Abstract
Purpose
Relatively little is known about psychological effects of environmental hazard disasters. This study examines the development of posttraumatic stress (PTS) and tendency to limited panic attack after a large chlorine spill in a community.
Methods
In January 2005, a large chlorine spill occurred in Graniteville, SC. Acute injuries were quantified on an ordinal severity scale. Eight to ten months later, participating victims completed the Short Screening Scale for PTSD (n = 225) and the Holden Psychological Screening Inventory (HPSI) (n = 193) as part of a public health intervention. Forced expiratory volume in 1 s (FEV1) and forced vital capacity were likewise measured via spirometry. Two sets of univariate logistic regression models were fit to detect independent effects of each potential covariate and risk factor on PTS score and tendency to panic. A supplemental analysis examined whether poor lung function may be a confounder and/or effect modifier of the effect of acute injury on PTS score and panic.
Results
Of those who completed psychological screening, 36.9% exhibited PTS symptoms. FEV1, acute injury, and the HPSI psychiatric subscale were independently associated with increased PTS score. Acute injury severity scale and female sex were associated with tendency to panic. Immediate acute injury severity and poor lung function later were independently associated with PTS symptomotology.
Conclusions
The high prevalence of PTS and endorsement of tendency to panic within our sample show a need for mental health treatment after a chemical hazard disaster. Mental health personnel should be considerate of those with serious physical injuries.
Similar content being viewed by others
References
Pastel R (2007) What we have learned about mass chemical disasters. Psychiatr Ann 37:754–765
Anger WK (2003) Neurobehavioral tests and systems to assess neurotoxic exposures in the workplace and community. Occup Environ Med 60:1–9
Dirkzwager AJE, Grievink L, Van der Velden PG, Yzermans CJ (2006) Risk factors for psychological and physical health problems after a man-made disaster: prospective study. Br J Psychiatry 189:144–149
Ford JD, Schnurr PP, Friedman MJ, Green BL, Adams G, Jex S (2004) Posttraumatic stress disorder symptoms, physical health, and health care utilization 50 years after repeated exposure to a toxic gas. J Trauma Stress 17:185–194
Kubzansky LD, Karestan CK, Spiro A, Vokonas PS, Sparrow D (2007) Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the normative aging study. Arch Gen Psychiatry 64:109–116
Norman SB, Means-Christensen AJ, Crasek MG, Sherbourne CD, Roy-Byrne PP, Stein MB (2006) Associations between psychological trauma and physical illness in primary care. J Trauma Stress 19:461–470
Stein MB, McQuaid JR, Pedrelli P, Lenox R, McCahill ME (2000) Posttraumatic stress disorder in the primary care medical setting. Gen Hosp Psychiatry 22:261–269
Weisberg RB, Bruce SE, Machuan JT, Kessler RC, Culpepper LC, Keller MB (2002) Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatr Serv 53:848–854
Inserra SG, Phifer BL, Anger WK, Lewin M, Hilsdon R, White MC (2004) Neurobehavioral evaluation for a community with chronic exposure to hydrogen sulfide gas. Environ Res 95:53–61
Broughton E (2005) The Bhopal disaster and its aftermath: a review. Environ Health 4:6
Dhara VR, Dhara R (2002) The union carbide disaster in bhopal: a review of health effects. Arch Environ Health 57:391–404
Misra UK, Kalita J (1997) A study of cognitive functions in methyl-iso-cyanate victims one year after Bhopal accident. Neurotoxicology 18:381–386
Kilburn K (1998) Chlorine and cresylate from a train derailment. Van Nostrand Reinhold, New York
Kilburn K (2000) Chlorine-induced damage documented by neurophysiological, neuropsychological, and pulmonary testing. Arch Environ Health 55:31–37
Kilburn K (2003) Brain but not lung functions impaired after a chlorine incident. Ind Health 41:299–305
Kilburn K (2003) Effects of chlorine and its cresylate byproducts on brain and lung performance. Arch Environ Health 58:746–755
Bowler RM, Mergler D, Huel G, Cone JE (1994) Psychological, psychosocial, and psychophysiological sequelae in a community affected by a railroad chemical disaster. J Trauma Stress 7:601–624
Greve KW, Bianchini KJ, Doane BM, Love JM, Stickle TR (2005) Psychological evaluation of the emotional effects of a community toxic exposure. J Occup Environ Med 47:51–59
Svendsen E, Whittle NC, Sanders L, McKeown RE, Sprayberry K, Heim M, Caldwell R, Gibson JJ, Vena JE (2010) GRACE: public health recovery methods following an environement. Arch Environ Occup Health 65:77–85
Buckley RL, Hunter CH, Addis RP, Parker MJ (2007) Modeling dispersion from toxic gas released after a train collision in Graniteville, SC. J Air Waste Manag Assoc 57:268–278
Hanna S, Dharmavaram S, Zhang J, Sykes I, Witlox H, Khajehnajafi S, Koslan K (2008) Comparison of six widely-used dense gas dispersion models for three recent chlorine railcar incidents. Process Saf Prog 27:248–259
US Environmental Protection Agency (2008) Acute Exposure Guideline Levels (AEGL) Program
Van Sickle D, Wenck MA, Belflower A, Drociuk D, Ferdinands J, Holguin F, Svendsen E, Bretous L, Jankelevich S, Gibson JJ, Garbe P, Moolenar RL (2009) Acute health effects after exposure to chlorine gas released after a train derailment. Am J Emerg Med 27:1–7
Wenck MA, Scikle DV, Drociuk D, Belflower A, Youngblood C, Whisnant MD (2007) Rapid assessment of exposure to chlorine released from a train derailment and resulting health impact. Public Health Rep 122:784–792
Breslau N, Peterson EL, Kessler RC, Schultz LR (1999) Short screening scale for DSM-IV posttraumatic stress disorder. Am J Psychiatry 156:908–911
Holden RR, Mendonca JD, Mazmanian D, Reddon JR (1992) Clinical construct validity of the Holden Psychological Screening Inventory (HPSI). J Clin Psychol 48:627–633
Mossman D (2000) Short screening scale for posttraumatic stress disorder. Am J Psychiatry 157:1026
Kimerling R, Ouimette P, Prins A, Nisco P, Lawler C, Cronkite R (2006) Brief report: utility of a short screening scale for DSM-IV PTSD in primary care. J Gen Intern Med 21:65–67
Bohnert KM, Breslau N (2011) Assessing the performance of the short screening scale for post‐traumatic stress disorder in a large nationally‐representative survey. Int J Methods Psychiatr Res 20:e1–e5
Reddon J, Choldin S (1998) Relationship between the Holden Psychological Screening Inventory (HPSI) and the Basic Personality Inventory (BPI) in a community sample. J Psychopathol Behav Assess 20:295–306
Holden RR, Starzyk KB, McLeod LD, Edwards MJ (2000) Comparisons among the Holden Psychological Screening Inventory (HPSI), the Brief Symptom Inventory (BSI), and the Balanced Inventory of Desirable Responding (BIDR). Assessment 7:163–175
Holden RR (1996) Holden Psychological Screening Inventory (HPSI). MHS, Toronto
Miller MR, Crapo RO, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (2005) General considerations for lung function testing. Eur Respir J 26:153–161
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968
Center UOSaHER (2003) NIOSH spirometry training guide. NIfOSaH Centers for Disease Control and Prevention, Morgantown
Neria Y, Nandi A, Galea S (2008) Post-traumatic stress disorder following disasters: a systematic review. Psychol Med 38:467–480
Norris FH (2005) Range, magnitude, and duration of the effects of disasters on mental health: review update 2005, Dartmouth College
Norris FH, Friedman M, Watson P, Byrne C, Diaz E, Kaniasty K (2002) 60, 000 disaster victims speak, part I: an empirical review of the empirical literature, 1981–2001. Psychiatry 65:207–239
Acknowledgments
This work was supported jointly with funding from the environmental emergency fund within the South Carolina Department of Health and Environmental Control and the University of South Carolina’s Center for Public Health Preparedness. The authors would like to acknowledge the contributions of Nancy Whittle, Marge Heim, Robert McKeown and Jane Stafford to these public health efforts. This work could not have been successfully performed without the many voluntary grief counselors who were available during the public health screenings and who assisted with the administration of these mental health questionnaires. We are indebted to the Aiken-Barnwell Mental Health Clinic for providing these volunteers and for hosting these screenings along with our two other gracious hosts, Graniteville First Baptist Church and Bethlehem Baptist Church, both in Graniteville. Without the help of these hosts we would not have been able to do this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ginsberg, J.P., Holbrook, J.R., Chanda, D. et al. Posttraumatic stress and tendency to panic in the aftermath of the chlorine gas disaster in Graniteville, South Carolina. Soc Psychiatry Psychiatr Epidemiol 47, 1441–1448 (2012). https://doi.org/10.1007/s00127-011-0449-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-011-0449-6