Psychosocial care to affected citizens and communities in case of CBRN incidents: A systematic review

Abstract

Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed.

Mental Health Consequences of Chemical and Radiologic Emergencies

“…1 Events occurring in or near schools and health care facilities seem to be particularly vulnerable to this phenomenon. 38 The presence of somatic symptoms en masse is sometimes called epidemic hysteria, or mass sociogenic illness, which describes the rapid spread of illness symptoms affecting members of a cohesive group despite no exposure.…”

“…This is despite that reasons exist to look at the mental health effects of technological disasters differently. 1,20,21 …”

“…[4][5][6] Even though the increase in psychological distress and psychiatric symptomatology in the aftermath of disasters has been well documented, the consequences of these increases have not received extensive emergency planning consideration in the United States. This is despite a consensus among most experts that disasters result in a substantial psychological burden for those affected 1,[7][8][9] and that early behavioral health interventions should be routinely incorporated into the response to disasters. 4,10 For instance, the 2006 Chernobyl Forum Report evaluating the effects of the Chernobyl nuclear disaster concluded that mental health was the most common public health problem unleashed by the accident, with issues including depression, anxiety, posttraumatic stress disorder, medically unexplained somatic symptoms, and stigma.…”

“…4,10 For instance, the 2006 Chernobyl Forum Report evaluating the effects of the Chernobyl nuclear disaster concluded that mental health was the most common public health problem unleashed by the accident, with issues including depression, anxiety, posttraumatic stress disorder, medically unexplained somatic symptoms, and stigma. 1,11,12 Although attention has been given to the mental health effects of natural disasters, 13 there is a more limited, albeit growing, literature on the mental health effects of technological disasters, specifically those resulting from chemical and radiologic releases. This article provides a comprehensive review of the literature on the immediate psychological and mental health consequences that emergency department physicians and first responders may encounter in the aftermath of a technological disaster.…”

Alcohol use disorder due to social isolation after a nuclear disaster in Fukushima

“…In addition, it may cause mental problems such as post-traumatic stress disorder in addition to physical problems 5. However, information on the long-term impact of a nuclear disaster on mental status is limited 6 7…”