Stress associated with asbestosis: the trauma of waiting for death

Our plain-English summary of Stress associated with asbestosis: the trauma of waiting for death, by Y. Barak, A. Achiron, Z. Rotstein, et al (Psycho-oncology, 1998).

The study

• Authors: Y. Barak, A. Achiron, Z. Rotstein, A. Elizur, S. Noy
• Journal: Psycho-oncology
• Published: 1998;7(2):126-8
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This brief report asked whether knowing that one may later develop mesothelioma is enough to cause psychiatric illness. Sixteen male electrical power plant workers had been exposed to asbestos between 1946 and 1965, for a mean of 18.2 years. In 1992, after four of them died of mesothelioma, the remaining 12 had lung function tests and chest CT scans. All 12 were diagnosed with chronic, fibrosis-like lung disease due to asbestosis. Their mean age at diagnosis was 61.2 years (range 55–66). The plant's physician told them of their condition as a group, saying they were at risk of 'cancer' and that their colleagues had died of such a disease. Over the next 12 months they reported anxiety, depressed mood, nightmares, sleep disturbances and anhedonia, and were referred for psychiatric evaluation a year later. As part of a psychiatric interview, the authors used the Revised PTSD Inventory, the Hamilton Anxiety Scale and the Impact of Events Scale. Six workers (50%) were diagnosed with post-traumatic stress disorder (PTSD). Those with PTSD had a mean Hamilton anxiety score of 16.4, compared with 3.1 in those without (p<0.001). They also had higher intrusion scores (31.5 vs 4.7) and avoidance scores (35.6 vs 7.2). Breathing disability did not differ between the groups. The authors suggested that the anticipation of death may have created a post-traumatic syndrome in which the trauma is the knowledge of future death.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This brief report described 16 male electrical power plant workers exposed to asbestos between 1946 and 1965, with a mean exposure of 18.2 years for the group. In 1992, after four of them died of mesothelioma, the remaining 12 were examined, and all were diagnosed with chronic, fibrosis-like lung disease due to asbestosis. The plant's physician told them as a group that they were at risk of 'cancer'. Over the following year they complained of nightmares, anxiety, sleep problems and depressed mood. They were then referred for psychiatric evaluation using standard rating scales. Six of the 12 (50%) were diagnosed with post-traumatic stress disorder (PTSD). Only one of these six was a Holocaust survivor previously treated for post-traumatic stress. Those with PTSD had much higher anxiety scores, and higher scores for intrusive and avoidant experiences, than those without (p less than 0.001). Breathing disability did not differ between the two groups. The authors concluded that PTSD emerged in half of this small series. They suggested that knowing of their future death may itself have acted as the trauma.

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: brief report describing a small case series
• Who was studied: 12 surviving male workers from a group of 16 at an electrical power plant. After four of the 16 died of mesothelioma, the 12 were examined in 1992 and diagnosed with chronic pulmonary disease (fibrosis-like) due to asbestosis. Mean age at diagnosis was 61.2 years (range 55 to 66). All were Jewish. The plant's physician informed them of their condition as a group, and they were referred for psychiatric evaluation about a year later after complaining of anxiety and depressed mood. The plant's location is not stated; the authors are at Israeli medical centers.
• Exposure: Occupational asbestos exposure at an electrical power plant between 1946 and 1965. Mean exposure was 18.2 years (SD 7.8), reported for the original group of 16 workers; no separate figure is given for the 12 survivors. Fiber type is not stated. The psychological exposure studied was being told of their asbestosis and their risk of 'cancer'.
• Main results:
  • 6 of the 12 workers (50%) were diagnosed with PTSD according to DSM-IV criteria. Only one of these six was a Holocaust survivor previously treated for post-traumatic stress.
  • All workers with PTSD had Hamilton Anxiety Scale scores higher than 10 (mean 16.4, range 12 to 23).
  • All workers without PTSD had Hamilton Anxiety Scale scores lower than 5 (mean 3.1, range 0 to 4). The difference from the PTSD group was statistically significant (p less than 0.001).
  • On the Impact of Events Scale, workers with PTSD had a mean intrusion score of 31.5 (range 23 to 40) and a mean avoidance score of 35.6 (range 30 to 41). Workers without PTSD had means of 4.7 and 7.2. The difference was significant (p less than 0.001).
  • A respiratory specialist rated breathing disability at a mean of 25% (range 10% to 40%). There were no differences between workers who developed PTSD and those who did not.
• The authors' conclusion: The authors concluded that PTSD emerged in 50% of this small series of asbestosis patients. They suggested that the anticipation of death may have created a post-traumatic syndrome in which the trauma was the knowledge of future death.
• Limitations the authors state:
  • The authors describe their group as a small series.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, CT Scan, Fibrosis.

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