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BackgroundIn winter 2013/14 there was widespread flooding in England. Previous studies have described an increased prevalence of psychological morbidity six months after flooding. Disruption to essential services may increase morbidity however there have been no studies examining whether those experiencing disruption but not directly flooded are affected.The National Study of Flooding and Health was established in order to investigate the longer-term impact of flooding and related disruptions on mental health and wellbeing.MethodsIn year one we conducted a cross sectional analysis of people living in neighbourhoods affected by flooding between 1 December 2013 and 31 March 2014. 8761 households were invited to participate. Participants were categorised according to exposure as flooded, disrupted by flooding or unaffected.We used validated instruments to screen for probable psychological morbidity, the Patient Health Questionnaire (PHQ 2), Generalised Anxiety Disorder scale (GAD-2) and Post Traumatic Stress Disorder (PTSD) checklist (PCL-6).We calculated prevalence and odds ratios for each outcome by exposure group relative to unaffected participants, adjusting for confounders.Results2126 people (23%) responded. The prevalence of psychological morbidity was elevated amongst flooded participants ([n = 622] depression 20.1%, anxiety 28.3%, PTSD 36.2%) and disrupted participants ([n = 1099] depression 9.6%, anxiety 10.7% PTSD 15.2%).Flooding was associated with higher odds of all outcomes (adjusted odds ratios (aORs), 95% CIs for depression 5.91 (3.91–10.99), anxiety 6.50 (3.77–11.24), PTSD 7.19 (4.33–11.93)).Flooded participants who reported domestic utilities disruption had higher odds of all outcomes than other flooded participants, (aORs, depression 6.19 (3.30–11.59), anxiety 6.64 (3.84–11.48), PTSD 7.27 (4.39–12.03) aORs without such disruption, depression, 3.14 (1.17–8.39), anxiety 3.45 (1.45–8.22), PTSD 2.90 (1.25–6.73)). Increased floodwater depth was significantly associated with higher odds of each outcome.Disruption without flooding was associated with borderline higher odds of anxiety (aOR 1.61 (0.94–2.77)) and higher odds of PTSD 2.06 (1.27–3.35)) compared with unaffected participants. Disruption to health/social care and work/education was also associated with higher odds of psychological morbidity.ConclusionsThis study provides an insight into the impact of flooding on mental health, suggesting that the impacts of flooding are large, prolonged and extend beyond just those whose homes are flooded.

This article demonstrates the differences in EWDI that exist between European countries with implications for both research and policy. Many deaths may be avoidable as environmental, social and personal factors are known to contribute to winter mortality. We now need to work to better understand the causes of inter-country differences.

SummaryBackgroundExtensive flooding occurred during the winter of 2013–14 in England. Previous studies have shown that flooding affects mental health. Using data from the 2013–14 Public Health England National Study of Flooding and Health, we compared the prevalence of symptoms of depression, anxiety, and post-traumatic stress disorder between participants displaced by flooding and those flooded, but not displaced, 1 year after flooding.MethodsIn this multivariable ordinal regression analysis, we collected data from a cross-sectional survey collected 1 year after the flooding event from flood-affected postcodes in five counties in England. The analysis was restricted to individuals whose homes were flooded (n=622) to analyse displacement due to flooding. The primary outcome measures were depression (measured by the PHQ-2 depression scale) and anxiety (measured by the two-item Generalised Anxiety Disorder [GAD]-2 anxiety scale), and post-traumatic stress disorder (measured by the Post-Traumatic Stress Disorder Checklist [PCL]-6 scale). We adjusted analyses for recorded potential confounders. We also analysed duration of displacement and amount of warning received.FindingsPeople who were displaced from their homes were significantly more likely to have higher scores on each scale; odds ratio (OR) for depression 1·95 (95% CI 1·30–2·93), for anxiety 1·66 (1·12–2·46), and for post-traumatic stress disorder 1·70 (1·17–2·48) than people who were not displaced. The increased risk of depression was significant even after adjustment for severity of flooding. Scores for depression and post-traumatic stress disorder were higher in people who were displaced and reported receiving no warning than those who had received a warning more than 12 h in advance of flooding (p=0·04 for depression, p=0·01 for post-traumatic stress disorder), although the difference in anxiety scores was not significant.InterpretationDisplacement after flooding was associated with higher reported symptoms of depression, anxiety, and post-traumatic stress disorder 1 year after flooding. The amount of warning received showed evidence of being protective against symptoms of the three mental illnesses studied, and the severity of flooding might be the reason for some, but not all, of the differences between the groups.FundingNational Institute for Health Research Health Protection Research Units (HPRU) in Emergency Preparedness and Response at King's College London, Environmental Change and Health at the London School of Hygiene and Tropical Medicine, and Evaluation of Interventions at the University of Bristol, Public Health England.

The sonolysis of 4-nitrophenol (4-NP) and aniline in O2-saturated aqueous solutions was performed at 610 kHz with ultrasonic power of 25 W and aqueous temperature of 15 +/- 1 degrees C. The initial rate of degradation of both 4-NP and aniline in sonolysis of aqueous media follows pseudo-first-order reaction kinetics. Investigation of the H2O2 generation rate in phosphate buffer media (0.01 M) over the range of pH 2-9 revealed a maximum yield at pH approximately 3.2. The pH, which results in modification of the physical properties (including charge) of molecules with ionisable functional groups, plays an important role in the sonochemical degradation of chemical contaminants. For hydrophilic substrates, the neutral species more easily diffuse to and accumulate at the hydrophobic interface of liquid-gas bubbles in comparison with their corresponding ionic forms. As a consequence, the degradation rate of 4-NP under ultrasonic irradiation decreases with increasing pH. In contrast, the disappearance rate of aniline exhibits a maximum under alkaline conditions due to the high solubility of the ionic anilinium ion and the (potentially) preferential movement of the uncharged form to the interface. Additionally, the rate of reaction of the uncharged aniline molecule (which dominates at pH > 4.6) with hydroxyl radicals is reported to be about three times as fast as the rate of reaction of the cationic anilinium species.

BackgroundThe longer term impact of flooding on health is poorly understood. In 2015, following widespread flooding in the UK during winter 2013/14, Public Health England launched the English National Study of Flooding and Health. The study identified a higher prevalence of probable psychological morbidity one year after exposure to flooding. We now report findings after two years.MethodsIn year two (2016), a self-assessment questionnaire including flooding-related exposures and validated instruments to screen for probable anxiety, depression and post-traumatic stress disorder (PTSD) was sent to all participants who consented to further follow-up. Participants exposure status was categorised according to responses in year one; we assessed for exposure to new episodes of flooding and continuing flood-related problems in respondents homes. We calculated the prevalence and odds ratio for each outcome by exposure group relative to unaffected participants, adjusting for confounders. We used the McNemar test to assess change in outcomes between year one and year two.ResultsIn year two, 1064 (70%) people responded. The prevalence of probable psychological morbidity remained elevated amongst flooded participants [n = 339] (depression 10.6%, anxiety 13.6%, PTSD 24.5%) and disrupted participants [n = 512] (depression 4.1%, anxiety 6.4%, PTSD 8.9%), although these rates were reduced compared to year one. A greater reduction in anxiety 7.6% (95% confidence interval [CI] 4.6–9.9) was seen than depression 3.8% (95% CI 1.5–6.1) and PTSD: 6.6% (95% CI 3.9–9.2). Exposure to flooding was associated with a higher odds of anxiety (adjusted odds ratio [aOR] 5.2 95%, 95% CI 1.7–16.3) and depression (aOR 8.7, 95% CI 1.9–39.8) but not PTSD. Exposure to disruption caused by flooding was not significantly associated with probable psychological morbidity. Persistent damage in the home as a consequence of the original flooding event was reported by 119 participants (14%). The odds of probable psychological morbidity amongst flooded participants who reported persistent damage, compared with those who were unaffected, were significantly higher than the same comparison amongst flooded participants who did not report persistent damage.ConclusionsThis study shows a continuance of probable psychological morbidity at least two years following exposure to flooding. Commissioners and providers of health and social care services should be aware that the increased need in populations may be prolonged. Efforts to resolve persistent damage to homes may reduce the risk of probable psychological morbidity.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5236-9) contains supplementary material, which is available to authorized users.

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