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The Mental Health Consequences of Chornobyl for Children and Mothers

This study examines the mental health impact of the Chornobyl disaster on children and mothers, including depression, anxiety, and somatization symptoms. It also explores the long-term effects and compares evacuee children with their classmates. Findings suggest that while there were no significant differences in neuropsychological performance or school grades, evacuee children perceived their well-being similarly to their classmates. However, evacuee mothers reported more health problems and evacuee children rated their health and scholastic competence lower. Follow-up research is being conducted to evaluate long-term outcomes.

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The Mental Health Consequences of Chornobyl for Children and Mothers

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

  2. Chornobyl Exploded

  3. 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 Day’s 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.

  6. 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

  7. 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)

  8. 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; N=721 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

  9. 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

  10. Evacuees (N=300) 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 (N=300) Median age, 11 Male, 48% In utero, 28% Either parent univ, 28% Mom unempl, 20% Dad unempl, 7% Russian Orth, 70% Characteristics

  11. Main findings • No unusual medical findings; no group diff’s • 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

  12. 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

  13. Post-traumatic stress symptoms in children ANOVA: Grp* Sex=ns

  14. 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; p<0.05) • Evacuee children rated their scholastic competence lower (3.0+1.5 v 3.3+1.6; p<0.05)

  15. Percents rating kids’ health as bad/very bad in 1997

  16. 8-years later Finished the World Mental Health Survey with KIIS Grant to do a follow-up of the Chornobyl children

  17. Panel study when kids were 18-19 Specific aims: *Evaluate if evacuee mothers continue to rate their children’s 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

  18. 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 children’s health problems *husbands’ alcoholism • Their 10 adolescent children: *bored by Chornobyl

  19. 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)

  20. 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 Evacuee Children 1 deceased 12 unlocated 22 refused 265 interviewed Classmate Moms 5 deceased 15 unlocated 41 refused 239 interviewed Classmate Children 0 deceased 15 unlocated 24 refused 261 interviewed Population-based control Moms 304 interviewed Population-based control Children 327 interviewed Follow-up 220 medical exam 229 medical exam 229 medical exam

  21. Response rates for surviving cohort Adolescents: Evacuees: 89% Classmates: 87% (Population-based controls: 85%) Mothers Evacuees: 86% Classmates: 81% (Population-based controls: 79%)

  22. Analysis of loss to follow-up • Only variable that predicted children’s participation was their mothers’ participation • Other predictors of mothers’ participation: --initial concerns about the child’s health --psychological distress --risk perceptions • Evacuee status NOT a predictor

  23. 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.

  24. 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

  25. 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 (21.2+3.0) • Children’s Somatization Scale (13.6+10.9) • Fewer evacuees smoked (48% vs 53% of controls)

  26. 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

  27. 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

  28. Mothers’ views • Evacuee mothers continued to view their children’s health as worse than the control mothers. • But compared to 1997, not as much worse…

  29. Mom-CSI 1997 and 2005 Repeated measures: Grp*** Time*** Interaction ***

  30. Mom Rates Child’s Health as Bad: 1997 and 2005

  31. Mom Rates Child’s Health as Worse than Peers: 1997 and 2005

  32. Mom Says Child Dx with Vascular Dystony 1997 and 2005

  33. How are the adolescents functioning? The same as their peers…

  34. Main role in 2005-2006

  35. 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)

  36. 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 • Children’s Manifest Anxiety scale

  37. Mental health 1997 and 2005:Children’s Manifest Anxiety Scale (C-MAS) Repeated measures: Grp=ns, time** interaction=ns

  38. What about Chornobyl? How do the adolescents view Chornobyl?

  39. 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 children’s perceptions (p<0.001)

  40. Importance of Chornobyl as life event Natasha’s 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

  41. Influence of Chornobyl event: adolescents

  42. Focus group discussions Bored by discussing Chornobyl, the adolescents in the focus group said: Not our issue. It’s our mother’s issue.

  43. Influence of Chornobyl event: mothers

  44. Bottom line Would you marry an evacuee? YES 90% evacuees 90% classmates 81% new controls P<0.001

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