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Background

The workshop was one activity of a larger ATSDR program, the Psychological Effects Program. The purpose of this program is to examine the possible effects that psychological stress associated with exposures to hazardous substances can produce on psychological and physical health. Three situations in which the public could possibly be affected by hazardous substances are proximity to a chemical accident, residence near a hazardous waste facility, or permanent relocation from a community because of its contaminated environment. A search of the scientific literature was performed regarding the neurobiological, psychological, and social effects of possible exposures in these three settings.

Much of the earlier work on psychosocial responses to exposures to hazardous substances was field research. To do this research, social scientists recorded their observations of communities being affected by possible exposures to hazardous substances. Psychologists and sociologists who observed communities exposed to toxic contaminants, such as the toxic leachate at Love Canal, New York, and contaminated groundwater in Legler, New Jersey, reported a splintering of the community into opposing factions and possible increases in psychologic distress because of the difficulty of the experience (1-3).

Since the early field studies, research has branched in several directions. First, psychologists and psychiatrists have studied the coping mechanisms involved in how people deal with the threat of an "invisible" toxic exposure (4-6).

Second, several clinical descriptive studies on the effects of possible exposures to hazardous substances on communities' psychology have been performed. This line of inquiry grew out of research into the psychological effects of natural disasters. Disaster effects research, which began in the 1950s, indicates that a small portion of residents after various disasters, such as fires, hurricanes, and floods, can develop psychological complications from the stress involved in these experiences. Stress can lead to disorders such as major depression, chronic anxiety, and post-traumatic stress disorder (PTSD). The stress following a natural disaster also can lead to temporary increases in stress-related physical illnesses.

A third area of research emerged when psychologists focused on the epidemiology of psychological responses in communities affected by hazardous substances. The results of these psychiatric epidemiologic studies have been mixed. The work of Baum and Fleming (7) points to the presence of physiologic changes indicative of long-term chronic stress in a community near a hazardous waste site. Horowitz and Stefanko (8) reported high levels of demoralization but no clinical disorders in a community located near a hazardous waste site. A study in Alsen, Louisiana, (9) revealed high levels of near-clinical anxiety and depression in an African-American community located near a hazardous waste facility. One recent study (10) conducted in a California community following an evacuation because of a toxic railroad spill reported significantly higher levels of depression and anxiety syndromes in the evacuated population versus the control population. Another recent study by a group of epidemiologists in Texas (11) documented a linear relationship between the level of exposure to a spilled chemical and the amount of psychological stress present 2 years after the accident.

If higher than normal levels of psychological stress and psychological sequelae are being found in communities affected by possible exposures to hazardous substances, then this presents a public health problem. The effects of long-term stress on physical health at these sites is unknown and requires further study.

The psychological effects workshop was convened to outline the extent of this new public health issue and to develop a strategy to address this potential public health problem.

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