Are the knowledge of non-malignant asbestos-related diseases and lung function impairment differentially associated with psychological well-being? A cross-sectional study in formerly asbestos-exposed workers in Germany

Our plain-English summary of Are the knowledge of non-malignant asbestos-related diseases and lung function impairment differentially associated with psychological well-being? A cross-sectional study in formerly asbestos-exposed workers in Germany, by J. Lang, M.K. Felten, T. Kraus (BMJ Open, 2019).

The study

• Authors: J. Lang, M.K. Felten, T. Kraus
• Journal: BMJ Open
• Published: 2019;9(10):e030094
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The knowledge of past asbestos exposure may lead to chronic psychological strain. In addition, the information about an increased cancer risk can place a psychological burden on individuals triggering mental health symptoms of depression or anxiety. This applies in particular to individuals with non-malignant asbestos-related disease (ARD) such as lung fibrosis and pleural thickening with or without lung function impairment. ARDs with or without lung function impairment may develop even years after exposure cessation. Therefore, the aim of the present study was to test for our cohort whether non-malignant ARD and lung function impairment have differential effects on mental health and psychological strain.

Design: Cross-sectional study.

Participants And Setting: Overall, 612 male participants (mean age=66.2 years, SD=9.5) attending a surveillance programme for ARDs received routine examinations including lung function testing (24% refused to fill in the psychological questionnaire) at a German university hospital study centre from August 2008 to August 2013.

Outcome Measures: Using multiple hierarchical regression analysis, ARD diagnosis and lung function impairment were used to predict psychological health as measured with validated questionnaires for depression and anxiety. Psychological strain was operationalised by intrusive thoughts and specific fear of cancer.

Results: The strongest predictor for mental health was obstructive functional impairment (eg, anxiety: β=0.22, p<0.001). Psychological strain was predicted by the presence of a non-malignant ARD (eg, intrusive thoughts: β=0.17, p=0.003).

Conclusions: The presence of mental health symptoms is associated with ventilation disturbances, whereas the knowledge of an already initiated morphological change-caused by asbestos exposure-is primarily associated with psychological strain. Specifically, the affected individuals are more prone to intrusive thoughts and specific fear of asbestos-related cancer. As an implication, physicians should be sensitised about possible consequences of risk communication and functional impairment to counteract excessive fear or anxiety.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This cross-sectional study examined 612 formerly asbestos-exposed German power industry men attending a surveillance programme at a university hospital centre, August 2008 to August 2013. Their median estimated exposure was 8 fibre years; fiber types were not named. All had lung function tests; 147 (24%) refused questionnaires on depression, anxiety, fear of asbestos-related cancer and intrusive thoughts. On the depression scale 10 men (2.8%) scored above the cut-off and 348 below; on the anxiety scale 39 (10.6%) scored above and 328 below. In a separate comparison, possible anxiety was more frequent with a diagnosed non-malignant asbestos-related disease (22 of 127) than without (17 of 240; OR 2.75, CI 1.4 to 5.39). In models adjusted for age, education and exposure, obstructive lung impairment was associated with depression and anxiety scores. In those models, the diagnosis predicted fear of cancer and intrusive thoughts, not depression or anxiety. The authors concluded that mental health symptoms were associated with breathing impairment, and knowing of asbestos-caused changes mainly with psychological strain. They noted small effects, low participation, an all-male sample and few restrictive impairments.

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: Cross-sectional study using questionnaires and lung function testing, analysed with hierarchical multiple regression
• Who was studied: 612 formerly asbestos-exposed male power industry workers (mean age 66.17 years) attending a local surveillance programme for asbestos-related diseases at a German university hospital study centre, August 2008 to August 2013; part of the larger CARE Study cohort
• Exposure: Past occupational asbestos exposure in the power industry (84.5% power generation, 9% power distribution, 1.5% gas supply). Cumulative exposure was estimated in fibre years from a job questionnaire and workplace monitoring data. The median was 8 fibre years. No fiber type is named.
• Main results:
  • 147 of the 612 attendees (24%) refused the psychological questionnaire.
  • On the depression scale (Table 2), 10 men (2.8%) were above the cut-off and 348 (97.2%) below it.
  • On the anxiety scale (Table 2), 39 men (10.6%) were above the cut-off and 328 (89.4%) below it.
  • A separate comparison (Table 3) set men with a diagnosed non-malignant asbestos-related disease against men without one.
• Possible anxiety disorder: 22 of 127 (17.32%) with a diagnosis versus 17 of 240 (7.08%) without (OR 2.75, CI 1.4 to 5.39, p=0.002).
• Depression: 6 of 125 versus 4 of 233 (OR 2.89, CI 0.80 to 10.43, p=0.091), which was not statistically significant.
  • In regression models controlled for age, education and cumulative asbestos exposure, obstructive lung impairment was the only predictor of depression scores (β=0.18, p=0.004) and anxiety scores (β=0.22, p<0.001).
  • In the jointly adjusted models, a diagnosis of non-malignant asbestos-related disease was not associated with depression or anxiety.
  • In the same models, a diagnosis of non-malignant asbestos-related disease predicted specific fear of asbestos-related cancer (β=0.13, p=0.046) and intrusive thoughts (β=0.17, p=0.003).
  • Restrictive lung impairment was also associated with intrusive thoughts (β=0.12, p=0.032).
• The authors' conclusion: The authors concluded that mental health symptoms were associated with ventilation (breathing) disturbances. In their view, knowledge of an already initiated asbestos-caused change was primarily associated with psychological strain, specifically intrusive thoughts and fear of asbestos-related cancer.
• Limitations the authors state:
  • Participation in the psychological survey was low.
  • Older men and men with more obstructive impairment were less likely to complete the survey.
  • Only men took part, which limits generalisability.
  • Restrictive impairments were rare, so results for restriction need to be treated with care.
  • Effect sizes were small.
  • The study was not longitudinal, so possible mediation effects could not be tested.
  • Symptoms may partly reflect acute stress from anticipating the medical examination.

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, Fibrosis, Pleural Thickening, Fear of Cancer Damages.

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