Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, PO Box 86-3000, Heredia, Costa Rica.
Occup Environ Med. 2010 Nov;67(11):778-84. doi: 10.1136/oem.2009.047266. Epub 2010 Aug 25.
Neuropsychiatric disorders and increased suicide rates have been associated with exposure to cholinesterase inhibiting organophosphates. This study examined symptoms of psychological distress, including suicidal ideation, among banana workers in Costa Rica previously exposed to a cholinesterase inhibiting pesticide.
78 workers who had received medical attention 1-3 years previously for occupational pesticide poisoning were recruited: 54 had been exposed to organophosphate, 24 to carbamate, and 43 and 35, respectively, had single and multiple poisoning episodes with a cholinesterase inhibitor. Referents were 130 non-poisoned workers randomly selected from company payrolls. Psychological distress symptoms during the month prior to interview were obtained using the Brief Symptom Inventory (BSI), which has a general severity index and nine subscale scores. Differences in abnormal BSI scores (T score≥63) were assessed through multivariate logistic regression for all poisoned and for subcategories of poisoned as compared to non-poisoned workers.
Organophosphate poisoned workers reported significantly more symptoms than non-poisoned on all but one symptom dimension. Significant trends of increasing symptoms with increasing number of previous poisonings were seen for somatisation, obsessive-compulsiveness, interpersonal sensitivity, depression and anxiety. Carbamate poisoned workers only had increased scores for somatisation. The ORs for suicidal thoughts were: all poisoned 3.58 (95% CI 1.45 to 8.84); organophosphate poisoned 3.72 (1.41 to 9.81); carbamate poisoned 2.57 (0.73 to 9.81); and 2.65 and 4.98, respectively for 1 and ≥2 poisonings (trend p=0.01).
This cross-sectional study showed a relationship between acute occupational poisoning with organophosphates and psychological distress including suicidal ideation. Stronger designs are needed to address causality.
神经精神疾病和自杀率升高与接触抑制胆碱酯酶的有机磷农药有关。本研究调查了在哥斯达黎加工作的香蕉工人的心理困扰症状，包括自杀意念，这些工人以前曾接触过抑制胆碱酯酶的杀虫剂。
招募了 78 名在 1-3 年前因职业性农药中毒接受过医疗救治的工人：54 名接触有机磷农药，24 名接触氨基甲酸酯，43 名和 35 名分别接触过一次和多次有机磷农药中毒。对照组是从公司工资单中随机选择的 130 名未中毒的工人。使用简明症状量表（BSI）在访谈前一个月内获得心理困扰症状，BSI 有一个一般严重程度指数和九个子量表评分。通过多变量逻辑回归评估所有中毒者和与未中毒者相比中毒亚组的异常 BSI 评分（T 评分≥63）差异。
与未中毒者相比，有机磷中毒者在除一个症状维度外的所有维度上报告的症状明显更多。随着以往中毒次数的增加，躯体化、强迫、人际敏感、抑郁和焦虑症状呈明显增加趋势。氨基甲酸酯中毒者只有躯体化症状评分增加。自杀念头的 OR 分别为：所有中毒者 3.58（95%CI 1.45-8.84）；有机磷中毒者 3.72（1.41-9.81）；氨基甲酸酯中毒者 2.57（0.73-9.81）；1 次和≥2 次中毒者分别为 2.65 和 4.98（趋势 p=0.01）。
这项横断面研究表明，急性职业性有机磷中毒与心理困扰，包括自杀意念有关。需要更有力的设计来解决因果关系问题。
