Effect of Insurance-Related Factors on the Association between Flooding and Mental Health Outcomes

Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States

BACKGROUND

While the impacts of social and environmental exposure on cardiovascular risks are often reported individually, the combined effect is poorly understood.

METHODS AND RESULTS

Using the 2022 Environmental Justice Index, socio-environmental justice index and environmental burden module ranks of census tracts were divided into quartiles (quartile 1, the least vulnerable census tracts; quartile 4, the most vulnerable census tracts). Age-adjusted rate ratios (RRs) of coronary artery disease, strokes, and various health measures reported in the Prevention Population-Level Analysis and Community Estimates data were compared between quartiles using multivariable Poisson regression. The quartile 4 Environmental Justice Index was associated with a higher rate of coronary artery disease (RR, 1.684 [95% CI, 1.660-1.708]) and stroke (RR, 2.112 [95% CI, 2.078-2.147]) compared with the quartile 1 Environmental Justice Index. Similarly, coronary artery disease 1.057 [95% CI,1.043-1.0716] and stroke (RR, 1.118 [95% CI, 1.102-1.135]) were significantly higher in the quartile 4 than in the quartile 1 environmental burden module. Similar results were observed for chronic kidney disease, hypertension, diabetes, obesity, high cholesterol, lack of health insurance, sleep <7 hours per night, no leisure time physical activity, and impaired mental and physical health >14 days.

CONCLUSIONS

The prevalence of CVD and its risk factors is highly associated with increased social and environmental adversities, and environmental exposure plays an important role independent of social factors.

The effects of secondary stressors, social identity, and social support on perceived stress and resilience: Findings from the COVID-19 pandemic

Primary stressors are direct outcomes of extreme events (e.g., viruses, floodwater) whereas secondary stressors stem from pre-disaster life circumstances and societal arrangements (e.g., illness, problematic pre-disaster policies) or from inefficient responses to the extreme event. Secondary stressors can cause significant long-term damage to people affected but are also tractable and amenable to change. In this study we explored the association between secondary stressors, social identity processes, social support, and perceived stress and resilience. Pre-registered analyses of data from the COVIDiSTRESS Global Survey Round II (N = 14,600; 43 countries) show that secondary stressors are positively associated with perceived stress and negatively associated with resilience, even when controlling for the effects of primary stressors. Being a woman or having lower socioeconomic status (SES) is associated with higher exposure to secondary stressors, higher perceived stress, and lower resilience. Importantly, social identification is positively associated with expected support and with increased resilience and lower perceived stress. However, neither gender, SES, or social identification moderated the relationship between secondary stressors and perceived stress and resilience. In conclusion, systemic reforms and the availability of social support are paramount to reducing the effects of secondary stressors.

Health and wellbeing implications of adaptation to flood risk

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning.

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.

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

BACKGROUND

Flooding is expected to increase due to climate change, population growth and urban development. The longer-term mental health impacts of flooding are not well understood. In 2015, the English National Study of Flooding and Health was established to improve understanding of the impact of flooding on health and inform future public health action.

METHODS

We used 3 years of data from the English National Study of Flooding and Health. Participants who had consented to follow up were sent a questionnaire. Participants were classified into either "unaffected", "disrupted" or "flooded" according to their exposure. Logistic regression models were used to calculate adjusted odds ratios for probable depression, anxiety and post-traumatic stress disorder (PTSD) in each exposure group. The Wald test was used to assess the difference in probable mental health outcomes for those who did and did not experience "persistent damage" to their home. Conditional logistic regression was conducted to assess change in prevalence over the 3 years and to identify possible determinants of recovery.

RESULTS

Eight hundred nineteen individuals were included in the final analysis - 119 were classified as unaffected, 421 disrupted and 279 flooded. Overall, 5.7% had probable depression, 8.1% had probable anxiety and 11.8% had probable PTSD, with higher prevalence in the flooded group compared with the unaffected group. After adjustment for potential confounders, probable mental health outcomes were higher in the flooded group compared to the unaffected group, significantly for probable depression (aOR 8.48, 95% CI 1.04-68.97) and PTSD (aOR 7.74, 95% CI 2.24-26.79). Seventy-seven (9.4%) participants reported experiencing persistent damage to their home, most commonly damp (n = 40) and visible mould (n = 26) in liveable rooms. Of the 569 participants who responded at all 3 years, a significant reduction in prevalence for all probable mental health outcomes was observed in the flooded group.

CONCLUSIONS

Flooding can have severe long-lasting consequences on mental health in affected populations. If these problems are not identified and treated early, they may persist for years. Further research is necessary to develop and evaluate interventions to increase resilience in at risk populations and to ensure timely access to support services following flooding.

Association between floods and hospital admissions for schizophrenia in Hefei, China: The lag effects of degrees of floods and time variation

BACKGROUND

Schizophrenia is a serious mental disorder, endangering 7.5 million patients in China. Floods, as the adverse consequence of temperature-rise, have a negative influence on mental health. However, the relationship between floods and schizophrenia is still insufficient. This study aimed to quantitative the relationship between floods and the admissions for schizophrenia in Hefei, China.

METHODS

A Poisson generalized linear model (GLM) combining a distributed lag non-linear model (DLNM) was used to quantify the lag effects of floods on schizophrenia and subgroups (male, female; ≤40 y, >40 y; the married, the unmarried) from 2005 to 2014, Hefei, China. We further explored the effects of different degrees (moderate and severe) of floods and their temporal changes on schizophrenia.

RESULTS

There was a significant association between floods and admissions risk for schizophrenia. And the lag effects for schizophrenia lasted ten days (lag 5-lag 14), with the greatest effect on lag 9 (RR = 1.036, 95% confidence interval (CI): 1.014-1.058). The married, ≤40 y were sensitive to floods. The significant difference wasn't found for genders. The effects of the severe flood were higher than moderate floods, with the largest RR of 1.073 (95%CI: 1.029-1.119). The adverse effects were found in the middle and late period with a decreasing trend in the later period.

CONCLUSIONS

This study suggests a significant association between floods and schizophrenia with ten days of lag effects in Hefei, China. Male, female, <40 y and the married are vulnerable to both moderate and severe floods. The findings might be used to allocate medical resources of mental health after floods.

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

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.