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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24334-3.