Extreme weather post-traumatic stress disorder

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Extreme weather events can have a significant impact on mental health, particularly in the form of post-traumatic stress disorder (PTSD). Extreme weather post-traumatic stress disorder occurs when someone experiences the symptoms of PTSD due to extreme weather events such as hurricanes, floods, wildfires, etc. [1] With the increasing frequency and severity of these events due to climate change, it is important to understand how they can lead to long-lasting psychological trauma and learn to provide support for those affected.

Contents

Background

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a condition caused by past, life-altering events in which people have experienced or witnessed. Events could include a serious accident, physical or sexual violence, combat, or natural disasters. Recently, studies have found that extreme weather also leads to PTSD. Symptoms of PTSD related to extreme weather events can include replaying flashbacks of an event, having greater anxiety, and/or detachment when thinking about an event. Symptoms can also arise months or years after the extreme weather event occurs. [2]

Extreme weather events

New Orleans Flooded after Hurricane Katrina KatrinaNewOrleansFlooded edit2.jpg
New Orleans Flooded after Hurricane Katrina

Examples of extreme weather events include tropical storms, hurricanes, heat waves, droughts, and floods. These events have been growing in frequency in the past few decades due to climate change. With this growing frequency, it will increase the effects of these events onto humans and society in the future. [3] People who are exposed to life threatening situations, including extreme weather events, are at a greater risk of experiencing PTSD symptoms or developing the disease. [2] Experiencing or knowing someone who experienced an injury from a natural disaster increased the likelihood and frequency of PTSD symptoms. Also, experiencing a close death of a family member in relation to the natural disaster or weather event often led to a higher likelihood of PTSD. [4]

Symptoms

Eco-anxiety

Eco-anxiety is a term that describes one's reaction to the ever changing and worsening environmental conditions. One is constantly worried or scared of the eventual doom of the Earth and our society. There are sustained effects on the effects of individuals, as well as the increase in eco-anxiety as a health condition. This has led to increased mental health issues in response to climate change, thus allowing for more research to be developed on the topic. [5]

Suicide

Among other issues, the effects of climate change and extreme weather can lead to an increase in suicide rates. [6] This can be experienced both when one experiences an extreme weather event, but also due to the uncertainty of the future, in relation to climate change.

Research has shown that there is a connection between farmer suicide rates and the occurrence of a drought. Droughts can lead to crop failure, inflation/economic hardships, prolonged heat exposure, and relocating which can overall accumulate high stress levels leading to more suicide attempts amongst farmers. [2]

There have also been many association between suicide, especially violent, and the increase in temperature due to global warming. [2]

Violence

It has been shown that there is a relationship between heat and violence, especially after heat waves. Therefore, it can be assumed that an increase in global temperature can lead to an increase in cases of violence. People experience an increase in aggressive behavior due to an increase in temperature, which can lead to violence or other mental health problems. [6]

Post-traumatic growth

Post-traumatic growth is a term used to describe the change that can occur after a traumatic event, in which the person experiences adaptation, growth, and a new sense of living. It is a positive reaction to one's experience of a negative event, in which one would want to change their life, or others lives for the better. Post-traumatic growth can occur after a traumatic event, including extreme weather events. When someone is given social support after an event, they are more likely to experience post-traumatic growth. [7]

Prevalence

PTSD surpasses depression and anxiety as the most common mental health outcome from extreme weather events. This phenomenon has been studied on global, regional, and local scales.[ citation needed ]

Climate-related disasters and exposures including drought, extreme temperature, floods, landslides, storms, and precipitation have various mental health outcomes, but PTSD is consistently the most commonly reported among low and middle-income countries. Across weather events, PTSD ranks highest among victims before depression and anxiety. PTSD in a flooded setting and PTSD in a storm setting are among the top three most common combinations of mental health outcomes and extreme weather events. [8] This trend can be seen throughout many countries in South America and Asia where there are significant increases in PTSD for individuals exposed to floods and storms compared to unexposed groups. [9]

Populations in the UK that have been exposed to flood events have higher rates of diagnoses than the general population. The most common problem associated with flooding is PTSD (30.4%), surpassing depression (21.3%) and anxiety (19.8%). [10]

Current[ when? ] research focuses on PTSD associated with floods and storms. Knowledge about other events such as droughts, heatwaves, landslides, and precipitation is more limited. Further investigation is needed[ according to whom? ] to determine the prevalence of PTSD in the instance of these various events and to identify which symptoms of PTSD correspond to which extreme weather incidents.[ citation needed ]

Risk factors

The Intergovernmental Panel on Climate Change has connected climate change to extreme weather events as a reason for concern, which has been transitioned from a high to very high risk at near term warming with medium confidence. Negative mental health effects due to climate change are predicted with very high confidence globally, and the association with trauma from extreme weather events is also evaluated with very high confidence. [11] As different events of extreme weather can cause extreme weather PTSD, and extreme weather is expected to increase globally, there is an enormous scale of people who may be affected by extreme weather PTSD. In an analysis of extreme weather events and mental health reviewing floods, droughts, storms, and heatwaves, PTSD rates as a result of these events ranged from 2.6% to 90% and results vary due to populations, disaster type, and study characteristics, and cross-cultural applications of PTSD diagnoses. [9]

Vulnerable populations

There are many factors that increase vulnerability as well. Low and middle-income countries are more vulnerable due to the interaction of inadequate mental healthcare and increased vulnerability to the effects of climate related disasters. Specifically, flood and storm related PTSD are observed frequently for people residing in low and middle income areas impacted by climate disasters. [12] Other vulnerable groups to extreme weather mental health effects include the economically disadvantaged, elderly, disabled, prisoners, substance abusers, and children. [13] Children are particularly vulnerable because the mental health impacts of extreme weather can contribute not only to PTSD, but to infectious and chronic disease susceptibility as well as cognitive deficits, lower IQ and dementia later in life. [14] Extreme weather events also force migration in many situations and PTSD is found in higher rates among refugees and forced migrant populations and there are more barriers to receiving treatment such as affordability, information on available services, and cultural or language barriers. [15]

Treatments and solutions

There are many treatment and prevention tactics available for extreme weather-related PTSD. Individual conditions and psychological behavior, government action, secondary stressors, and weather events make the assessment of interventions difficult. Some interventions have proven relatively ineffective while others have produced more successful outcomes.[ citation needed ]

One possible treatment for extreme weather PTSD is psychological debriefing, but this has been shown to be an ineffective intervention for flood events. [10] Prolonged exposure (PE), cognitive processing therapy (CPT), and cognitive therapy for PTSD (CT-PTSD) all significantly reduce PTSD symptoms in research and clinical settings. Emotional processing theory is the basis for PE. PE employs emotional processing techniques to activate trauma memory and modify the patient's pathological fear structure. CPT utilizes social cognitive theory (SCT) to consider the patient's cognitions, emotions, and behavior in the context of the trauma. CPT reduces symptoms of PTSD through cognitive restructuring. CT-PTSD is based on the theory that individuals afflicted with PTSD maintain a sense of a serious and current threat. Patients work to modify assessments of current threats, reduce dysfunctional cognitive strategies, and elaborate their trauma memory through a wide range of behavioral activation assignments. [16]

Treatment that is accesible to everyone includes social support. Social support has been shown in the past to prevent the severity of post-traumatic stress symptoms. A recent study reported that individuals who are self-compassionate experienced fewer post-traumatic stress symptoms after a weather-related traumatic event because of perceived increased social support. [17] Free resources such as the Disaster Distress Helpline (1-800-985-5990) are also available 24/7 for support by providing confidential counseling and coping mechanisms in order to reduce PTSD symptoms. [18]

Prevention and preparedness

Prevention and preparedness tactics include enhanced risk communication, mental health literacy and first aid, and government planning. Incorporating flood risk and management infrastructure in urban design is an effective mode of prevention for PTSD. Establishing resilience by allocating resources and encouraging community growth is also an effective tactic for reducing associated flood risks, especially among more vulnerable populations. [10]

Learning about storms and weather forecasts, creating safety plans, preparing in advance, and identifying your stressors in consideration to specific natural disasters can give you a sense of control. This ultimately can lessen the mental turmoil associated with these situations. [19]

Policy-based solutions such as enhanced monitoring of mental health and greater access to mental health resources have been shown to help effectively prepare for PTSD due to extreme weather events. Prevention planning for PTSD within the healthcare system can include increasing funding and encouraging mental health training for professionals in the field, both of which have produced beneficial outcomes. Establishing a robust and well-trained mental health force is a productive step in resilience planning and adaptation. [8]

Traditionally, mental health research has focused on high-income countries, excluding vulnerable populations. Low and middle-income countries are more burdened by exposure and vulnerabilities to extreme weather events, therefore a useful step in PTSD preparation and planning is expanding research among these populations. [9]

The Intergovernmental Panel on Climate Change has suggested increased mental health services as well as surveillance and monitoring of mental health impacts of extreme weather and other climate change related mental health effects as a potential solution (Intergovernmental Panel on Climate Change, p. 25). As extreme weather events grow stronger and more prevalent, the incorporation of treatments, solutions, prevention, and preparedness will be an important step for mitigating extreme weather PTSD. [ citation needed ]

Examples of extreme weather events

Many extreme weather events from the recent past have led to many new cases of Extreme Weather PTSD. Presented below are a list of extreme weather events and the prevalence of PTSD in the aftermath.

Hurricane Katrina

Hurricane Katrina Hurricane Katrina August 28 2005 NASA.jpg
Hurricane Katrina

A study researching the impact of Katrina on low income parents showed that over half of participants showed probable symptoms of PTSD. [20] Another study showed that most adults that did develop PTSD had still not recovered after approximately two years. [21] Many survivors continued to experience mental health issues even ten years after the tragedy. [22]

New York and New Jersey, United States flood

Hurricane Sandy was a post-tropical cyclone and flooding event in the New York City area causing $19 billion in damages and 43 deaths. Prevalence of PTSD following Hurricane Sandy was 2.0%. [6]

UK flooding and heat waves

PTSD after extreme weather events leading to flooding in the United Kingdom was recorded at 30.36%. [23]

Wildfire spreads in Fort McMurray. Wildfire spreads in Fort McMurray.jpg
Wildfire spreads in Fort McMurray.

Fort McMurray, Canada wildfires

After wildfires caused the evacuation of 90,000 residents of Fort McMurray, Canada, and the destruction of 10% of housing, PTSD afflicted 39.6% of those affected. [24]

Krymsk, Russia flooding and droughts

PTSD was expected to be a long term effect of the Krymsk area after flooding in 2012 after warning signs were found in residents during the following weeks. [25]

Tamil Nadu, India flooding

After particularly high intensity rainfall and the overflowing of neighboring rivers in Tamil Nadu, 26.9% of the studied population were diagnosed with PTSD. [26]

Related Research Articles

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Post-traumatic stress disorder</span> Mental disorder associated with trauma

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

Acute stress reaction (ASR), also known as psychological shock, mental shock, or simply shock, and acute stress disorder (ASD), is a psychological response to a terrifying, traumatic, or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Childhood trauma is often described as serious adverse childhood experiences. Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse. They may also witness abuse of a sibling or parent, or have a mentally ill parent. These events can have profound psychological, physiological, and sociological impacts leading to lasting negative effects on health and well-being. These events may include antisocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Additionally, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary mode of transmission is the shared family environment of the infant causing psychological, behavioral and social changes in the individual.

<span class="mw-page-title-main">Effects of climate change on mental health</span>

The effects of climate change on mental health and wellbeing are being documented as the consequences of climate change become more tangible and impactful. This is especially the case for vulnerable populations and those with pre-existing serious mental illness. There are three broad pathways by which these effects can take place: directly, indirectly or via awareness. The direct pathway includes stress-related conditions caused by exposure to extreme weather events. These include post-traumatic stress disorder (PTSD). Scientific studies have linked mental health to several climate-related exposures. These include heat, humidity, rainfall, drought, wildfires and floods. The indirect pathway can be disruption to economic and social activities. An example is when an area of farmland is less able to produce food. The third pathway can be of mere awareness of the climate change threat, even by individuals who are not otherwise affected by it. This especially manifests in the form of anxiety over the quality of life for future generations.

Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD. Secondary trauma has been researched in first responders, nurses and physicians, mental health care workers, and children of traumatized parents.

Disaster psychiatry is a field of psychiatry which focuses on responding to natural disasters, climate change, school shootings, large accidents, public health emergencies, and their associated community-wide disruptions and mental health implications. All disasters, regardless of exact type, are characterized by disruption: disruption of family and community support structures, threats to personal safety, and an overwhelming of available support resources. Disaster psychiatry is a crucial component of disaster preparedness, aiming to mitigate both immediate and prolonged psychiatric challenges. Its primary objective is to diminish acute symptoms and long-term psychiatric morbidity by minimizing exposure to stressors, offering education to normalize responses to trauma, and identifying individuals vulnerable to future psychiatric illness.

<span class="mw-page-title-main">Internet-based treatments for trauma survivors</span>

Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.

Being exposed to traumatic events such as war, violence, disasters, loss, injury or illness can cause trauma. Additionally, the most common diagnostic instruments such as the ICD-11 and the DSM-5 expand on this definition of trauma to include perceived threat to death, injury, or sexual violence to self or a loved one. Even after the situation has passed, the experience can bring up a sense of vulnerability, hopelessness, anger and fear.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

  1. ↑ Vergin, Julia (26 August 2023). "Extreme weather is a cause of post-traumatic stress". Deutsche Welle.
  2. 1 2 3 4 Padhy, SusantaKumar; Sarkar, Sidharth; Panigrahi, Mahima; Paul, Surender (2015). "Mental health effects of climate change". Indian Journal of Occupational and Environmental Medicine. 19 (1): 3–7. doi: 10.4103/0019-5278.156997 . PMC   4446935 . PMID   26023264.
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  4. ↑ Valladares-Garrido, Mario J.; Zapata-Castro, Luis E.; Peralta, C. Ichiro; García-Vicente, Abigaíl; Astudillo-Rueda, David; León-Figueroa, Darwin A.; Díaz-Vélez, Cristian (3 September 2022). "Post-Traumatic Stress Disorder after the 6.1 Magnitude Earthquake in Piura, Peru: A Cross-Sectional Study". International Journal of Environmental Research and Public Health. 19 (17): 11035. doi: 10.3390/ijerph191711035 . PMC   9518033 . PMID   36078753.
  5. ↑ Arcanjo, Marcus (September 2019). Eco-Anxiety: Mental Health Impacts of Environmental Disasters and Climate Change (PDF) (Report).
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  10. 1 2 3 Cruz, Joana; White, Piran C. L.; Bell, Andrew; Coventry, Peter A. (19 November 2020). "Effect of Extreme Weather Events on Mental Health: A Narrative Synthesis and Meta-Analysis for the UK". International Journal of Environmental Research and Public Health. 17 (22): 8581. doi: 10.3390/ijerph17228581 . PMC   7699288 . PMID   33227944.
  11. ↑ "Climate Change 2022: Impacts, Adaptation and Vulnerability". www.ipcc.ch. Retrieved 2023-03-13.
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  13. ↑ Benevolenza, Mia A.; DeRigne, LeaAnne (17 February 2019). "The impact of climate change and natural disasters on vulnerable populations: A systematic review of literature". Journal of Human Behavior in the Social Environment. 29 (2): 266–281. doi:10.1080/10911359.2018.1527739.
  14. ↑ Garcia, Daniel Martinez; Sheehan, Mary C. (January 2016). "Extreme Weather-driven Disasters and Children's Health". International Journal of Health Services. 46 (1): 79–105. doi:10.1177/0020731415625254. PMID   26721564.
  15. ↑ "Mental health and forced displacement" (Press release). World Health Organization. 31 August 2021.
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  17. ↑ Allen, Ashley Batts; Littleton, Heather; Bistricky, Steve; Benson, Kayla; Cox, Tyler; Benight, Charles C. (22 January 2024). "Self-compassion reduces posttraumatic stress symptom severity in hurricane survivors via perceived social support". Psychological Trauma: Theory, Research, Practice, and Policy. doi:10.1037/tra0001630. PMID   38252097. ProQuest   2917321507.
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  19. ↑ US Department of Commerce, NOAA. "Storm Stress and Anxiety". www.weather.gov. Retrieved 2024-10-15.
  20. ↑ Rhodes, Jean; Chan, Christian; Paxson, Christina; Rouse, Cecilia Elena; Waters, Mary; Fussell, Elizabeth (April 2010). "The impact of Hurricane Katrina on the mental and physical health of low-income parents in New Orleans". American Journal of Orthopsychiatry. 80 (2): 237–247. doi:10.1111/j.1939-0025.2010.01027.x. PMC   3276074 . PMID   20553517.
  21. ↑ McLaughlin, Katie A.; Berglund, Patricia; Gruber, Michael J.; Kessler, Ronald C.; Sampson, Nancy A.; Zaslavsky, Alan M. (June 2011). "Recovery from PTSD following Hurricane Katrina". Depression and Anxiety. 28 (6): 439–446. doi:10.1002/da.20790. PMC   3138333 . PMID   21308887.
  22. ↑ Reardon, Sara (August 2015). "Hurricane Katrina's psychological scars revealed". Nature. 524 (7566): 395–396. doi:10.1038/524395a. PMID   26310743.
  23. ↑ Cruz, Joana; White, Piran C. L.; Bell, Andrew; Coventry, Peter A. (19 November 2020). "Effect of Extreme Weather Events on Mental Health: A Narrative Synthesis and Meta-Analysis for the UK". International Journal of Environmental Research and Public Health. 17 (22): 8581. doi: 10.3390/ijerph17228581 . PMC   7699288 . PMID   33227944.
  24. ↑ Mao, Wanying; Adu, Medard; Eboreime, Ejemai; Shalaby, Reham; Nkire, Nnamdi; Agyapong, Belinda; Pazderka, Hannah; Obuobi-Donkor, Gloria; Owusu, Ernest; Oluwasina, Folajinmi; Zhang, Yanbo; Agyapong, Vincent I. O. (8 August 2022). "Post-Traumatic Stress Disorder, Major Depressive Disorder, and Wildfires: A Fifth-Year Postdisaster Evaluation among Residents of Fort McMurray". International Journal of Environmental Research and Public Health. 19 (15): 9759. doi: 10.3390/ijerph19159759 . PMC   9368448 . PMID   35955114.
  25. ↑ Grigorieva, Elena; Livenets, Alexandra (6 March 2022). "Risks to the Health of Russian Population from Floods and Droughts in 2010–2020: A Scoping Review". Climate. 10 (3): 37. Bibcode:2022Clim...10...37G. doi: 10.3390/cli10030037 .
  26. ↑ Bandla, Shailaja; Nappinnai, Nr; Gopalasamy, Srinivasagopalan (June 2019). "Psychiatric morbidity in December 2015 flood-affected population in Tamil Nadu, India". International Journal of Social Psychiatry. 65 (4): 338–344. doi:10.1177/0020764019846166. PMID   31068043.
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