ATSDR - Hazardous Substances and Public Health, Spring 2000, Part 1

Agency for Toxic Substances and Disease Registry

Search | Index | Home | Glossary | Contact Us

Scientific Research Continues on the Psychological Responses to Toxic Contamination

Pamela Tucker, MD, ATSDR

The basis of what is known about the psychological effects of environmental contamination from hazardous substances began with the study of people’s reactions to natural disasters in the 1950s. Psychologists and clinicians recognized that a small number of people exposed to various natural disasters (e.g., fires, hurricanes, and floods) could develop psychological sequelae from the stress such as major depression, chronic anxiety, and post-traumatic stress disorder (PTSD). Current thought among disaster relief workers holds that most people will suffer no or only transient effects from the stress of a natural disaster (i.e., acute stress disorder or, "people reacting normally to an abnormal situation") (1).

There are important differences between psychological effects from actual or perceived exposure to chemicals and those resulting from natural disasters. Sociologists and psychologists performing field research in communities near hazardous waste sites have pointed out that unlike a natural disaster—which has a discernible low point followed by a recovery phase when life begins to return to "normal"—life near a hazardous waste site is a more nebulous and uncertain situation. Environmental contamination has no discernible starting point, no distinct low points, may last for many years during the clean-up and remediation process, and, in case of exposure, may result in latent health effects for those people exposed to a hazardous substance (1).

The slow onset and recovery from these situations may make adjustment to them more difficult than a sudden, more tangible event such as a natural disaster. Living near a hazardous waste site can breed uncertainty about exposures and subsequent latent health effects (2) and spark social and political turmoil (3, 4), all of which serve as additional stressors. Also, exposures to neurotoxic chemicals can cause psychological changes, so it is important to rule out exposures before declaring a health problem to be solely psychologically based.

The first quantitative scientific studies of the psychological stress associated with environmental contamination were conducted about the Three Mile Island (TMI) accident. Baum and colleagues (5) found indicators of psychophysiological effects from stress in the people living near TMI when compared with people in control groups. The psychological effects found in many community members included elevated levels of psychological distress, feelings of perceived threat, and subclinical anxiety and depression. The physical signs of increased stress in the TMI group consisted of small subclinical increases in blood pressure and higher than normal levels of urinary cortisol and norepinephrine metabolites, which are indicators of physical arousal due to psychological stress. This pattern of subclinical psychological and physical symptoms of stress remained elevated for six years after the incident and only returned to normal levels after 10 years (6).

Baum and colleagues looked for this same pattern of chronic stress in a community located near a hazardous waste site. The findings were the same (7). Baum and Fleming concluded that "distress and mental health outcomes also represent major outcomes of environmental disasters."

Further support for the findings at TMI comes from a group of researchers in California who studied the towns affected by the Cantara loop railway spill (8). The study looked at the physical, psychological,and psychophysiological reactions of those who experienced exposure to metam sodium as a result of the spill. Psychological assessments of the affected residents showed increased worry and perceived decreases in social support. Biological testing showed changes indicative of chronic stress. Testing also showed greater occurrence of depression, anxiety, and somatic symptoms in the exposed population versus the control population. Researchers felt these outcomes were possibly connected to chronic arousal states. They postulated that "physiological and psychosocial effects of the chemical spill trauma precede long-term physiological manifestations."

Results of other recent studies further suggest that the experience of exposure to hazardous substances and the resulting psychological changes might result in adverse physical and psychological health effects. For example, in 1994, epidemiologists at the University of Texas investigated the physical and subsequent psychological effects found in a community that had been exposed to a toxic cloud of hydrogen fluoride (9).These researchers first investigated and documented both the short- and long-term physical health effects found in persons exposed to hydrogen fluoride vapors. They then evaluated the psychological effects of these exposures in this population and found that a linear relationship existed between the degree of gas exposure and the level of psychological distress. Specific findings included increased anxiety and somatic concerns.

The critical factors and underlying causes that result in these types of effects from stress are still not understood. The research done at TMI and at the toxic waste sites and spills conclude that the effects may be largely related to event characteristics and the individual responses. The responses can range from little concern to extreme agitation. Individual reactions are affected by many factors, including the event itself (e.g., did exposures and injuries occur?); the imagery associated with the episode; media coverage; and the individual’s circumstances (e.g., were they or someone they knew injured or affected?), his or her perception of the situation, appraisal of the degree of threat, and perceived sense of control over the circumstances.

There are still many questions to be answered about the psychological responses people have to toxic contamination: How do special populations like children and the elderly respond? How common is the chronic stress response such as that seen in the TMI and such events? What are the effects of this chronic stress on a person’s health? If these questions are answered, the psychological effects and the extent of these effects from real or perceived exposure to toxins can be more accurately defined and adequate preventive strategies developed to help to mitigate the psychosocial stresses of hazardous substances in our environment.

ATSDR is taking first steps to address the psychological effects associated with exposure or possible exposure to hazardous substances through its Psychological Effects Program. As part of this Program, ATSDR recently published the Report of the Expert Panel Workshop on the Psychological Responses to Hazardous Substances.

References

Agency for Toxic Substances and Disease Registry. Report of the expert panel workshop on the psychological responses to hazardous substances. 1999. Department of Health and Human Services, Atlanta.
Vyner HM. Invisible trauma: psychosocial effects of invisible environmental contaminants. Lexington, Massachu-setts: D.C. Heath; 1988.
Couch SR, Kroll-Smith JS. Patterns of victimization and the chronic technological disaster. In: Viano EC, editor. The victimology handbook. New York: Garland Publishers; 1991.
Edelstein, MR. Contaminated communities: the social and psychological impact of residential toxic exposure. Boulder (Colorado): Westview Press; 1988.
Baum A, Fleming I, Israel A, O’Keeffe MK. Symptoms of chronic stress following a natural disaster and discovery of a human-made hazard. Environ Behav 1992 May;24(3): 347-67.
Baum A, Fleming I, Davidson LM. Natural disaster and technological catastrophe. Environ Behav 1983 May; 15(3):333-54.
Baum A, Fleming I. Implications of psychological research on stress and technological accidents. Am Psychol 1993;48(6):665-72.
Bowler RM, Megler D, Huel G, Cone JE. Psychological, psychosocial, and psychophysiological sequelae in a community affected by a railroad chemical disaster. J Trauma Stress 1994;7(4):1-24.
Dayal HH, Baranowski T, Yi-hwei L, Morris R. Hazardous chemicals: psychological dimensions of the health sequelae of a community exposure in Texas. J Epidemiol Community Health 1994;48:560-8.

[Table of Contents]

ATSDR's Psychological Effects Program Addresses Stress-Related Health Concerns

Pam Tucker, MD, ATSDR

According to scientific and medical literature, people react in psychologically unique ways to exposures to hazardous substances. Since the discovery of toxic leachate in the basements of houses near Love Canal in the 1970s, psychologists, psychiatrists, and social scientists have studied the psychological responses in people exposed to hazardous substances because of technological breakdowns.

The psychological and social responses to possible exposure to environmental hazards have many similarities to those seen in natural disasters and emergencies. For both, event-related stress leads to transient disturbances in many people and serious disorders, such as anxiety and depression, in a few. In other words, "normal people reacting normally to an abnormal situation." However, chronic stress can be associated with life living near a hazardous waste site and can be accompanied by "long-lasting elevations in blood pressure, evidence of changes in immune-system function, persisting symptoms of post-traumatic stress disorder (e.g., hyperarousal, frequent and bother-some intrusive thoughts about the accident, and avoidance of reminders of it)" (1). These possible health consequences, as well as others, and how stress contributes to them still need further study.

The Psychological Effects Program was developed by the Agency for Toxic Substances and Disease Registry's (ATSDR's) Division of Toxicology and Environmental Medicine (DHEP) to address these possible stress-related health concerns that may occur in communities near hazardous waste sites or in communities that are exposed to a hazardous substance.

The Psychological Effects Program has the following four phases:

Phase 1-define current science and practice;
Phase 2-develop an action plan;
Phase 3-implement a public health action plan;
Phase 4-build capacity and evaluation efforts.

In September 1995, the Program took its first step when ATSDR co-sponsored with Emory University and the Connecticut Department of Health, an Expert Panel Workshop on the Psychological Responses to Hazardous Substances (2). Workshop participants included affected community members and social, psychological, and neurological scientists. The participants were asked to discuss an integrated approach to addressing the neurobiological, psychological, and social health effects found in communities near hazardous waste sites or following a chemical spill. They explored and examined what is known about how communities and individuals respond socially and psychologically to hazardous substances and the possible effects of those responses on their health.

The workshop used the holistic biopsychosocial model as its underpinning philosophy. As opposed to the Cartesian dualistic model, which defines the body as separate from the mind, this model assumes an intertwined, inseparable entity that looks at a combination of biological, sociocultural, and psychological factors as they interact and affect a person’s psychosocial and physical health. Therefore, not only were physical factors (e.g., hazardous substances and their potential impact on the nervous system) and the physiology of stress discussed, but also how psychological coping skills and social influences operating at Superfund sites can affect the health of both individuals and communities.

The workshop consisted of three panels and three sets of issues: Panel One, Biomedical and Psychophysiological Effects, examined the possible biological effects on the public’s health related to the chronic stress in communities near hazardous waste sites, as well as how to perform neurobehavioral testing to determine if any observed neurological effects are caused by chemical or stress effects on the nervous system. Panel Two, Community and Social Science Perspectives, discussed how people respond psychologically to exposures to hazardous waste and the influence of social and cultural factors on community reactions. Panel Three, Protecting and Promoting Psychosocial Health, began developing a framework for appropriate public health strategies. Following is a more indepth discussion of panel findings.

Panel One: Biomedical and Psychophysiological Effects

Stress reactions have been studied in both individuals and communities near hazardous waste sites, but the study of the full effect on the public’s health, in terms of specific disease outcomes, is still in the very early stages. There is, however, much that is known about psychological stress and how it affects health. Psychological stress causes both psychological changes that can be measured by self-reports and objective tests as well as physical changes, such as increased blood pressure, heart rate, and biochemical parameters (e.g., changes in stress hormones).

Panel One was charged with reviewing and discussing how health care providers can clinically examine an exposed individual to determine if health effects are the result of exposure to neurotoxic chemicals or from stress. They found that careful history-taking is essential to ensure differentiation of exposure to neurotoxic chemicals and/or the development of stress-related health effects.

Panel Two: Community and Social Science Perspectives

There are many reasons why psychosocial responses to hazardous substances are unique. Unlike the damage and injury caused by a natural disaster, many toxic substances are invisible to the senses, which results in feelings of uncertainty about exposure and its extent. As well, because chemically related health outcomes can be often delayed, there is difficulty in relating past exposure to subsequent disease. Kroll-Smith and Couch have stated that perhaps a primary reason technological disasters, as opposed to natural disasters, diminish the long-term psychosocial health of victims is because technological disasters, such toxic spills or releases, contaminate (i.e., poison an environment) rather than visibly damage (3), crippling a sense of long-term safety. They further state that this view is complicated by the perception held by the individual experiencing the disaster and that the individual’s "behavior is shaped less by statistical probabilities of danger than by the subjectively lived experiences of living under objectively ambiguous circumstances (3).

Panel Two also emphasized the importance of the individual response (as did all three panels) by outlining the unique aspects of the psychological and social responses to toxic exposures and the reasons behind those responses. Each person affected by a hazardous exposure develops his or her own beliefs about the nature of the resultant harm. These beliefs develop from the available facts, pre-existing opinions, cultural factors, sensory clues, and beliefs of leaders and others in the community. Panel participants determined that the viewpoint of the exposed person is crucial to understanding the diverse reactions that can occur in affected communities, that community members must be seen as experts on their community, and that the majority of responses people have to toxic substances are normal.

Panel Three: Protecting and Promoting Psychosocial Health

The psychological research done on natural disasters and emergencies has resulted in the development of specific issues to be addressed. In the case of technological disasters, "the management of hazards, formulation of regulations and guidelines for siting of potential hazards, construction of environmental impact assessments, interpretation of responses following accidents, and determination of post-accident damages" should, perhaps, also be considered within this context (1). Panel Three participants were asked to provide an overview of 1) what is known and not known about the effectiveness of previous prevention strategies in affected communities; 2) the most effective methods for preventing and mitigating stress-related problems in communities near hazardous waste sites; and 3) methods for increasing public and professional capacity to respond to psychological issues related to hazardous waste sites. They based their suggestions for solutions on their own past experiences with disaster relief work.

The Panel members formulated the following suggestions for solutions:

Conduct a community needs assessment to ensure the community desires are heard,
Apply disaster mental health concepts to guide interventions,
Implement relief work strategies used for natural disasters, and
Work to ensure citizens have as much control as possible over their situation.

Furthermore, Panel 3 emphasized the importance of community education regarding the normality of psychosocial stress related to hazardous substance exposure.

With the close of the workshop and the printing of the proceedings, Phase 1 of the completed. This is a first step in providing communities the necessary information to help them cope with the stress of hazardous substance exposure. In addition, as a result of the workshop, ATSDR is developing a training handbook for health care providers, social workers, and others to help them in their work with affected communities. (See the next article for an update on the recent accomplishments of the Psychological Effects Program.)

A limited number of published workshop proceedings, Report of the Expert Panel Workshop on the Psychological Responses to Hazardous Substances, are available for distribution. Please contact the ATSDR Information Center at 1-888- 42ATSDR for more information on how to obtain a copy of the report.

References

1. Baum A, Fleming I. Implications of psychological research on stress and technological accidents. Am Psychol 1993;48(6):665-72.

2. Agency for Toxic Substances and Disease Registry, Report of the expert panel workshop on the psychological responses to hazardous substances, Division of Health Education and Promotion, Atlanta. U.S. Department of Health and Human Services, 1999.

3. Kroll-Smith JS, Couch SR. What is a disaster? An ecological-symbolic approach to resolving the definitional debate. Int J Mass Emergencies and Disasters 1991 Nov;9(3):355-66.

[Table of Contents]

ATSDR's Psychological Effects Program Activities

1996

Developed projects with communities to help them deal with temporary or permanent relocation due to environmental contamination by hazardous substances and provided training for social workers involved in the relocation of hundreds of Gulf Coast residents during the methyl parathion response.

1997

Developed a training module and provided training for public health professionals to raise awareness and ability to respond to the psychological and social responses of communities affected by hazardous substances.
Held, in cooperation with the Wisconsin Department of Health and the residents of Douglas County, Wisconsin, a workshop on Emergencies in Douglas County: Assessing Community Needs for the Future, in response to the Burlington Northern railroad spill. The workshop provided ways to improve emergency responses in the case of a future spill.
Convened the second expert panel workshop on psychological responses to exposure to hazardous substances, The Feasibility of Measuring Stress Related to Hazardous Waste, in Atlanta, Georgia.
Provided workshops to assist communities with the chronic psychological effects of hazardous substances, when requested by the community.

1998

Worked with the Missouri Department of Health and the Office of Regional Operations (ATSDR) to develop a needs assessment on a community’s needs and desires for assistance with psychological effects.

1999

Began a joint initiative, ATSDR-EPA Initiative Regarding Community Stress Related to Hazardous Substances, involving ATSDR and the U.S. Environmental Protection Agency (EPA) to train EPA personnel to increase their awareness and ability to respond to community stress related to hazardous exposures. Two trainings have already been held. The initiative will also pilot public health responses in three sites over the next three years. Currently, initiative representatives are participating in a relocation in New Jersey, in a community-support network, which includes social workers to assist in both permanent and temporary relocations. Another project is ongoing with the Keystone community in Pennsylvania.
Published the Report of the Expert Panel Workshop on the Psychological Responses to Hazardous Substances.

Table of Contents | HSPH Newsletter Homepage | ATSDR Home Page

This page last updated on April 17, 2002
Contact Name: Wilma López/ WLópez@cdc.gov