorders and significantly poorer subjective ratings of health. Among liquidators, the most important risk factor was severity of exposure. In general population samples, the major risk factor was perceived exposure to harmful levels of radiation.

The mental health effects were fueled in part by an exaggerated sense of the danger to health from presumed exposure to radiation, that was propelled by the local medical community and government officials. Liquidators, evacuees and people living in contaminated regions were officially labeled as “sufferers” or “Chernobyl victims”, terms that were adopted by the mass media. Being recognized as a Chernobyl “victim” entitled people to financial, medical and educational compensation, which, combined with continuous monitoring by local and international organizations, may have had an iatrogenic effect on psychological well‐being.

 

In our 25‐year review of the impact of Chernobyl on mental health3, we concluded that the psychological consequences, especially for mothers and liquidators, continued to be a concern, and that mental health care in affected regions was not adequate to meet their needs. Given the extensive literature on comorbidity of mental and physical health, we also called on surveillance and long‐term medical studies to integrate mental health measures into their assessment protocols. To our knowledge, the latter recommendations have not yet been fully embraced.

Between the 25th and 30th anniversaries, with a single exception, no new epidemiologic studies of the long‐term mental health aftermath of Chernobyl were conducted. Rather, recent publications are based on data obtained prior to 2011. The exception is a health registry study in Tallinn, Estonia, that found an increase in clinical diagnoses of nervous system disorders and intentional self‐harm in liquidators compared to controls. Other recently published research on liquidators includes a survey from Tallinn that confirmed findings from Ukraine about elevated rates of common mental disorders and suicidal ideation5, and papers on neurocognitive abnormalities in Ukrainian liquidators. However, in sharp contrast to Chernobyl cancer studies, the results reported in the latter studies from Ukraine have not been verified by an international panel of experts.

 

Consistent with findings from early studies conducted in Gomel (Belarus) and Bryansk (Russia), two recent papers analyzed data from general population surveys conducted prior to 2011 and found poorer life satisfaction and socio‐economic well‐being among residents of areas with mildly elevated levels of radiation (albeit within normal limits of natural background radiation) compared to other areas. The authors also estimated that these socio‐economic adversities had a substantial negative impact on Ukraine's global gross domestic product7, 8. The authors inferred that these differences were a consequence of negative risk perceptions about radiation, though these perceptions were not measured directly. To our knowledge, no other reliably sampled, general population surveys of affected regions have been published.

In our 25 year review, we pointed out that findings regarding the cognitive functioning of children exposed in utero or as infants were inconsistent and suggested that any plans for continued monitoring of their health should include neurocognitive and psychological measures as well as indicators of social and occupational functioning. This cohort is now in their early 30s. No new light has been shed on this highly contentious issue. We maintain that the most reliable, direct and transparent evidence points to no significant impact of (low‐level) radiation exposure on this cohort. However, we continue to advocate for a long‐term study of the biopsychosocial and neuropsychiatric wellbeing of this cohort compared to demographically similar controls. This is particularly critical because early childhood exposure to major stress, which many of these children experienced as a result of their mothers’ and physicians’ concerns about their health and life expectancy, is a well‐established risk factor for adult onset psychopathology. It is also imperative that such a long‐term study be conducted collaboratively by international experts and local scientists, as was the case in our own research, and that dissemination of study findings be done by local authorities entrusted with the welfare of the population.

It is unfortunate that not a single Chernobyl related mental health intervention trial has been published. On the other hand, it is important to emphasize that the majority of people we and others have studied in relation to Chernobyl did not have a psychiatric diagnosis or elevated psychiatric symptomatology. Indeed, what has been missing from past research is an emphasis on understanding resilience. The importance of identifying and treating psychologically vulnerable individuals after disasters is incontrovertible. However, it is equally important not to overstate the effect, as this may further contribute to a culture of victimhood.

There is growing concern in Ukraine about the neuropsychiatric effects of the war on the Eastern border on combat personnel. It is important to determine if rates of PTSD in this personnel (particularly among combat soldiers who are the children of liquidators and the in utero Chernobyl exposed cohort raised in an atmosphere tainted by Chernobyl stress) are similar to those reported for other countries. International cooperation in a study of the long‐term health and mental health effects of Chernobyl may not only be relevant to settling disagreements about the neurocognitive outcomes of exposed children generally, but may shed light on whether their early life exposure to stress is a risk factor for maladaptive response to extreme stress later in life.

These findings are consistent with results from A-bomb survivors and populations studied after the Three Mile Island nuclear power plant accident. With regard to children, apart from findings from ecological studies that lack direct data on radiation or other teratologic exposures and local studies in Kiev, the epidemiologic evidence suggests that neither radiation exposure nor the stress of growing up in the shadow of the accident was associated with emotional disorders, cognitive dysfunction, or impaired academic performance. Thus, based on the studies of adults, the Chernobyl Forum concluded that mental health was the largest public health problem unleashed by the accident. Since mental health is a leading cause of disability, physical morbidity, and mortality, health monitoring after radiation accidents like Fukushima should include standard measures of well-being. Moreover, given the comorbidity of mental and physical health, the findings support the value of training non-psychiatrist physicians in recognizing and treating common mental health problems like depression in Fukushima patients.

WHO health effects review

Within the UN Chernobyl Forum initiative the World Health Organization (WHO) conducted a series of expert meetings from 2003 to 2005 to review all scientific evidence on health effects associated with the accident. The WHO Expert Group used as a basis the 2000 Report of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), updated with critical reviews of published literature and information provided by the governments of the three affected countries. The Expert Group was composed of many scientists who had conducted studies in the three affected countries as well as experts world wide. Special health care programmes, established to treat people in the three countries which were most affected by the accident, were also considered. This resulted in a WHO report on "Health Effects of the Chernobyl Accident and Special Health Care Programmes".

 

The WHO Expert Group placed particular emphasis on scientific quality, using information mainly in peer-reviewed journals, so that valid conclusions could be drawn. In addition, comparisons were made with the results from studies of people involved in previous high radiation-exposure situations, such as the atomic bomb survivors in Japan.

Radiation exposure

Ionizing radiation exposure is measured as "absorbed dose" in gray (Gy). The "effective dose" measured in sievert (Sv) takes account of the amount of ionizing radiation energy absorbed, the type of radiation and the susceptibility of various organs and tissues to radiation damage. For most exposures from the Chernobyl accident, absorbed doses are similar to effective doses (i.e. 1Gy is approximately equal to 1 Sv).

 

As human beings we are continually exposed to ionizing radiation from many natural sources, such as cosmic rays, and naturally occurring radioactive materials in all the foods we eat, fluids we drink and air we breath. This is called natural background radiation.

UNSCEAR reports that the average natural background radiation dose to human beings worldwide is about 2.4 mSv2 each year, but this varies typically over the range 1-10 mSv. However, for a limited number of people living in known high background radiation areas of the world, doses can exceed 20 mSv per year. There is no evidence to indicate this poses a health risk.

For most people more than half of their natural background radiation dose comes from radon, a radioactive gas that can accumulate in homes, schools and workplaces. When inhaled, the radiation exposure from radon may lead to lung cancer. Radiation doses to humans may be characterized as low-level if they are comparable to natural background levels.

Doses received from the Chernobyl accident

Below are the total average effective doses accumulated over 20 years by the highest Chernobyl exposed populations. These can be compared with the average doses people normally receive from natural background over 20 years. Doses from typical medical procedures are also given for comparison purposes.

While the effective doses of most of the residents of the contaminated areas are low, for many people, doses to the thyroid gland were large from ingestion of milk contaminated with radioactive iodine. Individual thyroid doses ranged from a few tens of mGy to several tens of Gy.

 

Apart from the people exposed to high levels of radioactive iodine mentioned above, only those liquidators who worked around the stricken reactor in the first two years after the accident (240 000), the evacuees (116 000), some of whom received doses well in excess of 100 mSv, and the residents of the highly contaminated SCZs (270 000), received doses significantly above typical natural background levels. Current residents of the low contaminated areas (37 kBq/m2) still receive small doses above natural background levels, but these are well within the typical range of background doses received world-wide. For comparison, the high radiation dose a patient typically receives from one whole body computer tomography (CT) scan is approximately equivalent to the total dose accumulated in 20 years by the residents of the low contaminated areas following the Chernobyl accident.

Thyroid cancer

A large increase in the incidence of thyroid cancer has occurred among people who were young children and adolescents at the time of the accident and lived in the most contaminated areas of Belarus, the Russian Federation and Ukraine. This was due to the high levels of radioactive iodine released from the Chernobyl reactor in the early days after the accident. Radioactive iodine was deposited in pastures eaten by cows who then concentrated it in their milk which was subsequently drunk by children. This was further exacerbated by a general iodine deficiency in the local diet causing more of the radioactive iodine to be accumulated in the thyroid. Since radioactive iodine is short lived, if people had stopped giving locally supplied contaminated milk to children for a few months following the accident, it is likely that most of the increase in radiation-induced thyroid cancer would not have resulted.

In Belarus, the Russian Federation and Ukraine nearly 5 000 cases of thyroid cancer have now been diagnosed to date among children who were aged up to 18 years at the time of the accident. While a large number of these cancers resulted from radiation following the accident, intense medical monitoring for thyroid disease among the affected population has also resulted in the detection of thyroid cancers at a sub-clinical level, and so contributed to the overall increase in thyroid cancer numbers. Fortunately, even in children with advanced tumours, treatment has been highly effective and the general prognosis for young patients is good. However, they will need to take drugs for the rest of their lives to replace the loss of thyroid function. Further, there needs to be more study to evaluate the prognosis for children, especially those with distant metastases. It is expected that the increased incidence of thyroid cancer from Chernobyl will continue for many years, although the long-term magnitude of the risk is difficult to quantify.

Leukaemia and non-thyroid solid cancer

Ionizing radiation is a known cause of certain types of leukaemia (a malignancy of blood cells). An elevated risk of leukaemia was first found among the survivors of the atomic bombings in Japan some two to five years after exposure. Recent investigations suggest a doubling of the incidence of leukaemia among the most highly exposed Chernobyl liquidators. No such increase has been clearly demonstrated among children or adults resident in any of the contaminated areas. From the experience of the Japanese bomb survivors it is possible that a large proportion of the leukaemia cases that could be linked to Chernobyl have already occurred, now that 20 years have passed since the accident. However, further studies are needed to clarify this.

While scientists have conducted studies to determine whether cancers in many other organs may have been caused by radiation, reviews by the WHO Expert Group revealed no evidence of increased cancer risks, apart from thyroid cancer, that can clearly be attributed to radiation from Chernobyl. Aside from the recent finding on leukaemia risk among Chernobyl liquidators, reports indicate a small increase in the incidence of pre-menopausal breast cancer in the most contaminated areas, which appear to be related to radiation dose. Both of these findings, however, need confirmation in well-designed epidemiological studies. The absence of demonstrated increases in cancer risk – apart from thyroid cancer – is not proof that no increase has occurred. Based on the experience of atomic bomb survivors, a small increase in the risk of cancer is expected, even at the low to moderate doses received. Such an increase, however, is expected to be difficult to identify.

Mortality

According to UNSCEAR (2000), 134 liquidators received radiation doses high enough to be diagnosed with acute radiation sickness (ARS). Among them, 28 persons died in 1986 due to ARS. Other liquidators have since died but their deaths could not necessarily be attributed to radiation exposure.

An increased number of cancer deaths can be expected during the lifetime of persons exposed to radiation from the accident. Since it is currently impossible to determine which individual cancers were caused by radiation, the number of such deaths can only be estimated statistically using information and projections from the studies of atomic bomb survivors and other highly exposed populations. It should be noted that the atomic bomb survivors received high radiation doses in a short time period, while Chernobyl caused low doses over a long time. This and other factors, such as trying to estimate doses people received some time after the accident, as well as differences in lifestyle and nutrition, cause very large uncertainties when making projections about future cancer deaths. In addition, a significant non-radiation related reduction in the average lifespan in the three countries over the past 15 years caused by overuse of alcohol and tobacco, and reduced health care, have significantly increased the difficulties in detecting any effect of radiation on cancer mortality.

 

Although there is controversy about the magnitude of the cancer risk from exposure to low doses of radiation, the US National Academy of Sciences BEIR VII Committee, published in 2006, a comprehensive review of the scientific evidence, and concluded that the risk seems to continue in a linear fashion at lower doses without a threshold (this is called the “linear no-threshold” or LNT model). However, there are uncertainties concerning the magnitude of the effect, particularly at doses much lower than about 100 mSv.

The Expert Group concluded that there may be up to 4 000 additional cancer deaths among the three highest exposed groups over their lifetime (240 000 liquidators; 116 000 evacuees and the 270 000 residents of the SCZs). Since more than 120 000 people in these three groups may eventually die of cancer, the additional cancer deaths from radiation exposure correspond to 3-4% above the normal incidence of cancers from all causes.

Projections concerning cancer deaths among the five million residents of areas with radioactive caesium deposition of 37 kBq/m2 in Belarus, the Russian Federation and Ukraine are much less certain because they are exposed to doses slightly above natural background radiation levels. Predictions, generally based on the LNT model, suggest that up to 5 000 additional cancer deaths may occur in this population from radiation exposure, or about 0.6% of the cancer deaths expected in this population due to other causes. Again, these numbers only provide an indication of the likely impact of the accident because of the important uncertainties listed above.

Chernobyl may also cause cancers in Europe outside Belarus, the Russian Federation and Ukraine. However, according to UNSCEAR, the average dose to these populations is much lower and so the relative increase in cancer deaths is expected to be much smaller. Predicted estimates are very uncertain and it is very unlikely that any increase in these countries will be detectable using national cancer statistics.

Cataracts

The lens of the eye is very sensitive to ionizing radiation and cataracts are known to result from effective doses of about 2 Sv. The production of cataracts is directly related to the dose. The higher the dose the faster the cataract appears.

Chernobyl cataract studies suggest that radiation opacities may occur from doses as low as 250 mSv. Recent studies among other populations exposed to ionizing radiation (e.g. atomic bomb survivors, astronauts, patients who received CT-scans to the head) support this finding.

Cardiovascular disease

A large Russian study among emergency workers has suggested an increased risk of death from cardiovascular disease in highly exposed individuals. While this finding needs further study with longer follow-up times, it is consistent with other studies, for example, on radiotherapy patients, who received considerably higher doses to the heart.

 

Mental health and psychological effects

The Chernobyl accident led to extensive relocation of people, loss of economic stability, and long-term threats to health in current and possibly future generations. Widespread feelings of worry and confusion, as well as a lack of physical and emotional well-being were commonplace. The dissolution of the Soviet Union soon after the Chernobyl accident, and the resultant instability in health care, added further to these reactions. High levels of stress, anxiety and medically unexplained physical symptoms continue to be reported among those affected by the accident.

The accident has had a serious impact on mental health and well-being in the general population, mainly at a sub-clinical level that has not generally resulted in medically diagnosed disorders. Designation of the affected population as “victims” rather than “survivors” has led to feelings of helplessness and lack of control over their future. This has resulted in excessive health concerns or reckless behaviour, such as the overuse of alcohol and tobacco, or the consumption of mushrooms, berries and game from areas still designated as having high levels of radioactive caesium.

Reproductive and hereditary effects and children's health

Given the low radiation doses received by most people exposed to the Chernobyl accident, no effects on fertility, numbers of stillbirths, adverse pregnancy outcomes or delivery complications have been demonstrated nor are there expected to be any. A modest but steady increase in reported congenital malformations in both contaminated and uncontaminated areas of Belarus appears related to improved reporting and not to radiation exposure.

WHO's role

The Expert Group report is a milestone in WHO´s efforts to assess and mitigate the health impact of the Chernobyl accident. WHO will actively promote the research and practical recommendations given in this report. In addition WHO will ensure that the people most affected by the Chernobyl accident will be provided with scientifically factual information that will allow them to make better-informed decisions about their health and future.[1]

[1] During the preparation of the article were used the materials of the site http://chornobyl.in.ua/navoichik-pripyat-chaes.html