Mining Disaster in Maceió-AL: Assessing the Health Impact on the Victims

Desastre de la Minería en Maceió-AL: Evaluando el Impacto en la Salud de los Afectados

Abstract

This study analyzed the health impact on residents of neighborhoods in Maceió-AL, who were affected by ground subsidence resulting from halite extraction by the mining company Braskem. A mixed-methods approach was employed, beginning with a cross-sectional study phase in which a validated scale (DASS-21) and a sociodemographic questionnaire were administered, followed by a phase of qualitative research. The findings revealed that the disaster significantly impacted the mental health of these individuals, with heightened levels of stress, anxiety, and depression surpassing normal thresholds. A correlation between mental disorders and the diagnosis of systemic arterial hypertension was observed, suggesting extended physical health implications from the disaster for the affected individuals, who are subjected to a perpetual state of uncertainty leading to mental disorders and the worsening of pre-existing chronic diseases. The study underscores the significance of Health Impact Assessment (HIA) in risk identification and decision-making processes to mitigate the disaster’s impacts.

Keywords:
Braskem; Mental Health; Mining; Anxiety; Depression

Resumo

Neste trabalho foi analisado o impacto à saúde dos moradores dos bairros de Maceió-AL, que foram afetados pelo afundamento do solo decorrente da extração de salgema pela empresa mineradora Braskem. Utilizou-se uma abordagem mista, com uma primeira fase de estudo transversal, na qual uma escala validada (DASS-21) e um questionário sociodemográfico foram aplicados, e uma segunda fase de pesquisa qualitativa. Os resultados indicaram que o desastre teve um impacto significativo na saúde mental desses indivíduos, com prevalência de estresse, ansiedade e depressão acima dos níveis normais. Identificou-se correlação entre os transtornos mentais e o diagnóstico de hipertensão arterial sistêmica, sugerindo implicações físicas prolongadas do desastre na saúde dos atingidos, que estão expostos a um estado constante de incerteza resultando em transtornos mentais e agravamento de doenças crônicas preexistentes. O estudo demonstra a importância da AIS na identificação de riscos e na tomada de decisão para mitigar os impactos do desastre.

Palavras-chave:
Braskem; Saúde mental; Mineração; Ansiedade; Depressão

Resumen

Este estudio analizó el impacto en la salud de los residentes de los barrios en Maceió-AL, afectados por el hundimiento del suelo resultante de la extracción de halita por la compañía minera Braskem. Se adoptó un enfoque de métodos mixtos, iniciando con una fase de estudio transversal en la que se administraron una escala validada (DASS-21) y un cuestionario sociodemográfico, seguida de una fase de investigación cualitativa. Los hallazgos revelaron que el desastre afectó significativamente la salud mental de estos individuos, con niveles elevados de estrés, ansiedad y depresión superando los umbrales normales. Se observó una correlación entre los trastornos mentales y el diagnóstico de hipertensión arterial sistémica, sugiriendo implicaciones prolongadas en la salud física de los afectados, quienes se encuentran sometidos a un estado perpetuo de incertidumbre que conduce a trastornos mentales y al empeoramiento de enfermedades crónicas preexistentes. El estudio subraya la importancia de la Evaluación del Impacto en la Salud (EIS) en la identificación de riesgos y en los procesos de toma de decisiones para mitigar los impactos del desastre.

Palabras-clave:
Braskem; Salud mental; Minería; Ansiedad; Depresión

Introduction

Mining is characterized as a profitable activity, with a share in the GDP of 1.257% and 1.293% in 2019 and 2020, respectively. This activity is based on natural capital that promotes physical, biological, and anthropological impacts. It causes environmental impacts, which are defined as anthropic action that culminates in a permanent or non-permanent modification of the environment. These impacts can be negative or positive, with their degradation intensity proportional to the degree of soil exploitation (BRASIL, 1986). When evaluating the licensing of large projects with the potential to produce significant environmental and social impacts, the literature indicates that although the physical, biotic, and even anthropic impacts are identified in the influence areas of large projects, the identification, prediction, and risks of impacts on public health are not extensively incorporated into environmental impact studies (BUSATO; GRISOTTI, 2022; RODRIGUES; GALVÃO; MENEZES, 2018).

Within the sphere of environmental impacts, it is possible to identify the health aspect, which can be evaluated through Health Impact Assessment (HIA), a multidisciplinary tool that allows for the identification and evaluation of the importance of impacts resulting from activities that affect the health and well-being of the population. AIS is characterized by the combination of both quantitative and qualitative approaches with the aim not only of identifying and predicting impacts but also of assessing risks and indicating paths to mitigate their effects. Whether in biophysical or anthropogenic environments, AIS contributes to the generation of evidence that supports decision-making (ABE; MIRAGLIA, 2018).

Considering the possible impacts of mining, in 2018, an extensive area in the city of Maceió was affected by soil instability and a 2.5 magnitude earthquake on the Richter Scale, according to the Mineral Resources Research Company (CPRM). This resulted in the cracking of numerous buildings and the displacement of several families by the civil defense, as well as the expulsion of more than 57,000 people. This region corresponds to the neighborhoods of Pinheiro, Mutange, Bebedouro, and Bom Parto. These four neighborhoods have a total area of approximately 5.26 km² that suffered from instability and the consequent seismic disturbance caused by salt mining by the company Braskem, as reported by the Brazilian Geological Service linked to the Mineral Resources Research Company (CRPM - SERVIÇO GEOLÓGICO DO BRASIL, 2019).

In the CPRM report, it was stated that the salt extraction cavities were destabilized, which resulted in halocinesis (movement of salt) and subsidence (sinking) of the ground because of the reactivation of geological structures. This also led to sudden deformations on the surface (cracks in the soil and buildings) observed in the affected neighborhoods, leading to the state of public calamity declared by the municipality’s government (CRPM - SERVIÇO GEOLÓGICO DO BRASIL, 2019).

The expropriation of houses and the proposed actions did not contribute to mitigating the impacts suffered. The adopted model, in which houses are bought by the state and families receive a subsidized amount to look for properties independently, has worse results pointed out by literature, intensifying the deleterious consequences, according to the company responsible for the damage until March 2023 more than 14.3 thousand properties were vacated (BERROETA; CARVALHO, 2021). Furthermore, other parallel problems arise, such as, for example, the increase in infectious diseases and health and public safety issues due to abandoned properties (ROMÃO et al., 2019).

The disaster that occurred in these communities was intense and permanent, affecting both the material sphere, represented by houses and public spaces, as well as the immaterial sphere, mainly corresponding to the physical and mental health of these individuals (FREITAS et al., 2019). Regarding intangible aspects, their impact is as significant, if not more, than physical aspects. Since it leads to several consequences, in the form of psychosocial and psychosomatic disorders (KHACHADOURIAN et al., 2022).

The process of expropriating people from their urban environment and losing the sense of community belonging deteriorates socio-spatial ties, promoting feelings of stress, uncertainty, and consequent anxiety (BERROETA; CARVALHO, 2021). These environmental modifications increase the risk of exposure to diseases, directly affecting the individuals’ quality of life, as well as contributing to the onset and worsening of other conditions such as mental illnesses, respiratory diseases, and exacerbation of chronic diseases such as diabetes and hypertension (ROMÃO et al., 2019).

This work aims to evaluate the health impact on residents affected by the sinking of neighborhoods in a disaster situation in Maceió - AL (Pinheiro, Mutange, Bebedouro and Bom Parto). The specific objectives are (1) to analyze the presence of anxiety, depression, and stress among residents whose homes were affected by the disaster; (2) to verify the relationship between anxiety, depression, and stress and the diagnosis of systemic arterial hypertension; and (3) to assess the impact of the sinking of neighborhoods in Maceió - AL on the health of affected residents, particularly those with chronic illnesses.

Methods

To evaluate the health impact of the disaster on the affected population, a sequential exploratory mixed-methods study was used, with two detailed phases described below.

First, we will describe the methodology used in the first phase. The sampling was non-probabilistic, through a virtual snowball method. A validated scale was applied to affected individuals, adults (aged 18 to 90), virtually via email or virtual social networks, to diagnose the mental health status of those affected by the disaster. The chosen scale was the DASS-21 (Depression Anxiety and Stress Scale), and a sociodemographic questionnaire was also administered. The sample for this phase consisted of 170 individuals. Data were collected from November 2021 to January 2023.

The Depression, Anxiety and Stress Scale (DASS) is a Likert-type instrument consisting of 42 items, divided into three scales of 14 items, to evaluate symptoms experienced in the previous week. The shortened version, DASS-21, has the same structure, but with only seven items in each subscale, allowing for a quick and accurate assessment of emotional states. The DASS-21 is self-administered and based on the differences between depression, anxiety, and stress, allowing for the identification of different levels of severity. The scale was adapted and validated for Brazilian Portuguese in 2013 (VIGNOLA, 2013).

According to the DASS scale, the classification of stress symptoms was:

• 0-10 = normal;

• 11-18 = mild;

• 19-26 = moderate;

• 27-34 = severe;

• 35-42 = extremely severe.

The classification of anxiety symptoms was:

• 0-6 = normal;

• 7-9 = mild;

• 10-14 = moderate;

• 15-19 = severe;

• 20-42 = extremely severe.

The classification of depression symptoms was:

• 0-9 = normal;

• 10-12 = mild;

• 13-20 = moderate;

• 21-27 = severe;

• 28-42 = extremely severe.

Regarding socioeconomic data, the following variables were obtained: gender, age range, education level, self-declared race/color, marital status, household income, current housing, and diagnosis of chronic illness.

The outcome variable, arterial hypertension, was self-reported and measured based on the answers to three questions from a questionnaire:

1. Do you have a medical diagnosis of high blood pressure (hypertension)?

2. Are you currently taking medication prescribed by a doctor for high blood pressure (hypertension)?

3. Were you diagnosed with hypertension after finding out about the sinking of the neighborhood where you live?

The response options were no, yes. Individuals who answered “yes” to at least one of the first two questions were considered hypertensive, while those who answered negatively to both questions were classified as normotensive. Individuals who answered “yes” to the third question were considered diagnosed after the disaster.

Regarding the statistical analysis, the data were initially submitted to descriptive statistical analysis. In our study, the reliability of the scale was shown to be adequate by Cronbach’s alpha coefficient (stress = 0.75; anxiety = 0.81, and depression = 0.85) (NUNNALLY, 1978).

The variables were dichotomized to allow for a good comparison of results; participants with a cut-off score ≥10 in depression, ≥8 in anxiety, and >15 in stress were considered as having these disorders as referenced by the DASS (KEATING et al., 1995). Univariate and multivariate logistic regressions estimated the odds ratios (OR) and 95% confidence intervals (95% CI), which allowed us to evaluate the relationship between symptoms of stress, depression, and anxiety with sociodemographic characteristics and the place of residence of the participants. These tests were performed using the PAST 4.03 program (HAMMER et al., 2001). Regarding hypertension, a t-test was also performed to compare whether the data obtained in the study is similar to the national average. In addition, we sought to verify whether mental disorders (anxiety, depression, and stress) contributed to an increase in the diagnosis of hypertension. To do this, the data was already dichotomized for each disorder (≥10 for depression, ≥8 for anxiety, and >15 for stress) and tested against the diagnosis of hypertension in three situations (before, after, and before/after) the disaster. These correlation analyses were performed using Sigma 12 software.

We will now describe the methodological aspects of the second phase of the study. As for the qualitative research sample, sampling was determined by data saturation, in which information was collected until no new data could be obtained, and data redundancy was reached. Therefore, the number of participants cannot be accurately determined, being defined by the need for information. (POLIT; HUNGLER, 2011). In this way, 13 people affected by the disaster participated in the research.

The qualitative data was collected through semi-structured interviews with questions about current health, the impact of the disaster on daily life, health, and challenges faced by the interviewees (VORMITTAG; OLIVEIRA, DE; GLERIANO, 2018). The participants’ speeches were recorded and transcribed in full, and the resulting data was individually organized into Word documents.

Content analysis was used, specifically the thematic analysis modality, using Bardin’s perspective as the methodological framework (BARDIN, 2011). This research technique allows for making replicable and valid inferences about data from a particular context. The thematic analysis consists of discovering cores of meaning that are present or frequent in communication and that means something for the targeted analytical object (PARANHOS et al., 2016).

Operationally, thematic analysis unfolds in three stages described in Figure 1, as directed by Bardin (BARDIN, 2011).

Figure 1
Thematic analysis according to Bardin.

The results obtained were compared to the literature through fragments of speeches and dialogues with other authors.

The technique used for data collection was recorded semi-structured interviews, using a digital voice recorder and a questionnaire with relevant questions about the subject, namely:

1. Was your home affected by what happened in the neighborhoods of Maceió due to salt mining?

2. Did you have to leave your home?

3. When you hear about what happened in the neighborhood where you lived, what comes to your mind?

4. Do you have any chronic illnesses?

5. Was your chronic illness diagnosed before or after the disaster?

6. Have you noticed any changes in your health regarding the chronic illness you have after the disaster?

7. How would you describe your mental health before and after the disaster?

The project was approved by the Ethics and Research Committee of Centro Universitário Tiradentes (Opinion Number: 4.668.538).

Results and Discussion

The study involved the participation of 170 individuals affected by the disaster, who responded to the online survey, forming the final sample of the first phase. As for the characterization of the sample (Table 1), the majority of respondents were women (70%) and were in the age group of 18 to 39 years (48.8%). Regarding education, 37.1% had completed higher education. As for race, the majority self-identified as mixed-race (45.3%) and white (42.9%). Regarding marital status, 41.2% were single and 39.4% were married. The family income of the respondents was mainly distributed among three categories: less than 2 minimum wages (31.2%), from 2 to 4 minimum wages (25.9%), and from 4 to 10 minimum wages (29.4%). The majority of respondents owned their housing (57%) and the number of residents in most homes (64.7%) ranged from 3 to 5 people. As for health conditions, 42.9% of respondents reported having some chronic illness at the time of the interview.

Table 1
Characterization of the study sample

Characteristic	n	%
Gender
Female	119	70
Male	50	29,4
Other	1	0,6
Age
18 to 39 years old	83	48,8
40 to 59 years old	68	40
60+	19	11,2
Education
Preschool	1	0,6
Elementary School	7	4,1
High School	46	27,1
Undergraduate	63	37,1
Postgraduate/ Specialization (Lato Sensu)	40	23,5
Master’s degree (Stricto Sensu)	8	4,7
Doctorate	5	2,9
Race
Asian	3	1,8
White	73	42,9
Mixed race	77	45,3
Black	17	10
Marital Status
Married	67	39,4
Divorced	13	7,6
Separated	3	1,8
Single	70	41,2
Common-law marriage	12	7,1
Widowed	5	2,9
Family income
Above 20 minimum wages	3	1,8
From 10 to 20 minimum wages	20	11,8
From 4 to 10 minimum wages	50	29,4
From 2 to 4 minimum wages	44	25,9
Up to 2 minimum wages	53	31,2
Current Housing
Rented apartment	26	15,3
Owned apartment	22	12,9
Rented house	47	27,6
Owned house	75	44,1
Chronic Disease
Yes	73	42,9
No	97	57,1

• Font: Authors, 2024.

The sample of the present study presents similarities and differences in relation to other similar studies. The similarity was found regarding the sex and race of the participants, while there were significant differences in relation to marital status, age range, education, and income. To illustrate these differences, we can compare the results of two previous studies on environmental disasters in Brazil.

In a 2022 study that investigated the epidemiological profile of participants in the Health Brumadinho Project - a prospective cohort that monitors the health of the population affected by the rupture of Vale’s dam in Brumadinho in January 2019 - the sample consisted of 3,080 individuals over 12 years of age, with 56.7% females and 42.2% white-skinned. The mean age of the participants was 46.1 years, the majority were married (60.0%), and 37.1% had incomplete elementary education (VIANA PEIXOTO et al., 2022).

Another study investigated the perception of physical, mental, and social health of the population exposed to the rupture of the tailings dam of Fundão on November 5, 2015, through self-assessment using a semi-structured questionnaire developed by the authors, who interviewed 507 people, 11 months after the disaster. The sample profile was that 58.3% of the participants were female, 34% were between 40 and 59 years old, and 21% were between 19 and 39 years old. The majority of the participants had a low level of education, with 63.9% having studied up to elementary school, and an income of up to three minimum wages (76.5%). In addition, 43.5% of the interviewees reported having health problems after the disaster (VORMITTAG; OLIVEIRA, DE; GLERIANO, 2018).

To assess the impact on the mental health of residents whose homes were affected by the disaster, an analysis of the presence of anxiety, depression, and stress was conducted by determining the prevalence of these psychological disorders among the interviewees. These results will be presented and discussed below.

The description of the stress, anxiety, and depression variables by the DASS-21 mental scale is displayed in Table 2. The average scores of the DASS-21 and the prevalence for each mental state are displayed in Table 2.

Table 2
Description of the stress, anxiety, and depression variables by the DASS-21 scale and prevalence and average of mental disorders (n=170).

		DASS-21	DASS-21	DASS-21
		Stress	Anxiety	Depression
Mean ± SD		19,8 ± 11,8	13,3 ± 11,5	17,0 ± 12,6
Normal - n (%)		44 (25,9%)	67 (39,4%)	54 (31,8%)
Mild - n (%)		44 (25,9%)	12 (7,1%)	21 (12,4%)
Moderate - n (%)		29 (17,1%)	26 (15,3%)	35 (20,6%)
Severe - n (%)		30 (17,6%)	14 (8,2%)	18 (10,6%)
Extremely severe - n (%)		23 (13,5%)	51 (30,0%)	42 (24,7%)
Normal		Mean ± SD	Interpretation	Prevalence (%)
Stress	<15	19,8 ± 11,8	Moderate	59,41
Anxiety	<8	13,3 ± 11,5	Moderate	53,53
Depression	<10	17,0 ± 12,6	Moderate	62,35

• Font: Authors, 2024.

The results indicated that the average level of stress was 19.8 ± 11.8, ranging from 0 to 42 points and that 59.41% of the interviewees scored above the normal limit for stress (Table 2). Of these individuals, 25.9% were classified as mild, 17.1% as moderate, 17.6% as severe, and 13.5% as extremely severe (Table 2). It was possible to observe in the qualitative stage of the study the presence of emotional stress in some interviewees, such as P.O., who reports that despite not having any chronic illness, the scenario is “(...) exhausting, very stressful, emotionally, it affects me this way, I get very stressed, tired, pressured and worried, you know (...). There is a lot of emotional stress in this sense.”

Regarding anxiety, the average level was 13.3 ± 11.5, ranging from 0 to 42 points, and 53.53% presented values above normal (Table 2), with 7.1% showing mild symptoms, 15.3% moderate, 8.2% severe, and 30.0% extremely severe (Table 2). These numbers are even higher than the prevalence of anxiety disorders in Brazil according to the WHO, which refers to 9.3% of the population (WORLD HEALTH ORGANIZATION, 2017).

In the second stage of our study, the qualitative stage, we obtained 13 interviews through a semi-structured form, where we observed that anxiety was the most reported disorder, with a prevalence of 76.9% of the interviewees. This frequency is also observed in the most repeated words regarding feelings, with worry (76.9%), fear (69.2%), and anguish (53.8%) being the top three reported. This feeling can be observed in the interviewees’ reports, particularly in which T.H.A. reported that before the disaster, she was “a healthy, cheerful, very communicative person, who liked to go out a lot. After this change and everything that happened, I started developing anxiety attacks (...). I started thinking that my life didn’t matter anymore (...)”.

In another interview, C.S.C. also reported that anxiety, panic attacks, and hypertension began after the disaster, due to feelings of despair and triggers that are activated, as described in the excerpt “Something that was mine, in an unfair way. And when you least expect it, you are taken over by this feeling of despair, of anxiety, and you enter into a crisis”. Another interviewee, M.A.C.P, also reported the development of this disorder, which led her to start using controlled medication and compromising her health, stating “I am on anxiety medication, my health is not the same as it was before (...)”.

The average level of depression was 17.0 ± 12.6, ranging from 0 to 42 points, and 62.35% of individuals presented values above normal (Table 2), with 12.4% having mild symptoms, 20.6% moderate, 10.6% severe, and 24.7% extremely severe (Table 2). These numbers are considerably higher than the prevalence of depressive disorders in Brazil, which ranks first among developing countries, with a prevalence of 5.8% (WORLD HEALTH ORGANIZATION, 2017). In the interviews conducted, depression was the second most reported psychological disorder, corresponding to 6 (46.2%) of the interviewees, while terms related to feelings that infer this disorder were frequent. Among them, the main ones are sadness and uncertainty, mentioned in 4 (30.8%) and 3 (23.1%) of the interviews, respectively.

Another interviewee, A.P.M.F., reported that she was diagnosed with depression during the disaster and that the symptoms started and remained after learning about the changes that would be imposed. “The quality of life changed. Today I realize that some symptoms can appear every day, like trembling, panic.” While T.H.A. refers that it was this situation that promoted the onset of depression, panic syndrome, and anxiety attacks in her and her parents. She also reports that the symptoms of the disorders developed by the disaster still accompany her, compromising her quality of life “(...) I am still being followed by doctors, and sometimes I have reflexes of things and at the moment, I lose my hearing, my vision fades, and all of this is still a reflection of what I went through there and I’m still going through (...)”.

These results suggest that the disaster had a significant impact on the mental health of these individuals, with a high proportion of them presenting symptoms of stress, anxiety, and depression above normal levels, highlighting the need for interventions to mitigate the negative effects on the mental health of these individuals.

Although there is a scarcity of studies investigating the health impact of mining disasters, as well as no previous investigation on the case we studied or any mining disaster in a similar urban perimeter, the results of our study corroborate with the findings of the literature. In a previous study that used data from the “Projeto Saúde Brumadinho,” the prevalence of psychiatric symptoms and their associated factors were investigated in the population affected by the disaster. The results revealed a high prevalence of all psychiatric symptoms investigated, with 29.3% presenting depressive symptoms, 22.9% with post-traumatic stress disorder, 18.9% with anxious symptoms, and 12.6% reporting the presence of suicidal ideation or self-harm. All psychiatric symptoms were more prevalent in women (GARCIA et al., 2022).

One study evaluating the health of the population of Barra Longa affected by the Mariana disaster revealed that 11% of the interviewees reported spontaneous mental and behavioral disorders. When presented with a list of symptoms, anxiety was cited by 10.6% of the interviewees, and depression by 12.4%. Among those studied, 83.4% reported emotional or behavioral symptoms, including insomnia (36.9%), worry or tension (21.7%), sadness (18.1%), easily startled (17.8%), irritability or aggression (15.6%), frequent crying (12.6%), difficulty making decisions (10.5%), apathy (10.1%), or sleepiness (9.5%). These findings suggest that the population of Barra Longa was psychologically affected by the disaster. However, it is important to note that the limitation of the study was the use of a semi-structured questionnaire created by the authors, instead of a psychometric instrument with proven reliability, validity, and effectiveness (VORMITTAG; DE OLIVEIRA; GLERIANO, 2018).

It is important to point out that the findings of psychiatric disorders observed in our study may also be related to Brazil’s position as one of the countries with the highest rates of prevalence of anxiety and depressive disorders, according to the World Health Organization (WHO). In a survey published in 2017, Brazil was classified as the world leader in anxiety disorders. These data suggest that the Brazilian population, in general, may be predisposed to developing psychiatric disorders, which may be exacerbated in disaster situations, such as the case we studied (WORLD HEALTH ORGANIZATION, 2017). We also highlight that the data were collected during the COVID-19 pandemic period, in which research has shown high rates of psychiatric disorders (BRUIN, DE, 2021; GOULARTE et al., 2021). Therefore, the high prevalence of psychiatric symptoms identified may indicate a negative impact on the mental health of residents due to the disaster combined with the pandemic.

Table 3 shows the prevalence of anxiety, stress, and depression symptoms stratified by sex, age, education level, self-reported ethnicity (race), marital status, income, housing, and presence of chronic disease. For stress symptoms, a significantly higher prevalence was observed among younger people (68.67%). The study by Garcia et al. (2022) revealed differences in the prevalence of investigated mental disorders according to age group, with higher prevalence among younger people, except for ideas of death and self-harm. In addition, a negative association was observed between symptoms of PTSD, depression, and anxiety in individuals aged 60 or older. These results suggest that age groups may play an important role in vulnerability to mental disorders and that advanced age may be a protective factor for these specific symptoms.

Regarding education level, a higher prevalence was found for symptoms of the three disorders studied among respondents who completed only elementary school and those with a doctoral degree. Such disparity in educational level is understood in view of the territorial scope of the disaster, as the Pinheiro neighborhood is predominantly residential with a more diverse population and higher income level, especially when compared to the Bebedouro and Mutange neighborhoods, which have a predominance of a population with low purchasing power. In terms of population, the Pinheiro neighborhood, with 19,062 inhabitants, represents the 17th most populous in Maceió. While the Bebedouro neighborhood, with 10,103 inhabitants, and the Mutange neighborhood, with 2,632 inhabitants, occupy the 29th and 46th positions, respectively (CRPM - SERVIÇO GEOLÓGICO DO BRASIL, 2019). However, the study sample shows a predominance of the population with higher education, with 27.1% having completed high school, 37.1% having completed college, and 23.5% having completed postgraduate or specialization programs. Thus, a more diverse sample concerning education levels could better reflect the real prevalence of disorders with the education level cut.

Another study observed a positive association between the average level of education and stress symptoms (GARCIA et al., 2022). Those with lower levels of education tend to have a higher likelihood of residing in disaster-affected areas, suffering the loss of their homes, and need temporary shelter. These individuals also face greater financial challenges in finding suitable housing. On the other hand, those with higher education have greater opportunities, better health status, higher salaries, and higher life expectancies, and tend to reside in areas less affected by disasters, or when affected tend to have greater ease with relocation (LUTZ; KC, 2011).

Statistically significant differences were also observed between housing locations and all outcomes. It is important to consider community environmental psychology and the relationships between people and places, as well as community relationships, to minimize the impact of disasters on the mental health of those affected. Residential changes and transformations of urban habitats during a disaster can have diverse consequences for well-being and mental health, as they break people’s ties with places. A study in four Chilean cities described how the loss of these ties affected people who were relocated after earthquakes, tsunamis, and volcanic eruptions. The strategy in which the housing complex was rebuilt in the same location after an earthquake and tsunami had better results, while the strategy in which families had to find individual solutions in the real estate market after a volcanic eruption had the worst results, as it hindered community organization and relocation. This approach also increased real estate speculation and consolidated the dissolution of socio-spatial ties (BERROETA et al., 2021). It should be noted that a similar strategy with a similar outcome was adopted in the case of the disaster in Maceió.

Table 3
The prevalence of psychiatric symptoms in the total sample and stratified by participants’ characteristics.

		Prevalence (%) (IC95%)
		Anxiety	Stress	Depression
Total		53,53	59,41	62,35
Gender	Female	53,78	61,34	61,34
	Male	52	56	61
	Other	100	0	100
	p	0,83223	0,51816	0,93628
Age	18-39	55,42	68,67	65,06
	40-59	54,41	52,94	60,29
	60+	42,11	42,11	52,63
	p	0,57917	0,015839	0,36764
Education	Preschool	100	100	100
	Elementary School	100	100	85,71
	High School	58,69	69,56	71,74
	Undergraduate	49,21	55,55	57,14
	Postgraduate/ Specialization	42,5	47,5	45
	Master’s degree	50	50	75
	Doctorate	80	60	100
	p	0,04565	0,0089374	0,025961
Race	Asian	66,67	66,67	66,67
	White	47,94	56,16	60,27
	Mixed race	57,14	61,04	57,14
	Black	58,82	78,57	70,59
	p	0,20614	0,45476	0,72865
Marital Status	Single	51,43	64,28	62,86
	Married	56,72	56,72	58,21
	Divorced	46,15	46,15	61,54
	Separated	0	33,33	66,67
	Common-law marriage	75	66,67	66,67
	Widowed	40	60	80
	p	0,50184	0,56398	0,442
Family income	From 2 to 4 minimum wages	62,26	69,81	77,36
	From 2 to 4	47,73	52,27	59,1
	From 4 to 10	48	52	48
	From 10 to 20	55	70	60
	Above 20 minimum wages	66,67	33,33	66,67
	p	0,19249	0,13849	0,058126
Current Housing	Rented apartment	53,85	50	61,54
	Owned apartment	59,1	72,73	59,1
	Rented house	57,45	61,7	74,47
	Owned house	49,33	57,33	54,67
	p	p<0,001	p<0,001	0,0033896
Chronic Disease	Yes	64,38	73,97	73,97
	No	45,36	48,45	52,58
	p	0,71329	0,400639	0,72475

• Font: Authors,2024.

Among the 170 interviewed residents, it was found that 73 (42.9%) had been diagnosed with some chronic disease, among those individuals, 36 (21.2%) were diagnosed with hypertension. Of those diagnosed with a chronic disease, 43 (25.3%) of individuals, had the diagnosis occurred after becoming aware of the disaster in the neighborhood where they lived, of these, 14 (8.2%) were diagnosed with hypertension. According to data from the Ministry of Health, in 2021, 26.3% of the Brazilian population was diagnosed with hypertension, so the frequency of hypertensive individuals among those interviewed after the disaster (21.2%) was lower than the national average (p=0.016379).

Regarding the health effects, a preliminary analysis conducted after the Vale mining disaster in Brumadinho highlighted that the affected population was at risk of seeing their pre-existing chronic health conditions, such as hypertension, diabetes, renal failure, and tuberculosis, worsen, as well as developing new harmful health problems such as mental illnesses (depression and anxiety), hypertensive crises, respiratory diseases, domestic accidents, and infectious disease outbreaks (ROMÃO et al., 2019). In the study conducted with residents of Barra Longa, who were affected by the Mariana disaster, it was found that 29% of rural area residents and 24% of urban area residents reported being diagnosed with hypertension after the disaster. Furthermore, the study showed that 36.9% of participants were diagnosed with cardiovascular diseases and diabetes after the disaster (VORMITTAG; OLIVEIRA, DE; GLERIANO, 2018).

To identify among individuals with a high degree of anxiety the presence of systemic arterial hypertension, the results of the DASS-21 were analyzed for these individuals. Among the 36 hypertensive residents, 12 of them showed normal symptoms regarding anxiety, which corresponds to 33% of the total, four (11%) showed mild symptoms, three (8%) showed moderate symptoms, two severe symptoms (6%) and 15 (42%) showed extremely severe symptoms. There was no significant difference between anxiety classes (p=0.052277) for hypertensive individuals.

The results were analyzed to verify the relationship between mental disorders and the diagnosis of systemic arterial hypertension. Considering the total number of hypertensive individuals, before and after the disaster, no significant association was observed between hypertension and depression, and anxiety disorders. However, among those interviewed with stress disorders, a positive association was observed (p=0.0396) with arterial hypertension (Table 4).

Table 4
Correlation between diagnosis of arterial hypertension and depression, anxiety, and stress disorders, considering the total number of hypertensive individuals (before and after the disaster, before the disaster, and after the disaster).

Before and after the disaster
	With disorder	Without disorder	Total
Depression	r=0,154 p=0,0987	r=0,0309 p=0,825	r=0,0926 p=0,230
Anxiety	r=0,140 p=0,157	r=0,180 p=0,145	r=0,108 p=0,161
Stress	r=0,205 p=0,0396	r-0,120 p=0,326	r=0,106 p=0,169
Before the disaster
	With disorder	Without disorder	Total
Depression	r=0,151 p=0,107	r=0,0309 p=0,825	r=0,0589 p=0,446
Anxiety	r=0,102 p=0,306	r=0,180 p=0,145	r=0,0516 p=0,504
Stress	r=0,134 p=0,183	r=0,155 p=0,204	r=0,0561 p=0,467
After the disaster
	With disorder	Without disorder	Total
Depression	r=0,252 p=0,00640	r=0,0896 p=0,519	r=0,240 p=0,00163
Anxiety	r=0,313 p=0,00129	r=-0,193 p=0,119	r=0,300 p=0,00000724
Stress	r=0,322 p=0,00101	r=0,0200 p=0,871	r=0,258 p=0,00682

• Font: Author, 2024.

According to a study conducted by Figueiredo and Castro (2015), stress is a natural body response to situations that demand an extra effort. This process is cyclical and aims at organism adaptation, being able to increase productivity, and the ability to face challenges. However, if stress persists and the person cannot deal with the situation constructively, it can become a problem and affect the quality of life.

Studies suggest that exposure to daily stressors may increase the intima-media thickness of the carotid artery in healthy adults, which is an indicator of subclinical atherosclerosis. Stressors appear to be associated with elevated blood pressure and consequent arterial thickening, which is known to be related to cardiovascular diseases (KAMARCK et al., 2018).

Regarding the number of hypertensive individuals before the disaster, no significant association is observed with any of the disorders (Table 4). On the other hand, considering the diagnosis after the disaster, among respondents diagnosed with depression, anxiety, and stress disorders, a positive association with hypertension diagnosis is observed (Table 4).

During our qualitative stage, it was possible to observe through the semi-structured questionnaire responses in the individuals’ reports who developed not only psychological disorders but also identified or noticed the aggravation of other diseases such as hypertension. Of the total interviews, 31% reported having a diagnosis of hypertension, whether it was previously or after the event. Some people, like C.S.C, report the onset after the disaster, “Obesity and hypertension that appeared now. It’s been a year since my pressure started to fluctuate (...).” While some individuals who already had the diagnosis of this comorbidity suffered its aggravation, such as M.A.C.P., who said that “After the disaster, I also have anxiety, in addition to hypertension. The pressure went up quite a bit to the point that I had a stroke, that was it”.

The results of a study conducted in 2002 indicated that psychosocial factors may be responsible for an increase in blood pressure (KAMARCK et al., 2002). In that same year, a review of evidence from prospective cohort studies evaluating associations between psychological factors and the development of hypertension found that there was moderate support for psychological factors as predictors of hypertension development, with stronger support for variables such as anger, anxiety, and depression. The review highlighted that the combined effects of these factors are of sufficient magnitude to suggest potential clinical and statistical relevance (RUTLEDGE; HOGAN, 2002).

Among the research on the topic, two were systematic reviews with meta-analysis. The study conducted by Pan et al. (2015) concluded that there is an association between anxiety and an increased risk of hypertension, emphasizing the importance of early detection and control of anxiety in hypertensive patients. The study conducted by Liu et al. (2017) concluded that although the analyzed articles were very heterogeneous, which made the meta-analysis difficult, an association was found between chronic psychosocial stress and hypertension.

A literature review aimed to summarize the most recent evidence on the relationship between anxiety disorders and hypertension. This association is of great importance for public health, as hypertension is the leading preventable risk factor for premature death, cardiovascular disease, and stroke worldwide, and anxiety disorders are the most prevalent psychiatric disorders worldwide. The review of recent longitudinal and cross-sectional studies, conducted in various geographical regions and age groups, predominantly demonstrated a positive association between anxiety and hypertension. In addition, observational studies indicate that young adults diagnosed with anxiety have a higher risk of developing hypertension, suggesting prolonged exposure to changes in autonomic mechanisms (JOHNSON, 2019),

A systematic review and meta-analysis conducted by Italian researchers based on 52 articles (GALLARDO et al., 2018) addressed the medium and long-term effects of earthquakes on high-income countries. Although this review did not include Brazil, similarities were identified in terms of the increased prevalence of metabolic diseases. The study also pointed out that previous research had demonstrated the relevance of psychological stress as a predictor of coronary artery disease, which allows us to link the increase in the incidence of coronary diseases to the psychological damage caused by disasters. In our study, the diagnosis of chronic diseases after the disaster was observed in 25.3% of cases, with 8.2% being diagnosed with hypertension after the disaster. The study also focused on diabetes, showing an increase in glycated hemoglobin levels by 0.16 from 2 to 12 months after earthquakes. Although these were disasters of different causes, the proposed factors that lead to the increase in metabolic diseases are similar to those found in our study, such as the disruption of routine activities, emotional stress, and changes in place of residence.

Conclusion

The evidence presented by this study suggests that residents in disaster-affected areas who are unable to return to their homes and normal routines are exposed to a constant state of stress and uncertainty that can result in mental disorders, including anxiety, depression, and stress. This prolonged state can have physical implications, such as an increase in blood pressure, contributing to the development of systemic arterial hypertension, or even aggravating pre-existing chronic diseases.

The analysis of this study supports that the mining disaster in the urban area of Maceió, which caused the displacement of more than 57,000 people from their homes, had an impact on the mental and physical health of those affected. The observed increase in the prevalence of anxiety, depression, and stress, with values even higher than those described in the literature for similar disasters, evidences the impact on mental health. The positive association between depression, anxiety, stress disorders, and the diagnosis of hypertension suggests that the impact on mental health has repercussions on physical health. Knowing that hypertension is directly related to cardiovascular diseases and increased morbidity and mortality of affected individuals, the possible consequences of such a diagnosis in the long term are speculated.

The HIA (Health Impact Assessment) proved to be an important tool for assessing the impact of the disaster on the lives of those affected. Given the complexity and the myriad dimensions of the impacts wrought by a disaster of such scale, a thorough and comprehensive analysis is crucial. This ensures that mitigation strategies and public policies implemented are effectively aligned with the real needs of the affected and do not inadvertently contribute to the amplification of the already suffered damages. Therefore, more studies assessing the health impact of this disaster are necessary, given that one of the limitations of this study was the size and diversity of the sample, since data collection occurred during a period when the affected were saturated with studies using similar collection strategies related to the Covid-19 pandemic.

References

• ABE, K. C.; MIRAGLIA, S. G. E. K. Avaliação de Impacto à Saúde (AIS) no Brasil e América Latina: uma ferramenta essencial a projetos, planos e políticas. Interface - Comunicação, Saúde, Educação, [s.l.], v. 22, n^o 65, p. 349-358, 2018. ISSN: 1414-3283, DOI: 10.1590/1807-57622016.0802.
  » https://doi.org/10.1590/1807-57622016.0802
• BARDIN, L. Análise de Conteúdo. São Paulo: Revista e Ampliada, 2011.
• BERROETA, H.; CARVALHO, L. P. Environmental-Community Psychology in the Disaster Research: The Importance of Social-Spatial Connections. Environment and Social Psychology, [s.l.], v. 6, n^o 2, p. 61-79, 2021. ISSN: 2424-8975, DOI: 10.18063/ESP.V6.I2.1403.
  » https://doi.org/10.18063/ESP.V6.I2.1403.
• BRASIL. Conselho Nacional do Meio Ambiente (CONAMA). Resolução CONAMA nº 1, de 23 de janeiro de 1986. Publicada no Diário Oficial da União (DOU), Brasília, DF, 17 fev. 1986. Seção 1, p. 2548-2549.
• BRUIN, W. B. DE. Age Differences in COVID-19 Risk Perceptions and Mental Health: Evidence From a National U.S. Survey Conducted in March 2020. The Journals of Gerontology: Series B, [s.l.], v. 76, n^o 2, p. e24-e29, 2021. ISSN: 1079-5014, DOI: 10.1093/GERONB/GBAA074.
  » https://doi.org/10.1093/GERONB/GBAA074.
• BUSATO, M. A.; GRISOTTI, M. Avaliação de impacto à saúde no processo de implantação de usinas hidrelétricas: contribuições metodológicas. Ambiente & Sociedade, [s.l.], v. 25, p. e00681, 2022. ISSN: 1414-753X, DOI: 10.1590/1809-4422ASOC20200068R1VU2022L3AO.
  » https://doi.org/10.1590/1809-4422ASOC20200068R1VU2022L3AO.
• CRPM - SERVIÇO GEOLÓGICO DO BRASIL. Estudos sobre a instabilidade do terreno nos bairros Pinheiro, Mutange e Bebedouro, Maceió (AL): volume I, relatório síntese dos resultados. n. 1. Maceió, 2019.
• FIGUEIREDO, J. DE O.; CASTRO, E. E. C. Ajustamento criativo e estresse na hipertensão arterial sistêmica. Revista da Abordagem Gestáltica, v. 21, n^o 1, p. 37-46, 2015. ISSN: 1809-6867, DOI: 10.18065/RAG.2020v26n1.10.
  » https://doi.org/10.18065/RAG.2020v26n1.10.
• FREITAS, C. M.; BARCELLOS, C.; ASMUS, C. I. R. F.; SILVA, M. A. D.; & XAVIER, D. R. Da Samarco em Mariana à Vale em Brumadinho: desastres em barragens de mineração e Saúde Coletiva. Cadernos de Saúde Pública, [s.l.], v. 35, n^o 5, p. e00052519, 2019. ISSN: 0102-311X, DOI: 10.1590/0102-311X00052519.
  » https://doi.org/10.1590/0102-311X00052519.
• GALLARDO, A. R.; PACELLI, B.; ALESINA, M.; SERRONE, D.; IACUTONE, G.; FAGGIANO, F.; ALLARA, E. International Journal of Epidemiology, [s.l.], v. 47, n^o 4, p. 1317-1332, 2018. ISSN: 0300-5771, DOI: 10.1093/IJE/DYY130.
  » https://doi.org/10.1093/IJE/DYY130.
• GARCIA, F. D.; NEVES, M. D. C. L. D.; FIRMO, J. O. A.; PEIXOTO, S. V.; CASTRO-COSTA, E. Prevalência de sintomas psiquiátricos e seus fatores associados na população adulta da área atingida pelo rompimento da barragem de rejeitos: Projeto Saúde Brumadinho. Revista Brasileira de Epidemiologia, [s.l.], v. 25, p. e220011, 2022. ISSN: 1415-790X, DOI: 10.1590/1980-549720220011.SUPL.2.
  » https://doi.org/10.1590/1980-549720220011.SUPL.2.
• GOULARTE, J. F.; SERAFIM, S. D.; COLOMBO, R.; HOGG, B.; CALDIERARO, M. A.; ROSA, A. R. COVID-19 and mental health in Brazil: Psychiatric symptoms in the general population. Journal of Psychiatric Research, [s.l.], v. 132, p. 32-37, 2021. ISSN: 0022-3956, DOI: 10.1016/J.JPSYCHIRES.2020.09.021.
  » https://doi.org/10.1016/J.JPSYCHIRES.2020.09.021.
• HAMMER, D. A. T.; HARPER, D. A. Past: Paleontological Statistics Software Package for Education and Data Analysis. Palaeontologia Electronica, [s.l.], v. 4, n^o 1, p. 178, 2001.
• JOHNSON, H. M. Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension. Current Hypertension Reports, [s.l.], v. 21, n^o 9, p. 1-7, 2019. ISSN: 15343111, DOI: 10.1007/S11906-019-0972-5/METRICS.
  » https://doi.org/10.1007/S11906-019-0972-5/METRICS.
• KAMARCK, T. W.; JANICKI, D. L.; SHIFFMAN, S.; POLK, D. E.; MULDOON, M. F.; LIEBENAUER, L. L.; SCHWARTZ, J. E. Psychosocial demands and ambulatory blood pressure: a field assessment approach. Physiology & Behavior, [s.l.], v. 77, n^o 4-5, p. 699-704, 2002. ISSN: 0031-9384, DOI: 10.1016/S0031-9384(02)00921-6.
  » https://doi.org/10.1016/S0031-9384(02)00921-6.
• KAMARCK, T. W.; LI, X.; WRIGHT, A. G.; MULDOON, M. F.; MANUCK, S. B. Ambulatory Blood Pressure Reactivity as a Moderator in the Association Between Daily Life Psychosocial Stress and Carotid Artery Atherosclerosis. Psychosomatic medicine, [s.l.], v. 80, n^o 8, p. 774, 2018. ISSN: 15347796, DOI: 10.1097/PSY.0000000000000627.
  » https://doi.org/10.1097/PSY.0000000000000627.
• KEATING, C. T. Manual for the depression anxiety stress scales. Sydney Psychology Foundation, [s.l.], v. 16, n^o 12 December, 1995. ISSN: 19326203, DOI: 10.1371/JOURNAL.PONE.0261774.
  » https://doi.org/10.1371/JOURNAL.PONE.0261774.
• KHACHADOURIAN, V.; ARMENIAN, H.; GOENJIAN, A.; DEMIRCHYAN, A. Recovery from post-earthquake psychopathology among survivors of the 1988 Armenian earthquake 23 years after the event. Psychol Behav Sci Int J, [s.l.], v. 19, n^o 1, 2022. ISSN: 2474-7688, DOI: 10.19080/PBSIJ.2022.19.556010.
  » https://doi.org/10.19080/PBSIJ.2022.19.556010.
• LIU, M. Y.; LI, N.; LI, W. A.; KHAN, H. Association between psychosocial stress and hypertension: a systematic review and meta-analysis. Neurological research, v. 39, n^o 6, p. 573-580, 2017. ISSN: 17431328, DOI: 10.1080/01616412.2017.1317904.
  » https://doi.org/10.1080/01616412.2017.1317904
• LUTZ, W.; KC, S. Global Human Capital: Integrating Education and Population. Science, [s.l.], v. 333, n^o 6042, p. 587-592, 2011. ISSN: 00368075, DOI: 10.1126/SCIENCE.1206964.
  » https://doi.org/10.1126/SCIENCE.1206964.
• NUNNALLY, J. C. Psychometric Theory. 2 ed. [s.l.]: McGraw-Hill, 1978.
• PAN, Y.; CAI, W.; CHENG, Q.; DONG, W.; AN, T.; YAN, J. Association between anxiety and hypertension: A systematic review and meta-analysis of epidemiological studies. Neuropsychiatric Disease and Treatment, [s.l.], v. 11, p. 1121-1130, 2015. ISSN: 11782021, DOI: 10.2147/NDT.S77710.
  » https://doi.org/10.2147/NDT.S77710.
• PARANHOS, R.; FIGUEIREDO FILHO, D. B.; ROCHA, E. C. D.; SILVA JÚNIOR, J. A. D.; FREITAS, D. Uma introdução aos métodos mistos. Sociologias, [s.l.], v. 18, n^o 42, p. 384-411, 2016. ISSN: 1517-4522, DOI: 10.1590/15174522-018004221.
  » https://doi.org/10.1590/15174522-018004221.
• POLIT, D. F. B. C. T.; HUNGLER, B. P. Fundamentos de pesquisa em enfermagem: métodos, avaliação e utilização. Porto Alegre: Artmed., 2011. 456p.
• RODRIGUES, D. F.; GALVÃO, V. K.; MENEZES, R. K. Consulta Prévia, Accountability Social e Conflitos no Licenciamento Ambiental em Mineração no Brasil e na Colômbia. Revista de Estudos e Pesquisas sobre as Américas, [s.l.], v. 12, n^o 1, 2018.
• ROMÃO, A.; FROES, C.; BARCELLOS, C. D. C.; SILVA, D. X.; SALDANHA, R.; CARRIJO, R. D. S. D. G. G.; PASCOAL, V. Avaliação preliminar dos impactos sobre a saúde do desastre da mineração da Vale (Brumadinho, MG). ARCA, [s.l.], 2019.
• RUTLEDGE, T.; HOGAN, B. E. A quantitative review of prospective evidence linking psychological factors with hypertension development. Psychosomatic Medicine, [s.l.], v. 64, n^o 5, p. 758-766, 2002. ISSN: 00333174, DOI: 10.1097/01.PSY.0000031578.42041.1C.
  » https://doi.org/10.1097/01.PSY.0000031578.42041.1C.
• VIANA PEIXOTO, S. I.; FIRMO, J. O. A.; FRÓES-ASMUS, C. I. R.; MAMBRINI, J. V. D. M.; FREITAS, C. M. D.; LIMA-COSTA, M. F.; SOUZA JÚNIOR, P. R. B. D. Projeto Saúde Brumadinho: aspectos metodológicos e perfil epidemiológico dos participantes da linha de base da coorte. Revista Brasileira de Epidemiologia, [s.l.], v. 25, n^o suppl 2, p. e220002, 2022. ISSN: 1415-790X, DOI: 10.1590/1980-549720220002.SUPL.2.1.
  » https://doi.org/10.1590/1980-549720220002.SUPL.2.1.
• VIGNOLA, R. C. B. [UNIFESP]. Escala de depressão, ansiedade e estresse (DASS): adaptação e validação para o português do Brasil. [s.l.], 2013.
• VORMITTAG, E. da M. P. A. de A.; OLIVEIRA, M. A. DE; GLERIANO, J. S. Health evaluation of the barra longa population affected by the disaster in Mariana County. Ambiente e Sociedade, [s.l.], v. 21, 2018. ISSN: 1414753X, DOI: 10.1590/1809-4422ASOC0122R2VU18L1AO.
  » https://doi.org/10.1590/1809-4422ASOC0122R2VU18L1AO.
• WORLD HEALTH ORGANIZATION. Depression and Other Common Mental Disorders Global Health Estimates. [s.l.]: [s.n.], 2017. Acesso em: 11/abr./23.

Publication Dates

• Publication in this collection
  16 May 2025
• Date of issue
  2025

History

• Received
  20 Apr 2023
• Accepted
  19 Aug 2024