Mental health of populations exposed to biological and chemical weapons

Overview

While attention has been focused on the biomedical role of public health in the rapid identification of a biological or chemical attack and its medical management, much less attention has been directed to address mental health needs. This document provides information for WHO Member States, particularly low-income and middle-income countries, to strengthen preparedness and response plans with regard to the social and mental health consequences of biological and chemical attacks.

Attacks involving biological or chemical weapons may induce significant mental and social effects in a number of ways - even when the agents induce low levels of mortality and physical morbidity. First, as the term ‘bioterrorism’ suggests, biological (and chemical) attacks are associated with the experience of intense social and psychological distress, especially fear (Box 1). Second, physical exposure to biological and chemical agents may induce organic mental disorders (e.g., organic psychosis, delirium, dementia) (Benedek et al, 2002; DiGiovanni, 1999). Third, exposure to any severe stressor – whether natural or human-made - is a risk factor for a range of long-term social and mental problems (including anxiety and mood disorders as well as non-pathological trauma and grief reactions) (Bromet & Havenaar, 2002). Fourth, fear of biological and chemical attacks may be associated with epidemics of medically unexplained illness (Box 2). Fifth, social problems may emerge after exposure to biological and chemical agents (e.g. population displacement; breakdown of community support systems; and social stigma associated with contagion or contamination).