Richard Amlôt

Psychosocial impact of the summer 2007 floods in England

BackgroundThe summer of 2007 was the wettest in the UK since records began in 1914 and resulted in severe flooding in several regions. We carried out a health impact assessment using population-based surveys to assess the prevalence of and risk factors for the psychosocial consequences of this flooding in the United Kingdom.MethodsSurveys were conducted in two regions using postal, online, telephone questionnaires and face-to-face interviews. Exposure variables included the presence of flood water in the home, evacuation and disruption to essential services (incident management variables), perceived impact of the floods on finances, house values and perceived health concerns. Validated tools were used to assess psychosocial outcome (mental health symptoms): psychological distress (GHQ-12), anxiety (GAD-7), depression (PHQ-9) and probable post-traumatic stress disorder (PTSD checklist-shortform). Multivariable logistic regression was used to describe the association between water level in the home, psychological exposure variables and incident management variables, and each mental health symptom, adjusted for age, sex, presence of an existing medical condition, employment status, area and data collection method.ResultsThe prevalence of all mental health symptoms was two to five-fold higher among individuals affected by flood water in the home. People who perceived negative impact on finances were more likely to report psychological distress (OR 2.5, 1.8-3.4), probable anxiety (OR 1.8, 1.3-2.7) probable depression (OR 2.0, 1.3-2.9) and probable PTSD (OR 3.2, 2.0-5.2). Disruption to essential services increased adverse psychological outcomes by two to three-fold. Evacuation was associated with some increase in psychological distress but not significantly for the other three measures.ConclusionThe psychosocial and mental health impact of flooding is a growing public health concern and improved strategies for minimising disruption to essential services and financial worries need to be built in to emergency preparedness and response systems. Public Health Agencies should address the underlying predictors of adverse psychosocial and mental health when providing information and advice to people who are or are likely to be affected by flooding.

The effects of flooding on mental health: Outcomes and recommendations from a review of the literature

Introduction While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects on some people’s health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of the hardiest of people who are affected. Methods The Health Protection Agency (HPA) undertook a review of the literature published from 2004 to 2010. It is intended to: assess and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes and recommendations from this review of the literature. Results The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are under-represented in the published data. Most people’s psychosocial needs are met through their close relationships with their families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, there are a number of methodological challenges that arise when conducting research and when analysing and comparing data on the psychosocial and mental health impacts of floods. Conclusions The HPA’s findings showed that a multi-sector approach that involves communities as well as agencies is the best way to promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research findings. Further research is needed on the longitudinal effects of flooding on people’s mental health, the effects of successive flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people who respond to the needs of other persons in the aftermath of disasters. Corresponding author: Carla Stanke Address: Health Protection Agency 151 Buckingham Palace Road London SW1W 9SZ E-mail: carla.stanke@hpa.org.uk Fax: 020 7811 7759 Telephone: 020 7811 7161

Secondary stressors and extreme events and disasters: a systematic review of primary research from 2010-2011.

Introduction Extreme events and disasters, such as earthquakes and floods, cause distress and are associated with some people developing mental disorders. Primary stressors inherent in many disasters can include injuries sustained or watching someone die. The literature recognises the distress which primary stressors cause and their association with mental disorders. Secondary stressors such as a lack of financial assistance, the gruelling process of submitting an insurance claim, parents’ worries about their children, and continued lack of infrastructure can manifest their effects shortly after a disaster and persist for extended periods of time. Secondary stressors, and their roles in affecting people’s longer-term mental health, should not be overlooked. We draw attention in this review to the nature of secondary stressors that are commonly identified in the literature, assess how they are measured, and develop a typology of these stressors that often affect people after extreme events. Methods We searched for relevant papers from 2010 and 2011 using MEDLINE®, Embase and PsycINFO®. We selected primary research papers that evaluated the associations between secondary stressors and distress or mental disorders following extreme events, and were published in English. We extracted information on which secondary stressors were assessed, and used thematic analysis to group the secondary stressors into a typology. Results Thirty-two relevant articles published in 2010 and 2011 were identified. Many secondary stressors were poorly defined and difficult to differentiate from primary stressors or other life events. We identified 11 categories of secondary stressors, though some extend over more than one category. The categories include: economic stressors such as problems with compensation, recovery of and rebuilding homes; loss of physical possessions and resources; health-related stressors; stress relating to education and schooling; stress arising from media reporting; family and social stressors; stress arising from loss of leisure and recreation; and stress related to changes in people’s views of the world or themselves. Limitations in this review include its focus on studies published in 2010 and 2011, which may have led to some secondary stressors being excluded. Assumptions have been made about whether certain items are secondary stressors, if unclear definitions made it difficult to differentiate them from primary stressors. Conclusions This is the first review, to our knowledge, that has developed a typology of secondary stressors that occur following extreme events. We discuss the differing natures of these stressors and the criteria that should be used to differentiate primary and secondary stressors. Some secondary stressors, for example, are entities in themselves, while others are persisting primary stressors that exert their effects through failure of societal responses to disasters to mitigate their immediate impacts. Future research should aim to define secondary stressors and investigate the interactions between stressors. This is essential if we are to identify which secondary stressors are amenable to interventions which might reduce their impacts on the psychosocial resilience and mental health of people who are affected by disasters. Corresponding Author: Dr Sarah Lock, Extreme Events and Health Protection, London, 151 Buckingham Palace Road, London, SW1W 9SZ. E-mail: sarah.lock@hpa.org.uk

The role of religious fundamentalism in terrorist violence: A social psychological analysis

This paper examines the social-psychological factors often implicated in discussions of terrorist violence/martyrdom, with a particular focus on the role of religion. We offer a brief description of the psychological theories underpinning terrorist research before focusing on social-psychological factors. The roles of psychopathology, irrationality and grievance/threat are examined, followed by empirical research on the beliefs which have been associated with the perpetration and support of terrorist violence, and the social factors which foster those beliefs, including social identity, socially carried interpretations, group leadership and individual differences. Although religion is not a single, simple causal factor in terrorist violence, religious elements often feature strongly in the belief systems associated with terrorist violence, and can also feature in other important fostering factors for terrorist violence, such as the use of rhetoric. Finally, the status of lay explanations of terrorist violence, focusing on the role of religious fundamentalism is examined.

Ticking All the Boxes? A Systematic Review of Education and Communication Interventions to Prevent Tick-Borne Disease

Tick-borne disease has become increasingly prevalent across Europe. Despite the effectiveness of protective behaviors, relatively few people adopt them when in areas where ticks are known to be present. In this systematic review we identified studies that assessed the impact of any educational or behavioral interventions intended to encourage the widespread use of protective behaviors against tick-borne disease. An extensive search of electronic databases returned a total of only nine such studies. Only two of these were fully randomized controlled trials, with the remaining studies using weaker designs and often relying solely on self-reports to assess behavior. The majority of research in this area has not explicitly noted the consideration of any formal psychological theory on how best to promote behaviors that protect health. Nonetheless, the results show that both knowledge of and attitudes towards tick-borne disease are amenable to change, although the stability of these changes over time has not yet been determined. Not all intervention strategies have proved effective, with some producing detrimental effects. More theory-based, methodologically-robust studies are urgently required if we are to gain a better understanding of the most effective strategies for encouraging members of the public to adopt behaviors known to protect against tick-borne disease.

Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster.

Abstract Background: When disasters occur, humanitarian relief workers frequently deploy to assist in rescue/recovery efforts. Aims: To conduct a systematic review of factors affecting the psychological wellbeing of disaster relief workers and identify recommendations for interventions. Method: We searched MEDLINE®, Embase, PsycINFO® and Web of Science for relevant studies, supplemented by hand searches. We performed thematic analysis on their results to identify factors predicting wellbeing. Results: Sixty-one publications were included. Key themes were: pre-deployment factors (preparedness/training); peri-deployment factors (deployment length/timing; traumatic exposure; emotional involvement; leadership; inter-agency cooperation; support; role; demands and workload; safety/equipment; self-doubt/guilt; coping strategies) and post-deployment factors (support; media; personal and professional growth). Conclusions: As well as role-specific stressors, many occupational stressors not specific to humanitarian relief (e.g. poor leadership, poor support) present a significant health hazard to relief workers. Humanitarian organisations should prioritise strengthening relationships between team members and supervisors, and dealing effectively with non-role-specific stressors, to improve the psychological resilience of their workforce.

Anxiety, distress and anger among British nationals in Japan following the Fukushima nuclear accident

BACKGROUND The 2011 earthquake and tsunami in Japan caused a meltdown at the Fukushima nuclear power plant. AIMS To quantify emotional responses among British nationals in Japan and to assess whether perceptions about the incident or accessing information about it were associated with responses. METHOD A total of 284 participants randomly selected from official records completed a survey that included instruments to measure emotional responses. RESULTS In total, 16% met the criteria for distress, 29.7% reported high anxiety relating to the incident and 30.4% reported high anger. Perceptions that strongly predicted these outcomes included feeling uncertain, being unable to rule out harmful exposure, and believing that exposure would have severe or hidden health effects or be difficult to detect. Using information sources was associated with higher emotional outcome, particularly for sources perceived to have low credibility. CONCLUSIONS Reducing uncertainty and improving the credibility of information is essential in reducing the psychological impact of radiological disasters.

How to Communicate with the Public About Chemical, Biological, Radiological, or Nuclear Terrorism: A Systematic Review of the Literature

A deliberate attack involving chemical, biological, radiological, or nuclear (CBRN) material has the potential to cause substantial fear among the public. This presents problems for communicators, who will need to provide information quickly after an attack while ensuring that their messages are easily understood and likely to be attended to by members of the public. Identifying in advance what people would want to know, where they would get information from, and how messages should be presented might allow communicators to ensure that their messages have the best chance of having their desired effect. In this review, we identified all peer-reviewed studies that have assessed communication strategies or information needs using hypothetical CBRN scenarios or in actual CBRN incidents. We identified 33 relevant studies. Their results support existing psychological models of why people engage in health protective behaviors, with information about the severity of the incident, the likelihood of being exposed, the efficacy and costs or risks of recommended behaviors, and the ability of individuals to perform recommended behaviors being sought by the public. Trust plays a crucial role in ensuring that people attend to messages. Finally, while a large variety of spokespeople and sources were identified as being turned to in the event of an incident, the use of multiple information sources was also common, affirming the importance of communicating a consistent message through multiple channels. Further research is required to extend these predominantly US-based findings to other countries and to confirm the findings of research using hypothetical scenarios.

ARE LONDONERS PREPARED FOR AN EMERGENCY? A LONGITUDINAL STUDY FOLLOWING THE LONDON BOMBINGS

The UK government sees increasing individual preparedness as a priority, but the level of preparedness of people in the UK for a large-scale emergency is not known. The London bombings of July 7, 2005, affected many Londoners and may have altered their sense of vulnerability to a future terrorist attack. We used a longitudinal study design to assess individual preparedness within the same sample of Londoners at 2 points in time: immediately after the bombings (T(1)) and 7 to 8 months later (T(2)). A demographically representative sample of 1,010 Londoners participated in a phone interview at T(1). Subsequently, at T(2), 574 of the same people participated in a follow-up phone interview. At T(1) 51% of Londoners had made 4 or more relevant emergency plans; 48% had gathered 4 or more relevant supplies in case of emergency. There was evidence of increased preparedness at T(2), by which time 90% had made 4 or more emergency plans. Ethnicity, low social status, and having felt a sense of threat during the bombings predicted increased preparedness between T(1) and T(2). Women in general, and women of low social status in particular, perceived themselves to be unprepared in the event of a future terrorist attack. In summary, Londoners show moderate levels of emergency preparedness, which increased following the London bombings. Although we cannot know whether this association is causal, the prospective nature of the study increases the likelihood that it is. However, preparedness is still patchy, and there are important demographic associations with levels of preparedness and perception of vulnerability. These findings have implications for future development of individual and community emergency preparedness policy.

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

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.