International Forum 2015 crime of war and energy for peace Yoshiharu Kim National Information Center for Disaster Mental Health National Center for Neurology and Psychiatry JAPAN
Persistent distress after psychological exposure to the Nagasaki atomic bomb explosion Yoshiharu Kim1, Atsuro Tsutsumi1, Takashi Izutsu1, Noriyuki Kawamura2, Takao Miyazaki3, Takehiko Kikkawa1,4 1 2 3 4
National Center of Neurology and Psychiatry, Japan Enomoto Clinic Niigata Seiryo University Junior College Chubu Gakuin University
Figure 1. Districts of Nagasaki
sea
Epicenter
12km
sea
sea
Previous registration as the victim of atomic bomb • The towns on the east and north edge of the Nagasaki city that were within several kilometers from the city central were not included into the official registration, while the towns on the southern area that were 10 kilometers away were included. • The reason was that the wind was blowing from north to south at the time of the bombing and that it could not go over the mountains on the east side of the Nagasaki city into the east edge area. In 1974 and 1976, as a result of the repeated claim made by the people in the “non registered area” and by the Nagasaki city and prefecture, some districts in the “non registered area” came to be officially registered as the “partially exposed area,” to leave sense of resentment in the residents of the remaining districts.
Report of witness and experience of atomic bomb Nagasaki city, April 1999 till March 2000
• No controlled desing • Poor distinguish between ordinary and atomic bomb experience • Poor attention to the very fact that the “true exposure” did not occur in this district
Objectives This is a study regarding subjective experience of being exposed to atomic bombing, not a real exposure, which will be called as exposure experience in the following. • 1 To compare the current mental health status between the subject and control groups. • 2 To detect correlation in the subject group between the current mental status with the exposure experience and other background factors.
Method 1 subjects recruit • 400 of the 9,800 residents who have lived in the nonregistered area since the time of the atomic bomb fall. • 30 cells were made by age, sex and 5 stages of the degree of exposure. In each district, the subjects were recruited from each cell reflecting the distribution pattern. • Controls: migrants into the area between 1950-1960. matched by age, sex classes with the subjects
Methods 2 • 347 participants, who had been in the vicinity of the atomic bomb explosion in Nagasaki • 288 controls, who moved into Nagasaki 5-15 years after the bombing • Measured mentally high risks using the General Health Questionnaire (28-item version) with a cut-off point of 5/6 • Assessed Individual perception of the explosion, health status, life events and habits
Table 1. Characteristics of the groups (Demographics) Sample (n=347)
Control (n=288)
Both groups high vs. low risk
Agea
66.3 ( 6.7)
70.3 (6.4) <0.001
<0.01
Sex (male)b
131 (37.8)
104 (36.1) N.S.
N.S.
Smoking (yes)b
54 (15.6)
42 (14.6) N.S.
N.S.
Drinking (yes)b
147 (42.4)
116 (40.3) N.S.
N.S.
Years of educationa
9.4 ( 2.4)
10.0 (2.5) <0.001
Office worker/civil servant
91 (26.2)
84 (29.2) N.S.
N.S.
Farmer/fishery
132 (38.0)
102 (35.4) N.S.
<0.05
Industry worker
42 (12.1)
37 (12.8) N.S.
N.S.
Self-employed
59 (17.0)
39 (13.5) N.S.
N.S.
Others
22 ( 6.3)
30 (10.4) N.S.
N.S.
Never employed
39 (11.2)
26 (9.0)
N.S.
N.S.
# of family members living witha
3.2 ( 1.7)
3.6 (2.1)
N.S.
<0.05
# of non-atomic traumatic eventsa
4.0 ( 2.1)
4.1 (2.0)
N.S.
<0.01
Loss of spouse/ relative within 3째due to atomic bombb
160 (46.1)
67 (23.3) <0.001
<0.05
Employment historyb
<0.001
Table 1. Contâ&#x20AC;&#x2122;d Characteristics of the groups (Physical & mental health findings) Sample (n=347)
Control (n=288)
Both groups high vs. low risk
267 (76.9)
223 (77.4) N.S.
<0.01
High risksb,d
255 (73.5)
114 (39.6) <0.001
Total scorea
10.6 (5.7 )
6.5 (5.4 ) <0.001
Physical
4.2 (2.0 )
2.4 (2.0 ) <0.001
Social
1.9 (1.8 )
1.1 (1.4 ) <0.001
Depressive
1.0 (1.6 )
0.6 (1.5 ) <0.001
Anxious
3.5 (2.0 )
2.3 (1.8 ) <0.001
Physical health findingb Presence of physical disease (past 6mo.) Mental health findings (GHQ28)
Knowledge of atomic bomb 1 Light and sound of the atomic bomb are not related to the radioactivity 2 Radioactivity decreases according to the distance from the blast center 3 Radioactivity decreases according to the time course 4 There is no exposure to radioactivity in daily life 5 When X-rayed in a hospital, you are exposed to radioactivity 6 There are acute and delayed types of exposure to the radioactivity, coming directly from the bomb, and through ash or rain.
correct knowledge on atomic bomb 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
t e y e ral d h c a e m r g n Ti atu X- elay Li sta n d Di
Exp Cont
perceived distance from the blast center radioactivity ă&#x192;ť
66% from the blast center to the point 0
distance blast center
Table 2. Contribution of variables to poorer mental health Adjusted odds ratio
95% CI
p
5.26
2.56
11.11
<0.001
Age
0.98
0.93
1.04
N.S.
# of family members living with
0.91
0.76
1.10
N.S.
Years of education
1.06
0.90
1.24
N.S.
Job history of farmer/ fishery
2.11
0.95
4.66
N.S.
Loss of spouse/ relative within 3째due to atomic bomb
1.75
0.89
3.44
N.S.
Presence of physical disease within 6 mo. b
1.77
0.82
3.80
N.S.
# of non-atomic traumatic events
1.18
0.99
1.41
N.S.
2.14
1.05
4.33
<0.05
1.94
0.85
4.41
N.S.
2.37
1.16
4.84
<0.05
Sample groupb
Erroneous knowledge on radiationc Radioactivity is different from lightening Radioactivity decreases over time Natural exposure to radiation occurs
Table 3. Contribution of variables to poorer mental healtha (sample group) Adjusted odds ratio
95% CI
p
Perception of explosion intensity
1.08
0.82
1.42
N.S.
Anxiety after the explosion
0.77
0.36
1.64
N.S.
Anxiety from knowing of radiological hazard
2.62
1.07
6.41
<0.05
Age
0.89
0.65
1.23
N.S.
# of family members living with
0.81
0.33
2.03
N.S.
Years of education
0.58
0.23
1.44
N.S.
Loss of spouse/ relative within 3째due to atomic bomb
3.34
0.53
21.07
N.S.
Presence of physical disease within 6 mo.b
0.87
0.09
8.41
N.S.
# of non-atomic traumatic events
1.38
0.85
2.24
N.S.
Radioactivity is different from lightening
0.01
0.00
1.70
N.S.
Radioactivity decreases with distance
0.20
0.01
2.96
N.S.
Natural exposure to radiation occurs
0.17
0.01
2.65
N.S.
Erroneous knowledge on radiationc
Limitation • reporting bias no significant group difference was observed in the prevalence of physical disease
• escapism •
no group difference regarding job history, education, smoking and alcohol habits, or recent history of physical illness
• rater’s bias
– Recruiting interviewers from those who lived in distant areas and had no relatives involved in atomic bombing in Hiroshima or Nagasaki, in addition to semi-structuring the whole interview procedure.
• recall bias
– the primary outcome measure is severity of the current distress, not of the past explosion, and that the intensity of perceived explosion was put into variables for stratified randomization of the sample. – the sizeable odds ratio.
• Survivor’s bias
– resulting from earlier death of more highly distressed individuals, could also not be excluded
Implications • Anxiety of radiological pollution can develop independently of substantial pollution • Information provision should be done beyond the boundary of substantial pollution • Appraisal or selective bias of information should be taken into account • Information would be better provided as a part of support, in an interactive way • Scientific “safety” is different from psychological “security”
No reason to be anxious No reason to feel safe. â&#x20AC;˘ Anxiety is projected to outer world and lead negative appraisal or selection of negative information, or biased perception, which in turn enhance anxiety.
The mental health of clean-up workers 18 years after the Chernobyl accident K. Loganovsky1, J. M. Havenaar2, N. L. Tintle3, L. T. Guey4, R. Kotov5 and E. J. Bromet5 1 Research Center for Radiation Medicine, Academy of Medical Sciences of Ukraine, Kyiv, Ukraine 2 Department of Psychiatry, Free University of Amsterdam, Amsterdam, The Netherlands 3 Department of Mathematics, Hope College, Holland, MI, USA 4 Spanish National Cancer Research Center (CNIO), Madrid, Spain 5 Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
• Stud samples
Methods
– 295 clean up workers who entered into the polluted areas of Chernobyl nuclear plant accident. – 397 geographically matched controls
• Assessments
– Composite International Diagnostic Interview (CIDI)
• Comparison
– group differences in common psychiatric disorders, suicide ideation and severe headaches, differential effects of disorder on days lost from work – in the clean-up workers, the relationship of exposure severity to disorder and current trauma and somatic symptoms.
• Analyses were adjusted for age in 1986 and mental health prior to the accident.
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