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Impact of repeat flooding on mental health and health-related quality of life: a cross-sectional analysis of the English National Study of Flooding and Health
  1. Clare E French1,2,
  2. Thomas D Waite3,
  3. Ben Armstrong4,
  4. G. James Rubin5,
  5. English National Study of Flooding and Health Study Group,
  6. Charles R Beck1,2,5,6,
  7. Isabel Oliver1,2,5,6
  1. 1 NIHR Health Protection Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, Bristol, UK
  2. 2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  3. 3 National Infection Service, Public Health England, London, UK
  4. 4 NIHR Health Protection Research Unit in Environmental Change and Health at the London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Department of Psychological Medicine, Weston Education Centre, King’s College London NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
  6. 6 Field Service South West, National Infection Service, Public Health England, Bristol, UK
  1. Correspondence to Dr Clare E French; clare.french{at}


Objective To assess the association between flooding/repeat flooding and: (1) psychological morbidity (anxiety, depression, post-traumatic stress disorder (PTSD)) and (2) health-related quality of life (HRQoL) at 6 months post-flooding.

Design Cross-sectional analysis of data from the English National Study of Flooding and Health.

Setting Cumbria, England.

Participants Questionnaires were sent to 2500 residential addresses at 6 months post-flooding; 590 people responded.

Outcomes Probable depression was assessed using the Patient Health Questionnaire, probable anxiety using the Generalised Anxiety Disorder scale and probable PTSD using the short-form PTSD checklist (PCL-6). HRQoL was assessed using the EQ-5D-5L. Mental health outcomes were analysed using logistic regression; HRQoL dimensions using ordinal regression; and summary index/Visual Analogue Scale scores using linear regression.

Results One hundred and nineteen participants had been flooded, over half of whom were experiencing a repeat flooding event (54%; n=64). Mental health outcomes were elevated among flooded compared with unaffected participants (adjusted OR for probable depression: 7.77, 95% CI: 1.51 to 40.13; anxiety: 4.16, 95% CI: 1.18 to 14.70; PTSD: 14.41, 95% CI: 3.91 to 53.13). The prevalence of depression was higher among repeat compared with single flooded participants, but this was not significant after adjustment. There was no difference in levels of anxiety or PTSD. Compared with unaffected participants, those flooded had lower EQ-5D-5L index scores (adjusted coefficient: −0.06, 95% CI: −0.12 to −0.01) and lower self-rated health scores (adjusted coefficient: −6.99, 95% CI: −11.96 to −2.02). There was, however, little difference in HRQoL overall between repeat and single flooded participants.

Conclusions Interventions are needed to help minimise the impact of flooding on people’s mental health and HRQoL.

  • epidemiology
  • public health
  • mental health
  • health-related quality of life
  • flooding

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  • Presented at Part of this work was presented at the Public Heath England Public Health Research and Science Conference 2018, Warwick, UK.

  • Contributors CEF led the design and conduct of these analyses, with expert statistical advice from BA, and drafted the manuscript. English National Study of Flooding and Health Study Group members including named authors IO, TDW, BA, CRB and GJR designed the National Study of Flooding and Health and acquired the data. IO, TDW, BA, CRB and GJR contributed to the design of the analyses and the interpretation the findings. All authors contributed to the writing of the manuscript and approved it for submission.

  • Funding The research was funded in part by the National Institute for Health Research Health Protection Research Units (NIHR HPRU) in Emergency Preparedness and Response at King’s College London, Environmental Change at the London School of Hygiene and Tropical Medicine and Evaluation of Interventions at the University of Bristol, in partnership with Public Health England (PHE). The views expressed are those of the authors and not those of the NHS, the NIHR, The Department of Health or Public Health England.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was granted by the Psychiatry, Nursing and Midwifery Research Ethics Subcommittee at King’s College London [Reference PNM 1314 152]. All participants consented to participate in the study.

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

  • Data availability statement The datasets analysed in this study are available from Public Health England Field Epidemiology Service on reasonable request.

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