The psychological impact of asbestos exposure: risk perception and emotional distress among former workers in Tuscany

Our plain-English summary of The psychological impact of asbestos exposure: risk perception and emotional distress among former workers in Tuscany, by M. Bonafede, E. Chellini, M. Bugani, et al (BMC Public Health, 2025).

The study

• Authors: M. Bonafede, E. Chellini, M. Bugani, A. Marinaccio, L. Miligi, S. Piro, A. Granieri, I.G. Franzoi, M.D. Sauta, A. Baldassarre, V. Cacciarini, R. Consigli, F. Dini, S. Fani, G. Guglielmi, A. Melosi, E. Pantani, A. Roselli, A.G. Sisinni, G. Spalla, L. Tomberli, A. Binazzi
• Journal: BMC Public Health
• Published: 2025;25(1):3424
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND: Exposure to asbestos continues to be a global health hazard, with significant mortality linked to asbestos-related diseases. Despite asbestos bans in many countries, including Italy (1992), former asbestos workers continue to experience health risks and psychological distress. This study examines the psychological impact of asbestos exposure among former workers enrolled in the Tuscany Region’s health surveillance program, focusing on risk perception, emotional distress, and service evaluation. METHODS: A cross-sectional study was conducted from October 2021 to September 2022, involving 362 former asbestos-exposed workers participating in the Tuscany Region’s health surveillance program. Participants were interviewed via structured telephone surveys administered by trained psychologists. The questionnaire assessed asbestos-risk perception, self-perceived asbestos exposure, psychological distress (sadness, anxiety, anger, fear), and satisfaction with health services. Statistical analyses, including generalized logistic regression models, were performed to evaluate associations between risk perception and psychological symptoms. RESULTS: Among participants, 77.9% believed they were at risk of developing an asbestos-related disease in the future, and 61.1% reported significant past exposure. Emotional distress was prevalent, with high self-perceived levels of sadness (mean: 5.1), anger (5.3), fear (4.9), and anxiety (4.0). Risk perception strongly correlated with psychological distress: those who believed they were at future risk exhibited higher levels of fear (OR: 2.86) and anger (OR: 2.56), while those who were uncertain about their past exposure showed increased anxiety (OR: 13.0) and anger (OR: 3.60). Additionally, knowing someone affected by an asbestos-related disease was associated with greater sadness (OR: 3.92) and fear (OR: 3.94). Despite psychological distress, health surveillance services were well-rated, particularly in staff availability (56.6%) and assistance quality (55.2%). CONCLUSIONS: This study emphasizes the psychological effects of asbestos exposure over the long term, underlining the need for integrated mental health support within health surveillance programs. The strong link between risk perception and emotional distress suggests that psychological interventions, like counselling and education ought to be used in conjunction with medical monitoring. Addressing these needs can enhance the well-being of former asbestos-exposed workers, mitigating the lasting effects of exposure-related uncertainty and fear. Future research should focus on developing targeted interventions to support this vulnerable population.

In plain English

This cross-sectional survey asked former asbestos-exposed workers in a Tuscany Region health surveillance program about perceived asbestos risk, emotions and services. Trained psychologists interviewed them by telephone in 2021 and 2022 using a questionnaire written for the study. Of 362 people interviewed, 356 were men. Mean scores for the previous 3 months (0 to 10) were 5.3 for anger, 5.1 sadness, 4.9 fear and 4.0 anxiety. In all, 77.9% believed they were at risk of a future asbestos-related disease. In models adjusted for age class and National Priority Contaminated Site residence, that belief, versus not holding it, was associated with high scores (5 to 10) for anger (odds ratio 2.56, 95% confidence interval 1.08 to 6.08) and fear (2.86, 1.19 to 6.83). Knowing someone with an asbestos-related disease, versus not, was associated with high sadness (3.92, 1.65 to 9.31), anger (2.45, 1.06 to 5.69) and fear (3.94, 1.65 to 9.36). Over half of service-quality responses were satisfactory or very satisfactory. The authors concluded that surveillance programs should also offer psychological support. They noted the questionnaire was not validated and exposure was self-assessed.

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 a structured telephone questionnaire developed ad hoc and given by trained psychologists. Logistic regression was adjusted for age class and residence in a National Priority Contaminated Site.
• Who was studied: Former asbestos-exposed workers enrolled in the Tuscany Region (Central Italy) health surveillance program, interviewed October 2021 to September 2022. 362 interviews were completed. 356 participants (98.3%) were male and 5 were female. 52.2% were aged 68 to 77, and 35.1% lived in National Priority Contaminated Sites.
• Exposure: Past occupational asbestos exposure, certified by a public Occupational Health Physician. No fiber types or products are specified. Participants rated their own past exposure intensity as low, moderate, high or don't know.
• Main results:
  • Mean self-rated scores (0 to 10) for emotions linked to asbestos exposure over the last 3 months, all participants: sadness 5.1 (SD 3.5), anger 5.3 (SD 3.7), fear 4.9 (SD 3.4), anxiety 4.0 (SD 3.1)
  • Of participants, 77.9% thought they were at risk of developing an asbestos-related disease in the future. 66.6% thought they were not currently suffering from one. 86.4% knew someone who had developed one.
  • Compared with those who did not think so, believing oneself at future risk was significantly associated with a high self-perceived level (score 5 to 10) of anger (OR 2.56, 95% CI 1.08 to 6.08) and fear (OR 2.86, 95% CI 1.19 to 6.83). These estimates were adjusted for age class and National Priority Contaminated Sites.
  • Compared with self-assessed light past exposure, high anxiety was significantly associated with self-assessed high past exposure (OR 17.0, 95% CI 2.03 to 142.3) and with not knowing one's past exposure (OR 13.0, 95% CI 1.61 to 106.4).
  • Not knowing one's past exposure was also significantly associated with high anger (OR 3.60, 95% CI 1.01 to 12.8) and high fear (OR 6.42, 95% CI 1.69 to 24.3).
  • Compared with not knowing anyone affected, knowing someone who had developed an asbestos-related disease was significantly associated with high sadness (OR 3.92, 95% CI 1.65 to 9.31), anger (OR 2.45, 95% CI 1.06 to 5.69) and fear (OR 3.94, 95% CI 1.65 to 9.36).
  • Believing oneself currently ill with an asbestos-related disease was not significantly associated with any of the four emotions. For example, the odds ratio for sadness was 1.12 (95% CI 0.25 to 4.99).
  • On average, people with high scores for sadness, anxiety, anger or fear agreed more that all exposed people will develop a disease and that cancer is the most frequent asbestos-related disease (p less than 0.05). There were no differences for the statements on effective treatments and on smoking cessation.
  • Separate analyses for residents and non-residents of National Priority Contaminated Sites found no statistically significant differences. The one exception was that more residents knew someone with an asbestos-related disease (91.3% vs 82.7%, p = 0.027).
  • More than half of responses on service quality were satisfactory or very satisfactory. The highest ratings were for welcome and assistance of the staff (87.6%), listening and availability of the medical staff (87%), and courtesy and promptness of the contact staff (85%).
• The authors' conclusion: The authors concluded that the psychological burden on people previously exposed remains substantial despite Italy's 1992 ban. They said health surveillance programs should provide psychological support and not only monitor physical health.
• Limitations the authors state:
  • Past exposure intensity was self-assessed, without comparison with an expert evaluation.
  • The psychological measures were not validated, and the questionnaire was developed ad hoc.
  • There were no measures of the questionnaire's reliability and statistical validity, which limits how far the results can be generalized.
  • Interviews were done by telephone.
  • Respondents were people who had come forward on their own for health surveillance of their past exposure.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Medical Monitoring.

Related studies

• Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato — M. Bonafede, A. Granieri, et al. (2020)
• Preliminary validation of a questionnaire assessing psychological distress in caregivers of patients with malignant mesothelioma: Mesothelioma Psychological Distress Tool-Caregivers — M. Bonafede, C. Chiorri, et al. (2022)
• Psychological Distress in Patients With Asbestos-Related Diseases and Their Families: A Systematic Literature Review — I.G. Franzoi, M.D. Sauta, et al. (2025)
• Confirmatory validation of a brief patient-reported outcome measure assessing psychological distress in caregivers of malignant mesothelioma patients: the Mesothelioma Psychological Distress Tool-Caregivers — A. Granieri, I.G. Franzoi, et al. (2024)
• Preliminary validation of a brief PROM assessing psychological distress in patients with malignant mesothelioma: The mesothelioma psychological distress tool-Patients — F. Guglielmucci, M. Bonafede, et al. (2022)
• What are the psychological effects of mesothelioma on patients and their carers? A scoping review — V. Sherborne, J. Seymour, et al. (2020)

Browse more research in BMC Public Health, or return to medical research.