PSYCHOLOGICAL EFFECTS OF PSYCHOLOGICAL EFFECTS OF

LONG TERM EXPOSURE AND LONG TERM EXPOSURE AND RADIATION INJURYRADIATION INJURY

Module XXModule XX

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SyllabusSyllabus 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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IntroductionIntroduction 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 Medical consequences of radiation accidentsradiation 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 Health effects directly related to radiation exposureto 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 Health effects indirectly related to radiation exposure 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 Why do people fear ionizing radiation?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 effectsPsychological effects

Psychological effects include

Mental suffering Changes in risk perception Modification in individual and social

behaviour

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Psychological effectsPsychological 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 Severity of psychological reactionsreactions

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 What is psychological stress caused by accident?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 What is psychological stress caused by accident? 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 Changes in health behaviour of affected peopleof 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 reactionsStress reactions

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

Physical

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Stress reactionsStress reactions

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

Delayed Decreased attention

span Poor concentration Memory problems Flashbacks

Cognitive

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Stress reactionsStress reactions

Early Anxiety Anger Fear Irritability Guilt Feeling overwhelmed Grief Hopelessness

Delayed Feeling abandoned Resentment Feeling alienation Withdrawal Numbness Depression

Emotional

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Psychological problemsPsychological problemsLateLate

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 Psychological effects of relocationrelocation

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 What can we do about stress?stress?

Accidents can not be predictedBUT

Psychological reaction to radiation accident could be

prevented / mitigatedusing different methods applied

before / during / after accident

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Management of psychological Management of psychological consequences after accidentconsequences 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 How to reduce psychological effectspsychological 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 populationWarning 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 Requirements for warning messagewarning message

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

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Psychological support in Psychological support in different types of accidentsdifferent types of accidents

Psychological support is needed for:Accident

NoNoYesMedical misadministration in diagnosis and therapy

NoNoYesResult of use/misuse of industrial sources

NoNoYesLaboratory accidents

Not alwaysYesYes, if anyNuclear power satellite re-entryNot alwaysYesYesTransportation

Not alwaysYesYesInvolving lost/stolen sourcesYesYesYesCriticalityYesYesYesNuclear (reactor)

Emergency responders

General public

Affected victims

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Psychological stress of Psychological stress of injured individualsinjured 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 problemsMedical 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 Mitigation of psychological consequencesconsequences

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 Mitigation of psychological consequencesconsequences

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 Mitigation of psychological consequencesconsequences

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

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Mitigation of psychological Mitigation of psychological consequencesconsequences

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

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Mitigation of psychological Mitigation of psychological consequencesconsequences

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 Mitigation of psychological consequencesconsequences

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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SummarySummary 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