Anxious and depressive symptoms in the French Asbestos-Related Diseases Cohort: risk factors and self-perception of risk

Our plain-English summary of Anxious and depressive symptoms in the French Asbestos-Related Diseases Cohort: risk factors and self-perception of risk, by I. Mounchetrou Njoya, C. Paris, J. Dinet, et al (European Journal of Public Health, 2017).

The study

• Authors: I. Mounchetrou Njoya, C. Paris, J. Dinet, A. Luc, J. Lighezzolo-Alnot, J.C. Pairon, I. Thaon
• Journal: European Journal of Public Health
• Published: 2017;27(2):359-366
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Asbestos is known to be an independent risk factor for lung and pleural cancers. However, to date, little attention has been paid to the psychological effects of asbestos exposure among exposed subjects. The objectives of this study were to estimate the prevalence of anxious and depressive symptoms among >2000 French participants of the Asbestos-Related Diseases Cohort (ARDCO), 6 years after their inclusion, to identify the risk factors associated with those anxious and depressive symptoms and to evaluate the impact of the asbestos-risk perception.

Methods: The ARDCO was constituted in four regions of France between October 2003 and December 2005, by including former asbestos workers. Between 2011 and 2012, participants of the ARDCO program were invited to undergo another chest CT scan 6 years after the previous scan. Participants were asked to complete questionnaires including asbestos exposure assessment, Hospital Anxiety and Depression Scale (HADS), asbestos-risk perception and self-perception of asbestos-related diseases.

Results: Among the 2225 participants, 2210 fully completed questionnaires were collected and analyzed. The prevalence of symptoms of probable anxiety and probable depression was 19.7% and 9.9%, respectively. The risk of anxious and depressive symptoms was independently associated with self-perception of the intensity of asbestos exposure, asbestos-risk perception and self-perception of asbestos-related diseases.

Conclusion: The results obtained in this large study confirm that previously asbestos-exposed subjects are likely to develop anxious and depressive symptoms. Finally, implications related to the prevention of anxiety and depression among asbestos-exposed workers is discussed.

© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

In plain English

This observational study examined anxiety and depression symptoms in former asbestos-exposed workers from a French screening cohort (ARDCO) in four regions. In 2011 and 2012, of 4339 participants invited for a second CT scan, 2225 (51.3%) returned the questionnaire and 2210 fully completed the Hospital Anxiety and Depression Scale. Symptoms of probable anxiety were found in 19.7% of participants and probable depression in 9.9%. Participants rating their own past exposure as high had higher adjusted odds of probable anxiety (odds ratio 3.29, 95% CI 2.08 to 5.20) and probable depression (2.64, 95% CI 1.39 to 5.01) than those rating it nil or light. Experts' exposure ratings were not significantly linked to symptoms. Those who believed they currently had an asbestos-related disease had odds ratios of 5.81 (95% CI 3.77 to 8.96) for probable anxiety and 10.81 (95% CI 6.21 to 18.82) for probable depression, versus those who said no. The authors concluded that previously exposed people are more likely to develop these symptoms. They noted there was no control group and volunteers may not represent all exposed workers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Observational, multicentre study: a questionnaire survey of participants at the second follow-up (ARDCO II) of an asbestos-related disease screening cohort
• Who was studied: Unemployed or retired asbestos-exposed workers covered by French National Health Insurance. They were first enrolled in four French regions (Aquitaine, Rhône-Alpes, Basse-Normandie, Haute-Normandie) between October 2003 and December 2005. In 2011 and 2012, 4339 were eligible for a second CT scan, 2225 (51.3%) returned questionnaires and 2210 fully completed the HADS. Mean age was 69.8 years and 95.9% were male.
• Exposure: Past occupational asbestos exposure, with intensity rated both by the participants themselves and by industrial hygienists (experts). No fiber types are named. The study also looked at participants' beliefs about asbestos risk and whether they thought they had or would develop an asbestos-related disease.
• Main results:
  • Among the 2210 participants analyzed, 19.7% (n = 435) had symptoms of probable anxiety and 9.9% (n = 219) had symptoms of probable depression.
  • Probable anxiety was found in 34.8% of women and 19.0% of men in the study. Probable depression was found in 18.5% of women and 9.5% of men. The authors described these as higher than published figures for the French general population of the same age, taken from another study.
  • Anxiety scores were significantly associated with self-rated exposure intensity (P less than 0.0001) but not with the experts' assessment (P = 0.19).
  • Depression scores were significantly associated with self-rated exposure intensity (P less than 0.0001) but not with the experts' assessment (P = 0.088).
  • In adjusted model 1 for probable anxiety, three factors were linked to higher odds: the highest self-rated exposure (OR 3.29, 95% CI 2.08 to 5.20, vs nil or light), believing that all exposed subjects will develop a disease (OR 2.44, 95% CI 1.69 to 3.51, vs false), and believing they currently have an asbestos-related disease (OR 5.81, 95% CI 3.77 to 8.96, vs no).
  • In adjusted model 1 for probable depression, the highest self-rated exposure gave OR 2.64 (95% CI 1.39 to 5.01). Believing they currently have an asbestos-related disease gave OR 10.81 (95% CI 6.21 to 18.82). Believing that all exposed subjects will develop a disease gave OR 2.01 (95% CI 1.28 to 3.16).
  • Not knowing whether they currently had an asbestos-related disease was also associated with increased odds of anxiety and depression in model 1.
• The authors' conclusion: The authors concluded that previously asbestos-exposed subjects are more likely to develop anxious and depressive symptoms. They found these symptoms associated with self-assessed exposure intensity, perception of asbestos risk and self-perception of asbestos-related diseases. They called for future studies of the effect of giving information to exposed subjects.
• Limitations the authors state:
  • The participation rate was medium (51.3%), though participants and non-participants differed only by region and expert-assessed exposure.
  • Participants were volunteers and may not be representative. They may have been more anxious and depressive than other French asbestos-exposed workers.
  • There was no control group.
  • Actual asbestos-related diseases were not included in the final model.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, CT Scan.

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