Consequences of toxic disasters for rescue, recovery, and clean-up workers require integrated mental and physical health monitoring: Editorial comment for social psychiatry and psychiatric epidemiology.

Societies have an obligation to monitor and treat the health of workers participating in the clean-up of toxic disaster sites. Most of the research to date has focused on mortality and on mental or physical health, independent of one another. In this issue, Laidra et al. [1] present findings on the long-term well-being of Estonian men who assisted in the clean-up of the area around the Chernobyl nuclear power plant. Strikingly, 24 years later, these men, at an average age of 55, continued to have significantly more depressive and anxiety symptoms than controls, and were less likely to be employed and married and to describe their overall health as good. These findings complement and extend prior studies of Chernobyl clean-up workers that showed an increase in non-radiation related physical morbidity [2], PTSD, depression, and work absenteeism [3], and suicide [4]. Local Ukrainian studies have also raised the possibility of neurocognitive and brain-related impairments in highly exposed workers (reviewed in [5]). Two other large-scale radiation disasters occurred in the last 75 years—the bombings of Hiroshima and Nagasaki in 1945 and the Fukushima nuclear power plant melt-downs in 2011. In contrast to numerous studies of radiation worker cohorts [6], we found no studies of the workers who handled the contaminated rubble in Japan. Similar to Chernobyl, the physical and mental health consequences of Fukushima are being monitored independent of one another. The physical health of clean-up workers is checked by government agencies, and mental health is being investigated in a separate research protocol [7]. Other large-scale toxic disasters have also occurred over the last 50+ years, including the Union Carbide gas leak in Bhopal, India, the sarin gas attack on the Tokyo subway, the oil spills in Alaska, Galicia (Spain) and the Gulf of Mexico, and the World Trade Center (WTC) disaster. Because such events occurred without warning and were protracted, medical monitoring and treatment programs and epidemiologic research were often established months to years later, after attention to the immediate impact of the disaster was rendered. For example, after the 2001 WTC disaster, the medical monitoring and treatment program for 9/11 responders funded by the Centers for Disease Control (CDC) was not initiated until July, 2002 [8]. There are multiple challenges inherent in developing strategies for understanding the long-term physical and mental health of clean-up workers after toxic disasters. In large part, these challenges stem from the uniqueness of these events with respect to the specific cultural, demographic and political contexts in which they occur, the varying degrees of physical, social and psychological trauma, and the varying levels of contamination that can make it impossible to establish individualized exposomes. All of these immediate factors interact with the workers’ personal disease predispositions. It is therefore essential to detail and characterize the nature of the exposure and its impact as close to the event as possible. This would require changes in funding mechanisms and a rapid response epidemiology corps ready to spring into action at the first sign of potential disaster. In contrast, to date most studies have been delayed and reductionistic, focusing on a specific disease or organ system, or mortality, leaving the extent and pathogenesis of multisystem disorders and symptoms poorly understood. This also hinders the design of multidisciplinary, maximally efficacious, intervention programs. Another unique challenge for studies of clean-up workers after massive toxic disasters is the loss of trust in scientists. To a large extent, this is a consequence of the political issues surrounding responsibility for the cause and remediation of the disaster, graphic media reports on health effects that conflict with scientific findings, and a lack of experience among scientists in communicating science to the general public. How can studies of responders to toxic disasters be improved so as to enhance the translational value of the data?