Differential Mental Health Impact Six Months After Extensive River Flooding in Rural Australia: A Cross-Sectional Analysis Through an Equity Lens

Association between climate change and patient health outcomes: a mixed-methods systematic review

INTRODUCTION

Climate change poses significant threats to the environment, biodiversity, and socioeconomic stability worldwide. Its impact on human health, particularly within healthcare systems, is growing in concern. Nurses, as front-line healthcare workers, play a crucial role in addressing climate-related health risks. However, there is a gap in understanding nursing perspectives on climate change and its implications for patient health outcomes.

AIM

To synthesize empirical evidence on the association between climate change and patient health outcomes from a nursing perspective.

METHODS

A mixed-methods systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in January 2024 in six scientific databases including CINAHL, PubMed, Scopus, ProQuest, Web of Science, and OVID Nursing. Studies focusing on climate change and patient health outcomes from a nursing perspective were included. Data extraction, quality appraisal, and synthesis were performed systematically.

RESULTS

The systematic review included 18 studies of a mainly quantitative nature. Three main themes emerged as follows: Climate Healthcare Interplay; Future Nurses as Agents of Change; and Navigating Sustainability Challenges in Nursing. These themes highlighted nurses' awareness of the interrelation between climate and health, the need for environmental education in nursing, and the challenges that hinder sustainable nursing practices.

CONCLUSION

This review underscores the importance of integrating climate change topics into nursing education and fostering organizational support for sustainable nursing practices. Addressing these challenges is essential for nurses to mitigate the health risks posed by climate change effectively.

Flooding and health in Australia: a scoping review and coauthorship analysis of published research

BACKGROUND

Australia is frequently affected by floods, and their severity and frequency are predicted to increase due to the effects of climate change. Over the past decade, there has been an increase in the number of publications reporting on the health impacts of flooding in Australia, but no synthesis of this research evidence has previously been published. The aim of this scoping review is to identify and map publications on the health impacts of flooding in Australia and to describe the networks of researchers contributing to this research.

METHODS

In the study, we applied the scoping review methodology guided by Johanna Briggs Institute and coauthorship network analysis. Searches were conducted in MEDLINE, Embase, PsycINFO, CINHAL, Scopus and Web of Science for all publications up to 31 December 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Coauthor networks were constructed using social network analysis methods.

RESULTS

69 publications were included, spanning a 70-year period from 1951 to 2023. The top three health impacts studied were post-traumatic stress disorder (PTSD), distress and child developmental outcomes, with the predominant focus in the past 10 years of recent publications on prenatal maternal stress, child outcomes and mental health impacts. There was minimal focus on socially vulnerable groups and long-term health impacts and few qualitative research studies were reported. Coauthorship analysis showed the primarily disease-specific nature of flood-related research.

CONCLUSION

Our review enhances understanding of the research on the physical and mental health impacts of flooding in Australia by identifying the areas of relatively greater research activity, existing research gaps and potential future research priorities. Given the context-dependent nature of flood and other climate-related health impacts, and of mitigation and adaptation responses, we anticipate that our review findings will enhance the understanding of this topic for Australia and other higher-income countries, identifying areas of focus and current research gaps.

Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review

INTRODUCTION

Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population.

OBJECTIVE

To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision.

DESIGN

A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010-2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion.

FINDINGS

Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge.

DISCUSSION

The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors.

CONCLUSION

A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.

Young people's experiences of the Northern Rivers 2017 flood and its effects on their mental health

OBJECTIVE

To explore young people's (YP) experiences of catastrophic flooding in the Northern Rivers area of northern NSW in 2017 and its effect on their mental health.

DESIGN

Content analysis of free-text survey responses (written responses to open questions, rather than selecting a response option).

SETTING

Northern Rivers NSW.

PARTICIPANTS

YP aged 16-25 years who were Northern Rivers residents at the time of the 2017 flood.

RESULTS

YP found their flood experience to be novel and challenging. They expressed worry, distress, anxiety, and worsened pre-existing mental health issues as a result of the flood. YP reported a number of primary stressors (inadequate preparedness, warning and support during the flood) and secondary stressors (loss/damage of property and possessions, financial strain and disruptions to daily life) which potentially contributed to poor mental health. Some YP reported positive outcomes from their flood experience, notably increased community connectedness and personal resilience. However, they also expressed concern for the future, particularly potential reoccurrence of extreme floods as well as climate change. YP conveyed a desire for better community involvement to improve preparedness for future floods and a clear motivation to take action on climate change.

CONCLUSION

The flood was a challenging experience for YP which was commonly described as negatively affecting their mental health. Understanding what YP view as significant events or issues arising from their personal flood experience may help target support mechanisms and services to maintain their mental. More focus on community-based initiatives to improve disaster preparedness can support mental health in YP.

Volunteering as prosocial behaviour by medical students following a flooding disaster and impacts on their mental health: A mixed-methods study

BACKGROUND

Volunteering is a form of prosocial behaviour that has a been recognised as having positive benefits for medical students. However, there is a lack of research on what influences students to volunteer during and after weather-related disasters. Our study (1) explores factors related to medical students' willingness and readiness to volunteer, and (2) describes mental health impacts of the flood events on students.

METHODS

We conducted a mixed-methods study of medical students on rural clinical placements in a regional area of Australia, 2 to 6 weeks after two major flooding events in 2022. Data were collected through survey and focus groups. Summary statistics were generated from the survey data, and Fisher's exact test was used to determine associations between student experience of the flood and self-rated well-being. Qualitative data were deductively analysed using Byrne and colleagues' theory of prosocial behaviour during an emergency.

RESULTS

The 36 students who participated in focus groups (including the 34 who completed the survey) (response rates 84% and 79%, respectively) demonstrated high levels of prosocial behaviours and were willing to volunteer. A sense of moral obligation was the primary reason for volunteering, whereas concerns for their physical and psychological safety, and missing key aspects of their training, were the strongest reasons for not continuing to volunteer. Students reported personal stress, anxiety and trauma during this period, with significant associations between self-rated impacts on their well-being and feelings of being terrified, helpless and hopeless during the flooding events and of still being distressed weeks later (p < .05).

CONCLUSIONS

This study expands on prosocial behaviour theory by applying Byrne and colleagues elaborated model in the context of medical student volunteering during the 2022 major flooding events in Australia. Modifiable barriers to prosocial behaviour are identified along with proposed strategies to address these barriers.

A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community

BACKGROUND

Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health.

METHODS

The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively.

RESULTS

Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign.

CONCLUSIONS

The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.

Prevalence and determinants of post-traumatic stress disorder five months after the 2019 huge flooding in Iran

BACKGROUND

Despite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019.

METHODS

An analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants.

RESULTS

Out of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7-28.8%) and was significantly higher in Lorestan province (39.7%, P < 0.001). Determinants of PTSD, were unemployment (adjusted odds ratio [AOR] = 3.53, CI 95%: 1.38-9.00), primary (AOR = 2.44, CI 95%: 1.10-5.41) or high school (AOR = 2.35, CI 95%: 1.25-4.40) education (vs. university), a history of mental disorders (AOR = 2.36, CI 95%: 1.22-4.58), high damage to assets (AOR = 2.29, CI 95%: 1.40-3.75), limited access to health care services after the flood (AOR = 1.95, CI 95%: 1.20-3.19), not receiving compensation for flood damage (AOR = 1.94, CI 95%: 1.01-3.83), high wealth index (AOR = 1.90, CI 95%: 1.23-2.93), and flooded house with a height of more than one meter (AOR = 1.66, CI 95%: 1.02-2.76).

CONCLUSION

Results show a notable prevalence of PTSD, especially in Lorestan province, among adults affected by floods. Determinants of PTSD include unemployment, lower education, psychiatric history, extensive property damage, limited post-flood healthcare access, lack of compensation, and increased flood exposure. We recommend adopting an inclusive screening approach for high-risk groups and developing appropriate therapeutic and supportive interventions.

Exploring the impact of recovery funding on the well-being and health workforce capability of rural practices during natural disasters and emergencies

INTRODUCTION

This study examines the impact of funding provided to support the well-being of rural health practitioners and their practice staff following the 2019-2022 bushfires.

OBJECTIVE

To assess the benefits and implications of grant funding for rural practices to aid recovery following bushfires in NSW, Australia.

DESIGN

An explanatory sequential mixed method design consisted of a survey and a thematic analysis of semi-structured Interviews.

FINDINGS

Five key themes emerged from analysis: (1) the disasters altered the role of the practice and therapeutic relationships; (2) the funding had a positive impact on access to professional development; (3) the training had a positive impact on staff well-being and resilience; (4) the professional development had a positive impact on rural practitioner's sense of capability; and (5) important elements of future grant opportunities.

DISCUSSION

The findings indicate the importance of recovering funding to facilitate access to professional development for rural health practioners during natural disasters which improved their mental health and wellbeing, capability and support to clients.

CONCLUSION

Recovery funding facilitated improvement in workforce capability, professional resilience, mental health and well-being in the face of natural disasters and emergencies. There was a link between training and maintaining the capability of rural health care practitioners and their practice staff. Capability was an important factor in the well-being and resilience of the health workforce and their ability to support clients.

[The impact of the Ahr Valley flood on the health of the local population - an analysis based on SHI routine data]

BACKGROUND

In recent decades, Germany has experienced flood events that posed a threat to the health of the local population. However, there is a paucity of studies on the health consequences of these events. Therefore, the aim of the study was to investigate the health consequences of the Ahr Valley flood in 2021.

METHODS

The data basis of this longitudinal study are nationwide billing data (inpatient/outpatient) of the BKK-Landesverband Nordwest. The study region was Ahrweiler and the study periods were the third quarters of 2020 and 2021. Among other things, prevalence rate ratio tests were used to determine which diagnoses (inpatient/outpatient) were spatially and temporally associated with the flood event on the basis of ICD-10 coding.

RESULTS

The results show a significant increase in billed services for some diagnosis groups in the inpatient sector. In particular, there was an increase in F diagnoses (mental and behavioural disorders), S diagnoses (injuries) and various diagnosis codes within Z codes (factors influencing health status and leading to healthcare utilisation). In the outpatient sector, a decrease was observed in many diagnosis groups (F and Z diagnoses).

CONCLUSION

The results of the study showed that the mental health of the local population was particularly affected by the floods. Healthcare was also affected. As floods are expected to become more frequent and severe in the future, measures to protect the population and health infrastructure need to be adapted accordingly.

Climate change, environmental extremes, and human health in Australia: challenges, adaptation strategies, and policy gaps

Climate change presents a major public health concern in Australia, marked by unprecedented wildfires, heatwaves, floods, droughts, and the spread of climate-sensitive infectious diseases. Despite these challenges, Australia's response to the climate crisis has been inadequate and subject to change by politics, public sentiment, and global developments. This study illustrates the spatiotemporal patterns of selected climate-related environmental extremes (heatwaves, wildfires, floods, and droughts) across Australia during the past two decades, and summarizes climate adaptation measures and actions that have been taken by the national, state/territory, and local governments. Our findings reveal significant impacts of climate-related environmental extremes on the health and well-being of Australians. While governments have implemented various adaptation strategies, these plans must be further developed to yield concrete actions. Moreover, Indigenous Australians should not be left out in these adaptation efforts. A collaborative, comprehensive approach involving all levels of government is urgently needed to prevent, mitigate, and adapt to the health impacts of climate change.

Justice, culture, and relationships: Australian Indigenous prescription for planetary health

Indigenous communities shoulder a disproportionate burden of ill health compounded by climate change. In Australia, the oldest surviving cultures have adapted their ecological knowledge over millennia and across climatic ages. However, European colonization has severely curtailed Indigenous peoples' ability to adjust to climate change. An effective response to the climate crisis requires decolonizing processes to reform our relationship with the planet. From an Australian Indigenous perspective, precursors for a self-determined and healthier future are justice, culture, and relationships. We review existing studies on Indigenous-led contemporary climate and health initiatives to assess these precursors. There are examples that highlight the need to attend to issues of restorative justice as the basis for respectful valuing of culture and genuine collaboration to address the climate crisis.

Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review

Climate change is exposing populations to increasing temperatures and extreme weather events in many parts of Australia. To prepare for climate challenges, there is a growing need for Local Health Districts (LHDs) to identify potential health impacts in their region and strengthen the capacity of the health system to respond accordingly. This rapid review summarised existing evidence and research gaps on the impact of climate change on health and health services in Northern New South Wales (NSW)-a 'hotspot' for climate disaster declarations. We systematically searched online databases and selected 11 peer-reviewed studies published between 2012-2022 for the Northern NSW region. The most explored health outcome was mental health in the aftermath of floods and droughts, followed by increased healthcare utilisation due to respiratory, cardiovascular and mortality outcomes associated with bushfire smoke or heat waves. Future research directions were recommended to understand: the compounding impacts of extreme events on health and the health system, local data needs that can better inform models that predict future health risks and healthcare utilisation for the region, and the needs of vulnerable populations that require a whole-of-system response during the different phases of disasters. In conclusion, the review provided climate change and health research directions the LHD may undertake to inform future adaptation and mitigation policies and strategies relevant to their region.

Climate-Related Natural Disasters: Reflections on an Agenda for Rural Health Research

The increasing frequency and severity of climate-related disasters will exacerbate the health inequities that already exist between people living in rural communities and those living in urban areas. There is a need to improve understanding of the differences in the impacts on and needs of rural communities, in order that policy, adaptation, mitigation, response and recovery efforts meet the needs of those who are most affected by flooding and who have the fewest resources to mitigate the impact and adapt to the increased flood risk. This paper is a reflection by a rural-based academic on the significance and experience of community-based flood-related research, with a discussion of the challenges and opportunities for research on rural health and climate change. From an equity perspective, there is a need for all analyses of national and regional datasets on climate and health to, wherever possible, examine the differential impacts and policy and practice implications for regional, remote and urban communities. At the same time, there is a need to build local capacity in rural communities for community-based participatory action research, and to enhance this capacity through building networks and collaborations between different researchers based in rural areas, and between rural- and urban-based researchers. We should also encourage the documentation, evaluation and sharing of experience and lessons from local and regional efforts to adapt to and mitigate the impacts of climate change on health in rural communities.

Exposure to risk and experiences of river flooding for people with disability and carers in rural Australia: a cross-sectional survey

OBJECTIVES

In this paper, we explore the exposure to risk and experiences of people with disability and carers during a flooding event and the subsequent mental health impacts.

DESIGN

A cross-sectional survey between September and November 2017. Binary logistic regression models were used to investigate associations between the mental health of people with disability and carers and their exposure to the flood. Inductive content analysis was used to analyse qualitative data.

SETTING

Flood-affected communities in the rural area of Northern Rivers, New South Wales, Australia, 6 months after river flooding in 2017.

PARTICIPANTS

People over 16 years and a resident in the Northern Rivers at the time of the flood were invited to participate. Using a purposive, snowballing sampling technique participants were drawn from a wide range of socioeconomic backgrounds and had experienced different degrees of flood exposure.

RESULTS

Of 2252 respondents, there were 164 people with disability and 91 carers. Both groups had increased odds of having their home flooded (people with a disability: OR 2.41 95% CI 1.71 to 3.39; carers: OR 1.76 95% CI 1.10 to 2.84). On evacuation, respondents reported inaccessible, conflicting and confusing information regarding flood warnings. Essential services such as healthcare and social services were disrupted (people with a disability: OR 3.98 95% CI 2.82 to 5.60; carers 2.17 95% CI 1.33 to 3.54) and access to safe and mould free housing post flood event was limited. After taking sociodemographic factors into account, respondents with a disability and carers had greater odds of probable post-traumatic stress disorder compared with other respondents (people with a disability: 3.32 95% CI 2.22 to 4.96; carers: 1.87 95% CI 1.10 to 3.19).

CONCLUSION

Our findings show the profound impact and systemic neglect experienced by people with disability and carers during and after the 2017 flood event in the Northern Rivers. As people with disability will take longer to recover, they will require longer-term tailored supports and purposeful inclusion in flood preparedness and recovery efforts.

Aboriginal Population and Climate Change in Australia: Implications for Health and Adaptation Planning

The health impacts of climate are widely recognised, and extensive modelling is available on predicted changes to climate globally. The impact of these changes may affect populations differently depending on a range of factors, including geography, socioeconomics and culture. This study reviewed current evidence on the health risks of climate change for Australian Aboriginal populations and linked Aboriginal demographic data to historical and projected climate data to describe the distribution of climate-related exposures in Aboriginal compared to non-Aboriginal populations in New South Wales (NSW), Australia. The study showed Aboriginal populations were disproportionately exposed to a range of climate extremes in heat, rainfall and drought, and this disproportionate exposure was predicted to increase with climate change over the coming decades. Aboriginal people currently experience higher rates of climate-sensitive health conditions and socioeconomic disadvantages, which will impact their capacity to adapt to climate change. Climate change may also adversely affect cultural practices. These factors will likely impact the health and well-being of Aboriginal people in NSW and inhibit measures to close the gap in health between Aboriginal and non-Aboriginal populations. Climate change, health and equity need to be key considerations in all policies at all levels of government. Effective Aboriginal community engagement is urgently needed to develop and implement climate adaptation responses to improve health and social service preparedness and secure environmental health infrastructure such as drinking water supplies and suitably managed social housing. Further Aboriginal-led research is required to identify the cultural impacts of climate change on health, including adaptive responses based on Aboriginal knowledges.

Insurance Issues as Secondary Stressors Following Flooding in Rural Australia-A Mixed Methods Study

Flood events can be dramatic and traumatic. People exposed to floods are liable to suffer from a variety of adverse mental health outcomes. The adverse effects of stressors during the recovery process (secondary stressors) can sometimes be just as severe as the initial trauma. Six months after extensive flooding in rural Australia, a survey of 2530 locals was conducted focusing on their flood experiences and mental health status. This mixed methods study analysed (a) quantitative data from 521 respondents (21% of total survey respondents) who had insurance coverage and whose household was inundated, 96 (18%) of whom reported an insurance dispute or denial; and (b) qualitative data on insurance-related topics in the survey’s open comments sections. The mental health outcomes were all significantly associated with the degree of flood inundation. The association was strong for probable PTSD and ongoing distress (Adjusted Odds Ratios (AORs) with 95% confidence intervals 2.67 (1.8–4.0) and 2.30 (1.6–3.3), respectively). The associations were less strong but still significant for anxiety and depression (AORs 1.79 (1.2–2.7) and 1.84 (1.2–2.9)). The secondary stressor of insurance dispute had stronger associations with ongoing distress and depression than the initial flood exposure (AORs 2.43 (1.5–3.9) and 2.34 (1.4–3.9), respectively). Insurance was frequently mentioned in the open comment sections of the survey. Most comments (78% of comments from all survey respondents) were negative, with common adverse trends including dispute/denial, large premium increases after a claim, inconsistencies in companies’ responses and delayed assessments preventing timely remediation.

Climate Change and Children’s Mental Health: A Developmental Perspective

Climate change is a major global public-health challenge that will have wide-ranging impacts on human psychological health and well-being. Children and adolescents are at particular risk because of their rapidly developing brain, vulnerability to disease, and limited capacity to avoid or adapt to threats and impacts. They are also more likely to worry about climate change than any other age group. Drawing on a developmental life-course perspective, we show that climate-change-related threats can additively, interactively, and cumulatively increase psychopathology risk from conception onward; that these effects are already occurring; and that they constitute an important threat to healthy human development worldwide. We then argue that monitoring, measuring, and mitigating these risks is a matter of social justice and a crucial long-term investment in developmental and mental health sciences. We conclude with a discussion of conceptual and measurement challenges and outline research priorities going forward.

Suicidal Behavior and Flood Effects in Bangladesh: A Two-Site Interview Study

Background

Bangladeshi flood survivors are reported with such higher mental disorders that are not ever observed in any other cohorts. Although there are a few studies that assessed mental disorders, suicide or suicidal behaviors are not investigated yet. Hence, the present study for the first time investigated suicidal behaviors and its relationship with socio-demographics, flood effects and psychopathology.

Methods

A cross-sectional interview study was carried out between November and December 2019, after 4/5 months of the flood occurrence. Two completely affected villages from two districts residing in two parts of the country were randomly selected (whereas Manikganj district was less affected by the recent flood compared to Kurigram), and a total of 348 flood survivors were interviewed (45.53 ± 14.85 years). Questions related to basic socio-demographics, flood effects, psychological impacts, and suicidal behaviors were asked in the interviews.

Results

In the total sample, 57.5% of flood survivors reported having suicidal ideation, whereas 5.7% and 2.0% madea suicide plan and suicide attempt, respectively. Within two study sites, participants belonging to Kurigram reported significantly higher suicidal ideation compared to Manikganj (84.8% vs 33.2%, χ² = 94.475, p<0.001). Belonging to a lower-class family, having less education, and less earning members in the family, being affected severely by the flood, suffering from depression, anxiety, and PTSD, and experiencing financial threat, and economic hardship were suicidal behavior risk factors in the total sample.

Conclusion

Considering the present findings (ie, suicidality commensurately increases with flood effects), a multi-sectoral policy and its effective implementation should be adopted for alleviating the flood-related psychological burdens.

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Belonging and Inclusivity Make a Resilient Future for All: A Cross-Sectional Analysis of Post-Flood Social Capital in a Diverse Australian Rural Community

In 2017, marginalised groups were disproportionately impacted by extensive flooding in a rural community in Northern New South Wales, Australia, with greater risk of home inundation, displacement and poor mental health. While social capital has been linked with good health and wellbeing, there has been limited investigation into its potential benefits in post-disaster contexts, particularly for marginalised groups. Six months post-flood, a cross-sectional survey was conducted to quantify associations between flood impact, individual social capital and psychological distress (including probable post-traumatic stress disorder). We adopted a community-academic partnership approach and purposive recruitment to increase participation from socio-economically marginalised groups (Aboriginal people and people in financial hardship). These groups reported lower levels of social capital (informal social connectedness, feelings of belonging, trust and optimism) compared to general community participants. Despite this, informal social connectedness and belonging were important factors for all participant groups, associated with reduced risk of psychological distress. In this flood-prone, rural community, there is a pressing need to build social capital collectively through co-designed strategies that simultaneously address the social, cultural and economic needs of marginalised groups. Multiple benefits will ensue for the whole community: reduced inequities; strengthened resilience; improved preparedness and lessened risk of long-term distress from disaster events.