The English national cohort study of flooding and health: cross-sectional analysis of mental health outcomes at year one

Abstract

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.

The English National Cohort Study of Flooding & Health: psychological morbidity at three years of follow up

“…It is important to note that the crude mental health prevalence presented are not exactly comparable to those presented at year two of this study, in the previously published paper by Jermacane et al [10]. In Jermacane et al, 2018, individuals who had responded to some, but not all mental health questions, were included in the denominator data, but in the present study those subjects were excluded, in line with the approach of Waite et al [9] for year one data. In our paper, we have calculated prevalence according to the method used by Waite et al, 2017 at all 3 years, to allow for easier comparison across all 3 years.…”

“…This study is at year three of follow-up as part of the English NSFH, which was designed as a longitudinal observational open cohort. The participants are people affected by flooding between 1 December 2013 and 31 March 2014 (which are described in more detail elsewhere [9]).…”

“…The original cohort comprised of 2126 participants, with 1408 providing consent for follow-up [9]. At year two, of the 1408 contacted a total of 1064 responded [10].…”

“…The NSFH has previously identified a significant adverse impact on mental health, both at one and 2 years post-flooding, in those whose homes were flooded and whose lives were otherwise disrupted by flooding, compared with those unaffected [9,10]. The NSFH also identified that adverse outcomes are associated with secondary stressors [11], such as insurance-related issues [12], and with displacement from home without warning [13].…”

Shared roles and responsibilities in flood risk management

“…The importance of assisting and empowering at‐risk communities to understand and manage their flooding has arguably never been greater, with increasing populations residing in flood‐prone areas as well as flood risk altering due to climate and land use changes. Furthermore, as well as the long‐recognised physical, social, and financial damages of flooding, there is also stronger evidence about the breadth, severity, and duration of health impacts (Waite et al, ), thus reinforcing the need for effective flood risk management.…”