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Mental health impacts of flooding: a controlled interrupted time series analysis of prescribing data in England
  1. Ai Milojevic,
  2. Ben Armstrong,
  3. Paul Wilkinson
  1. Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Ai Milojevic, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; ai.milojevic{at}


Background There is emerging evidence that people affected by flooding suffer adverse impacts on their mental well-being, mostly based on self-reports.

Methods We examined prescription records for drugs used in the management of common mental disorder among primary care practices located in the vicinity of recent large flood events in England, 2011–2014. A controlled interrupted time series analysis was conducted of the number of prescribing items for antidepressant drugs in the year before and after the flood onset. Pre–post changes were compared by distance of the practice from the inundated boundaries among 930 practices located within 10 km of a flood.

Results After control for deprivation and population density, there was an increase of 0.59% (95% CI 0.24 to 0.94) prescriptions in the postflood year among practices located within 1 km of a flood over and above the change observed in the furthest distance band. The increase was greater in more deprived areas.

Conclusions This study suggests an increase in prescribed antidepressant drugs in the year after flooding in primary care practices close to recent major floods in England. The degree to which the increase is actually concentrated in those flooded can only be determined by more detailed linkage studies.

  • environmental epidemiology
  • mental health
  • prescribing
  • primary health care
  • time-series

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  • Contributors AM designed the study, conducted the analysis and drafted the initial paper. BA contributed to the quality assurance of statistical methods of this analysis and PW helped selection of antidepressant drugs from British National Formulary codes. All authors contributed to draft and review the paper.

  • Funding This work was supported by Economic and Social Research Council (ES/L007517/1) and the National Institute for Health Research Health Protection Research Unit in Environmental Change and Health.

  • Competing interests None declared.

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