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Symptoms of psychological distress and suicidal ideation among banana workers with a history of poisoning by organophosphate or n-methyl carbamate pesticides
  1. Catharina Wesseling1,
  2. Berna van Wendel de Joode1,
  3. Matthew Keifer2,
  4. Leslie London3,
  5. Donna Mergler4,
  6. Lorann Stallones5
  1. 1Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica
  2. 2International Scholars in Occupational and Environmental Health (ISOEH), University of Washington, Seattle, USA
  3. 3Occupational and Environmental Health Research Unit, University of Cape Town, Cape Town, South Africa
  4. 4CINBIOSE, University of Quebec at Montreal, Canada
  5. 5Colorado Injury Control Research Center, Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
  1. Correspondence to Catharina Wesseling, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, PO Box 86-3000, Heredia, Costa Rica; Ineke_wesseling{at}


Objectives 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.

Methods 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.

Results 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).

Conclusions 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.

  • Cholinesterase inhibiting pesticides
  • organophosphates
  • carbamates
  • psychological distress symptoms
  • suicide
  • costa rica
  • Epidemiology
  • mental health
  • neurobehavioural effects
  • pesticides
  • agriculture

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  • Funding The original study was funded by a grant from the Department of Research Cooperation of the Swedish International Development Cooperation Agency (Sida/SAREC), and later received additional support from the Colorado Injury Control Research Center at Colorado State University.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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